Leqembi is Eisai’s brand name for lecanemab-irmb, an anti-amyloid antibody for early Alzheimer’s disease. Until recently it existed only as an IV infusion given every two weeks in a clinic. As of 2026 there is a second option, a once-weekly autoinjector called Leqembi Iqlik that you or a care partner use at home.
Those two forms are priced very differently and, more importantly for a cash payer, they are billed through completely different channels. The infusion goes through the medical benefit as a buy-and-bill drug with a separate administration charge. The autoinjector goes through the pharmacy benefit like any specialty prescription. Everything below was researched on September 4, 2026.
What Does Leqembi Cost Without Insurance?
Three sources price the IV drug and they agree closely. Eisai publishes a list price of $271.83 for a 200 mg vial and $679.60 for a 500 mg vial, stated on Leqembi.com as current as of July 2026. Drugs.com lists cash prices of $273.43 and $671.73 for the same two vials. Medicare’s Part B payment limit for HCPCS J0174, effective July 1 through September 30, 2026, is $1.342 per milligram.
The dose is 10 mg/kg every two weeks, so a 165-pound patient needs about 750 mg, which is dispensed as four 200 mg vials. That is $1,087.32 at Eisai’s list price, $1,093.72 at the Drugs.com cash price, and $1,073.60 at Medicare’s allowance. Eisai’s own worked example on the same page puts a full year of IV treatment for that patient at $28,270.32.
| Leqembi cost item | Low | Average | High |
|---|---|---|---|
| IV drug, one infusion for a 165-pound patient (800 mg) | $1,074 | $1,087 | $3,010 |
| IV infusion administration, CPT 96365 | $60 | $217 | $223 |
| One IV visit, drug plus administration | $1,134 | $1,304 | $3,233 |
| First year on IV, 26 infusions | $29,484 | $33,904 | $84,058 |
| Leqembi Iqlik, one week at the starting dose (two autoinjectors) | $770 | $770 | $770 |
| Leqembi Iqlik, first 18 months at the starting dose | $60,060 | $60,060 | $60,060 |
| Leqembi Iqlik, one year of maintenance (one autoinjector weekly) | $20,020 | $20,020 | $20,020 |
| Eisai Patient Assistance Program free drug, if you qualify | $0 | $0 | $0 |
The High column is not a typo. In CMS’s 2024 national claims data, providers submitted an average charge of $3.762644 per milligram of lecanemab against a Medicare allowed amount of $1.304948, so the average gross charge for an 800 mg dose is about $3,010 while the allowed amount is about $1,044. That is a 188% markup over the allowed rate, and it is the number a self-pay patient gets quoted.
A second federal file confirms the allowed side. CMS’s Medicare Part B spending data shows Leqembi at $1.3086 average spending per milligram in 2024, $1,049.02 per claim and $11,429.32 per beneficiary for the year, across 7,907 beneficiaries and $90.4 million of spending.
What Drives the Price
The dose is weight-based, so your bill is not the same as anyone else’s
At 10 mg/kg every two weeks, a 130-pound patient and a 220-pound patient are not paying the same amount. The drug is also supplied in fixed 200 mg and 500 mg vials, so the actual charge rounds up to whole vials and any leftover in an opened vial is billed as discarded drug. Ask which vial combination your clinic uses before you accept a quote.
Infusion versus autoinjector is a channel decision, not just a convenience decision
The FDA label sets the IV starting dose at 10 mg/kg every two weeks over approximately one hour, and the subcutaneous starting dose at 500 mg once a week using the Iqlik autoinjector. After 18 months, treatment either continues at the starting dose or moves to maintenance, which is 10 mg/kg every four weeks by IV or one 360 mg autoinjector weekly.
At list price the autoinjector is the more expensive drug. What it removes is the infusion center. There is no facility fee, no chair time and no administration code. For a patient with Medicare Part D coverage, Eisai notes that the 2026 annual out-of-pocket cap for covered prescriptions is $2,100, after which covered drugs cost $0 for the rest of the year. That cap does not exist on the Part B side, where coinsurance runs on every infusion with no ceiling.
Where you sit for the infusion
The one-hour infusion bills as CPT 96365. Under the July 2026 hospital outpatient payment file, Medicare pays a hospital $217.31 for that code. In CMS’s 2024 national claims data the physician-office allowed amount was $60.45 and the average submitted charge was $222.72. Over 26 infusions a year that setting choice is worth roughly $4,000 at Medicare rates alone, before any hospital facility fee.
There is no retail price to shop for the IV form
CMS’s National Average Drug Acquisition Cost survey returns zero rows for both “Leqembi” and “lecanemab” under two different search operators, while a control drug returns thousands of rows. That is a real finding rather than a search failure: the IV product does not move through retail pharmacy at all, so there is no coupon site or discount card that touches it.
Diagnosis and monitoring costs sit outside all of this
Eisai states plainly that its list price does not include diagnostic or treatment-related tests. The label requires confirmation of amyloid pathology before starting and brain MRIs after 1, 2, 3 and 6 months of treatment. Those scans are billed separately and are not small. Budget for them as a distinct line before you commit.
Cash Price vs. Insurance
There is no self-pay discount channel for Leqembi in the way there is for a generic pill. Nothing on this page is a shoppable retail price. What you are actually choosing between is a covered benefit, a manufacturer free-drug program, or a large medical bill.
That said, the cash-versus-billed distinction still matters. The 2024 claims data above shows the average submitted charge running at nearly three times the allowed amount. If you have already received a bill in the $3,000-per-infusion range, that number is a gross charge and it is negotiable. Start with an itemized bill and the benchmark figures on this page, then work through our guide to negotiating medical bills.
One more structural note. Independent charity foundations, which are often the fallback for expensive drugs, are thin here. The PAN Foundation’s Alzheimer’s disease fund is restricted to patients with government insurance (Medicare, Medicaid or TRICARE) and was listed as closed to new applicants as of September 4, 2026. That is exactly backwards from what an uninsured patient needs, which puts the weight on the manufacturer program.
How to Pay Less
Apply to the LEQEMBI Patient Assistance Program. This is the program built for you. Eisai’s published terms provide Leqembi at no cost to patients who are uninsured, or insured without coverage for the drug after a denied first-level appeal, with household income at or equal to 300% of the federal poverty level or less. You must be 18 or older and a U.S. or Puerto Rico resident. Uninsured patients are enrolled for a rolling 12-month period and must re-enroll to continue. For the IV form the drug ships directly to your infusion provider; for Iqlik it ships to your home.
Do not plan around the copay card. The LEQEMBI Copay Assistance Program terms state the offer is not valid for uninsured or self-paying patients, and it excludes Medicare, Medicaid, Medigap, VA, DoD and TRICARE. It also explicitly does not cover medical administration charges. The LEQEMBI Temporary Supply Program is likewise limited to commercially insured patients waiting on a coverage decision.
Ask what the infusion would cost in a non-hospital setting. A physician office or a freestanding infusion center is paid a fraction of what a hospital outpatient department is paid for the same hour. If a health system is quoting you, ask whether the same drug can be given at an affiliated office site.
Pull the hospital’s posted price before you accept a quote. Every hospital is required to publish its cash price and payer-specific rates. Our guide to hospital price transparency walks through finding the file, and the fair price checker gives you a comparison point.
Ask about charity care in the same conversation. A course of infusions plus MRIs is a large enough number to clear most nonprofit hospital financial-assistance thresholds. Read how hospital charity care works before you sign a payment plan, because signing one can complicate an application.
Compare the total, not the drug. If your clinician offers both forms, price the whole package. The autoinjector costs more per milligram but eliminates the administration fee and the trip. The infusion costs less per milligram but adds 26 clinic visits a year. The same tradeoff shows up on other self-injected specialty drugs like Kesimpta.
The Bottom Line
For an uninsured patient, Leqembi is a $1,074 to $1,094 drug per IV infusion and roughly $28,000 to $34,000 a year all in, or $20,020 to $40,040 a year for the Iqlik autoinjector depending on whether you are in the starting or maintenance phase. Neither number is reachable through a discount card, and the copay card explicitly excludes you.
The pattern matches other clinic-administered biologics such as Vabysmo and iron infusions: the drug is billed through the medical benefit, the gross charge runs well above the allowed amount, and the free-drug program is the only thing that actually gets an uninsured patient to zero.
All figures were researched September 4, 2026. Eisai’s list prices are stated as current as of July 2026. The CMS payment limits cited are effective July 1 through September 30, 2026, are built on first-quarter 2026 average sales price data, and reset on October 1, 2026, as do the hospital outpatient rates.