Acalabrutinib (Calquence) is a second-generation BTK inhibitor made by AstraZeneca and approved by the FDA for adults with chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL), and mantle cell lymphoma (MCL). First approved for MCL in 2017 and for CLL and SLL in 2019, Calquence is now one of the most widely prescribed targeted therapies for blood cancers in the US. In February 2026, the FDA also approved Calquence in combination with venetoclax as the first all-oral, fixed-duration regimen for treatment-naive CLL and SLL patients.
Calquence is classified as a specialty drug and is dispensed exclusively through specialty pharmacies such as Accredo, CVS Specialty, and Walgreens Specialty Pharmacy. Standard retail chains like Walmart and Costco do not carry Calquence. The drug is billed under Medicare Part D (not Part B) because it is self-administered orally, and patients with Medicare Part D coverage are subject to the 2026 annual out-of-pocket cap of $2,100. Because Calquence falls into the antineoplastic (cancer) protected class under Medicare, virtually all Part D plans cover it, though formulary tier placement at the specialty tier means prior authorization and step therapy requirements are common. Patients without coverage face retail cash prices of $14,000 to $16,000 per month at specialty pharmacies.
The Inflation Reduction Act of 2022 authorized CMS to negotiate drug prices directly with manufacturers. Acalabrutinib was selected for the second round of negotiations (IPAY 2027), with a negotiated Maximum Fair Price of $8,600 per month, a reduction of approximately 40 percent from its 2024 list price of $14,228. Those prices take effect January 1, 2027, not in 2026. Patients who reach the $2,100 Part D annual out-of-pocket cap in 2026 before the negotiated price kicks in will still benefit from $0 cost-sharing above that cap. Medicare beneficiaries who cannot afford Calquence in 2026 should explore the AZ&Me program, which provides free drug to qualifying patients regardless of Medicare enrollment.
What Calquence Costs by Point of Pay (2026)
The price you pay depends almost entirely on WHERE you pay. The same calquence can cost many times more at a hospital than at your local pharmacy:
2026 Calquence Price by Point of Pay| Where you pay | Typical cost | Notes |
|---|
| Specialty pharmacy (retail cash, 2026) | $14,000 - $16,000/month | List price at specialty pharmacies without insurance. Available only at specialty pharmacy networks (Accredo, CVS Specialty, Walgreens Specialty). |
| Medicare Part D (2026) | $0 - $2,100/year total OOP cap | Covered for CLL, SLL, and MCL. Annual OOP cap of $2,100 across all Part D drugs combined. Specialty tier placement; prior authorization typically required. |
| Commercial insurance | $0 - $500/month after PA | Specialty tier copay varies by plan. Calquence Patient Savings Program can reduce to $0 for eligible commercially insured patients. Prior authorization is standard. |
| Calquence Patient Savings Program | $0/month (commercially insured patients only) | AstraZeneca copay assistance program; not available to Medicare, Medicaid, or TRICARE beneficiaries per federal anti-kickback law. |
| Medicaid | $1 - $4/prescription, with PA | Covered for CLL and MCL in most states. Nominal copay applies. State formulary rules vary. |
Retail prices reflect 2026 specialty pharmacy list price data from Drugs.com and GoodRx. Part D ranges depend on your plan's formulary tier and position in the benefit year. The $8,600 IRA Maximum Fair Price takes effect January 1, 2027.
Source: CMS Part D 2026 benefit design, AstraZeneca patient programs, GoodRx, Drugs.com
Why Hospitals Charge So Much
Calquence is an oral specialty drug that patients self-administer at home. Hospital inpatient facilities rarely administer Calquence directly, but when a hospitalized patient needs to continue their Calquence regimen, the hospital pharmacy dispenses it at inpatient facility rates rather than retail specialty pharmacy rates. Inpatient pharmacy charges for Calquence can reach $15,000 to $20,000 per month because hospitals layer acquisition cost with pharmacy handling fees, administrative overhead, and facility markup, often reaching 20 to 50 percent above the drug's wholesale acquisition cost.
Patients who receive an itemized hospital bill showing Calquence charges should request the National Drug Code (NDC) for the dispensed product and compare the billed amount to the wholesale acquisition cost (WAC), which runs approximately $14,228 per 30-day supply in 2026. Charges significantly above the WAC are often negotiable with the hospital's financial counseling department. If your commercial plan covers Calquence at the outpatient specialty pharmacy rate, an inpatient billing at the facility rate may result in a much larger patient balance. Request that your prescriber or hospitalist document the medical necessity of continued Calquence during your inpatient stay, which can support a billing adjustment.
Three structural factors drive specialty cancer drug pricing in hospital settings. First, hospitals typically pay a different contracted price than specialty pharmacies, and that acquisition cost is passed through at a marked-up rate. Second, 340B-eligible hospitals may acquire Calquence at a significant discount under the federal 340B drug pricing program, but savings do not always flow to uninsured or underinsured patients. Third, insurer contracts with specialty pharmacies often do not extend to the hospital setting, creating a coverage gap where the patient owes the difference. Use the Medical Bill Analyzer at CoveredUSA to identify line items where you may have been overbilled.
Patient Assistance Programs
AstraZeneca runs two separate financial assistance programs for Calquence: the Calquence Patient Savings Program for commercially insured patients, and AstraZeneca AZ&Me for uninsured and Medicare patients. Without insurance, the 2026 retail cash price of $14,000 to $16,000 per month is out of reach for most households. The AZ&Me patient assistance program addresses this gap directly. Income-eligible patients who qualify may receive Calquence at no cost through AZ&Me, regardless of whether they have Medicare or no insurance at all.
Patient assistance programs for Calquence| Manufacturer program | Cost / Benefit | How to apply |
|---|
| Calquence Patient Savings Program (AstraZeneca) | $0/month copay assistance for commercially insured patients; eligibility varies by plan | myaccess360.com/patient/calquence-acalabrutinib/patient-affordability.html |
| AstraZeneca AZ&Me Prescription Savings Program | Free Calquence for uninsured patients at or below 300% FPL (approximately $47,880 for individual in 2026); separate Medicare track for Part D patients | azandmeapp.com |
| Leukemia and Lymphoma Society (LLS) Co-Pay Assistance | Up to $10,000/year in copay assistance for eligible blood cancer patients regardless of income | lls.org/support-resources/financial-support |
| PAN Foundation Chronic Lymphocytic Leukemia Fund | Up to $3,000 - $10,000 in grants per 12-month period for qualifying CLL patients | panfoundation.org |
Manufacturer savings cards and copay programs are not available to Medicare, Medicaid, TRICARE, or VA beneficiaries by federal law (anti-kickback statute, 42 U.S.C. 1320a-7b). This includes the Calquence Patient Savings Program. If you have government insurance, apply for AZ&Me or an independent foundation grant instead. AZ&Me specifically has a Medicare Part D track for eligible beneficiaries with incomes at or below approximately $35,000 for an individual or $48,000 for a couple.
Source: AstraZeneca AZ&Me patient programs (azandmeapp.com), Leukemia and Lymphoma Society, PAN Foundation
Medicare Part D
Calquence is a Medicare Part D drug because patients self-administer it at home as an oral tablet. For 2026, the total annual out-of-pocket spending cap for all Part D drugs combined is $2,100 under the Inflation Reduction Act of 2022. Once you reach $2,100 in out-of-pocket costs on covered Part D drugs in a calendar year, your cost-sharing drops to $0 for the remainder of the year. Because Calquence is among the most expensive specialty drugs, many Part D patients on continuous Calquence therapy will hit the $2,100 cap within the first one to three months of the benefit year.
Calquence falls into the antineoplastic (cancer treatment) protected class under Medicare Part D, which means nearly all Part D plans are required to cover it. However, coverage on the formulary tier at the specialty level means most plans require prior authorization confirming the diagnosis and medical necessity. Step therapy requirements, where insurers demand you first try ibrutinib (Imbruvica), may apply on some commercial plans, but Medicare Part D plans generally cannot impose step therapy for protected-class cancer drugs. If your Part D plan denies Calquence, file an exception request citing CMS's protected-class policy.
Starting January 1, 2027, Medicare beneficiaries on Calquence will benefit from the IRA Round 2 Maximum Fair Price of $8,600 per month, a roughly 40 percent reduction from the 2024 list price. In 2026, the full negotiated savings are not yet in effect, so the $2,100 annual cap remains the primary protection for Medicare Part D patients. Patients who qualify for Medicare's Low-Income Subsidy (Extra Help) pay even less, typically $0 to $12 per month. Contact your State Health Insurance Assistance Program (SHIP) or visit medicare.gov to check Extra Help eligibility.
Common Calquence Billing Errors
Calquence billing errors are common because it is a high-cost specialty drug with complex formulary rules. If you received a bill for Calquence above $2,100 for the year on Medicare Part D, or above your plan's specialist copay on commercial insurance, check for these issues before paying:
- Prior authorization denied and not appealed: Calquence requires PA on most plans. If the initial PA was denied without an appeal, you may be paying cash unnecessarily. Ask your oncologist's office to file a peer-to-peer review.
- Billed at Part B rate instead of Part D: Calquence is an oral drug billed under Part D, not Part B. A billing using J-codes or a physician office administration code for oral Calquence is incorrect. Part B covers infused or injected cancer drugs administered in-clinic, not oral tablets taken at home.
- Charged past the $2,100 annual Part D OOP cap: once you exceed $2,100 in total Part D out-of-pocket spending in a benefit year, your cost-sharing for covered drugs becomes $0. Contact your plan if you are billed after crossing this threshold.
- Manufacturer coupon applied despite Medicare enrollment: the Calquence Patient Savings Program is not permitted for Medicare, Medicaid, or TRICARE beneficiaries. If a pharmacist mistakenly runs your claim through a manufacturer coupon and you have Medicare, it may create compliance problems that affect your claim.
- Inpatient hospital dispensing billed at $15,000 or more instead of the outpatient specialty pharmacy rate: if your plan covers Calquence at your outpatient specialty rate, request that the hospital bill it through your outpatient pharmacy benefit or dispute the facility markup.
Frequently Asked Questions
Is there a generic for Calquence in 2026?
No. Acalabrutinib (Calquence) has no approved generic as of 2026. AstraZeneca holds patents protecting Calquence through approximately 2035, with formulation patents potentially extending to 2036. Generic manufacturers including Alembic have filed Paragraph IV patent challenges, but AstraZeneca reached consent judgments that delay generic entry until patents expire. Calquence is a small-molecule drug, not a biologic, so biosimilar rules do not apply. The nearest lower-cost alternative is ibrutinib (Imbruvica), a Round 1 IRA-negotiated BTK inhibitor at a 2026 Medicare Maximum Fair Price of $9,319 per month.
How does the IRA Medicare price negotiation affect Calquence?
Calquence was selected for the second round of Medicare drug price negotiation under the Inflation Reduction Act of 2022. CMS negotiated a Maximum Fair Price of $8,600 per month for acalabrutinib, a reduction of approximately 40 percent from the 2024 list price of $14,228. This negotiated price takes effect January 1, 2027, not in 2026. In 2026, Medicare Part D patients are still protected by the $2,100 annual out-of-pocket cap established by the IRA, which means most Calquence patients on Part D will pay no more than $2,100 total for all their covered drugs combined this year.
How do I apply for the AstraZeneca AZ&Me patient assistance program for Calquence?
To apply for AZ&Me, visit azandmeapp.com or call 1-800-AZandMe (1-800-292-6363). The program has an uninsured track (income at or below 300% FPL, approximately $47,880 for a single person in 2026) and a Medicare Part D track (individual income at or below approximately $35,000 or couples at $48,000). You will need a completed application with a prescriber signature, proof of household income (tax return or pay stubs), proof of US residency, and a valid Calquence prescription. Processing takes 7 to 14 business days. If approved, free Calquence is shipped directly through an authorized specialty pharmacy.
Can I use the Calquence savings card if I have Medicare?
No. The Calquence Patient Savings Program (AstraZeneca's commercial copay assistance program) is not available to Medicare, Medicaid, TRICARE, or VA beneficiaries under federal anti-kickback law (42 U.S.C. 1320a-7b). Manufacturer copay cards are only for commercially insured patients. If you have Medicare and cannot afford Calquence, apply for the AZ&Me program instead, which has a separate Medicare track for Part D patients with individual incomes at or below approximately $35,000 per year. The Leukemia and Lymphoma Society also offers independent copay grants for blood cancer patients regardless of insurance type.
What does Calquence cost without insurance at the pharmacy in 2026?
Without insurance in 2026, Calquence costs approximately $14,000 to $16,000 per 30-day supply at specialty pharmacies such as CVS Specialty, Walgreens Specialty, and Accredo. The Drugs.com price guide lists roughly $15,934 for a 60-tablet supply at current list pricing. GoodRx shows discounted estimates starting near $9,076 at some specialty pharmacies with a coupon, though availability varies by location. Standard retail pharmacies like Walmart and Costco do not carry Calquence. For uninsured patients, the AZ&Me patient assistance program is typically the most affordable path.
What if my insurance denies coverage for Calquence?
Start by requesting a written denial notice with the denial code. Ask your oncologist to file a peer-to-peer review with the plan's medical director within 72 hours of the denial. Calquence is a Category 1 recommended treatment for CLL and SLL per 2025 NCCN guidelines, which is powerful evidence in an appeal. If a commercial plan denies on step therapy grounds, your oncologist can file a medical exception citing Calquence's different cardiac safety profile versus ibrutinib. Medicare Part D plans cannot impose step therapy for antineoplastic drugs in the protected class. If appeals fail, apply for AZ&Me or independent foundation assistance from the LLS or PAN Foundation.
Does Medicare Part D cover Calquence?
Yes. Calquence (acalabrutinib) is covered under Medicare Part D for its FDA-approved indications: CLL, SLL, and MCL. Because acalabrutinib is an antineoplastic drug in a Medicare protected class, nearly all Part D plans must include it on the formulary. However, most plans place it on the specialty tier, which may require prior authorization. Your total out-of-pocket spending on all Part D drugs is capped at $2,100 for 2026. Because Calquence is so expensive, most patients on continuous therapy hit the $2,100 cap within the first few months and then pay $0 for covered drugs for the rest of the year.
How is Calquence different from Imbruvica (ibrutinib) for CLL?
Both Calquence (acalabrutinib) and Imbruvica (ibrutinib) are BTK inhibitors used for CLL, SLL, and MCL. Calquence is a second-generation BTK inhibitor designed to be more selective, with clinical data showing a lower rate of atrial fibrillation and bleeding compared to ibrutinib. Both are oral daily medications. From a cost perspective in 2026, ibrutinib has an IRA Round 1 Medicare Maximum Fair Price of $9,319 per month, while Calquence is still at the retail list price of approximately $14,228 until the Round 2 MFP of $8,600 takes effect on January 1, 2027. Patients with cardiac conditions may have a medical reason to prefer Calquence; discuss with your hematologist.
