Medicare rate
$31.479
per 10 mg unit · ASP+6%, Q3 2026
The Medicare allowed amount for any dose, the patient's share with the infusion and visit lines, what a Medigap plan leaves them with, and what changes on a commercial plan.
Q3 2026 ASP, effective July 1 · 2026 physician fee schedule · reviewed
Enter the dose and weight, pick the plan, and add a Medigap plan if there is one.
Indication sets the usual dose · Example: 80 kg at 5 mg/kg, type over it
| Item | Allowed | Qty | Total | No Assist | With Assist |
|---|---|---|---|---|---|
| Remicade (JZ) J1745 | $31.479 | 40 | $1,259.16 | $251.83 | — |
| Chemotherapy/complex biologic infusion, initial hour 96413 | $133.27 | 1 | $133.27 | $26.65 | — |
| each additional hour 96415 | $28.39 | 1 | $28.39 | $5.68 | — |
| Office/outpatient visit (E&M) 99214 | $135.61 | 1 | $135.61 | $27.12 | — |
| $1,556.43 | $311.28 | — |
No open, diagnosis-matched foundation fund covers infliximab for IBD at our last check — CareCost watches the closed funds and flags one the moment it reopens. Manufacturer copay cards, including Janssen CarePath, exclude Medicare patients.
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That is Original Medicare. On a commercial plan the numbers are different: the payer's contract rate, and the patient's deductible and out-of-pocket position. CareCost has both. That is the next step.
Enter your email. The estimate opens with this dose and plan already filled in. CareCost adds the payer's published rate on commercial plans, the copay programs with their status, and a printable summary.
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The plan's own allowed amount, not Medicare's. The allowed amount from the payer's published price file.
Deductible and out-of-pocket applied. You enter them once from the benefits check; they stay on the patient's file and the math is done line by line.
The copay program applied. CarePath on a commercial plan, the foundation funds on Medicare, each with its status and the date we checked.
A printable patient cost estimate, drug, infusion and visit lines included.
What it returns on a commercial plan · Aetna, Crohn's, 85 kg example, not editable
With CarePath (manufacturer copay card): $5.00.
Every rate on this page links to its source file. Methodology · Privacy
Medicare Part B pays for Remicade at ASP+6% — the average sales price plus a 6% add-on that CMS recalculates every quarter ($31.479 per 10 mg billing unit for Q3 2026). Once the patient has met the annual Part B deductible ($283 in 2026), Medicare pays 80% of the allowed amount for the drug and its administration, and the patient owes the remaining 20% coinsurance. Medicare's 80% is reduced by the 2% sequester (an effective ASP+4.3%); the patient's 20% is unaffected. Part B carries no out-of-pocket maximum, so that 20% coinsurance applies to every infusion for the rest of the year unless a foundation fund, Medigap policy, or Medicare Advantage secondary plan picks it up.
For the reference patient — 80 kg, 5 mg/kg, 40 units — the
drug, infusion and visit lines allow $1,556.43, and the Part B coinsurance on that is
$311.28. This table shows what each standardized Medigap plan leaves the patient with
for that same claim, computed from medigap-plans.js' coverage rules.
| Plan | Covers Part B deductible ($283) | Covers Part B coinsurance | Patient owes, deductible met | Patient owes, deductible not met |
|---|---|---|---|---|
| Plan A | No | 100% | $0.00 | $283.00 |
| Plan B | No | 100% | $0.00 | $283.00 |
| Plan C | Yes | 100% | $0.00 | $0.00 |
| Plan D | No | 100% | $0.00 | $283.00 |
| Plan F* | Yes | 100% | $0.00 | $0.00 |
| Plan G* | No | 100% | $0.00 | $283.00 |
| Plan K | No | 50% | $155.64 | $410.34 |
| Plan L | No | 75% | $77.82 | $346.67 |
| Plan M | No | 100% | $0.00 | $283.00 |
| Plan N | No | 100% (except up to $20 office-visit copay) | $20.00 | $303.00 |
* Also sold as a high-deductible plan (2026 HD deductible $2,950). Plans C and F are not available to people newly eligible for Medicare on or after January 1, 2020. Plans K and L pay a percentage of coinsurance until their annual out-of-pocket maximum is reached ($8,000 for K, $4,000 for L in 2026), then 100%. Plan N's coinsurance coverage excludes a copay of up to $20 for an office visit and up to $50 for an ER visit that doesn't result in admission — this table applies the $20 office-visit copay, the only one of those two codes in this claim.
| Drug | HCPCS | ASP+6% per unit (10 mg) | For 40 units |
|---|---|---|---|
| Remicade (reference product) | J1745 | $31.479 | $1,259.16 |
| Inflectra (infliximab-dyyb) | Q5103 | $27.710 | $1,108.40 |
| Renflexis (infliximab-abda) | Q5104 | $26.615 | $1,064.60 |
| Avsola (infliximab-axxq) | Q5121 | $30.830 | $1,233.20 |
Q5109 (the infliximab-qbtx biosimilar) has no entry in the Q3 2026 Medicare ASP file and is omitted from this table.
Medicare pays the same ASP+6% rate for the Remicade drug itself no matter where it's infused. The difference is what gets billed alongside it: an office infusion bills the physician fee schedule's administration codes (96413/96415) and an office visit (99214) — the codes used in the estimator above — while a hospital outpatient department bills its own facility fee under the hospital outpatient prospective payment system instead of those physician-fee-schedule codes. Our data doesn't carry a Remicade-specific hospital-outpatient facility rate, so this estimator only prices the office/physician-fee-schedule path.
| Quarter | ASP+6% per unit (10 mg) |
|---|---|
| 2025 Q1 | $30.525 |
| 2025 Q2 | $30.523 |
| 2025 Q3 | $31.179 |
| 2025 Q4 | $31.090 |
| 2026 Q1 | $32.423 |
| 2026 Q2 | $31.041 |
| 2026 Q3 (current) | $31.479 |
$31.479 per 10 mg billing unit for Q3 2026 (ASP+6%). An 80 kg patient at the standard 5 mg/kg dose needs 40 units, so Medicare's allowed drug amount is $1,259.16.
For an 80 kg patient at 5 mg/kg, the drug plus the infusion and office-visit codes total $1,556.43 allowed. After the Part B deductible is met, the patient's 20% coinsurance is $311.28 with an office visit ($284.16 without) — before any foundation fund is applied.
Manufacturer copay cards, including Janssen CarePath, exclude Medicare patients. A diagnosis-matched foundation fund can still cover the coinsurance up to its annual cap when one is open — but as of our last check, every foundation fund that matches infliximab for IBD, RA, or psoriasis is closed. CareCost watches the closed funds and flags one the moment it reopens.
Commercial plans pay their own negotiated rate, not ASP+6% — our corpus holds published rates from 37 payers. What a commercial patient owes depends on that negotiated rate and their specific deductible, coinsurance and out-of-pocket max, not the Medicare fee schedule.
Sources: CMS ASP pricing files (Q3 2026); Medicare physician fee schedule (96413, 96415, 99214, national non-facility); Medicare Part B deductible (2026); Janssen CarePath and foundation fund terms and status (public/programs-bundle.js, generated from the live programs corpus).