# How much do monoclonal antibodies cost? > Monoclonal antibody treatment averaged about $96,700 a year at US list price, from under $600 per preventive dose to over $12,500 per cancer dose. See how Medicare rates compare with manufacturing costs. A monoclonal antibody treatment in the United States usually costs tens of thousands of dollars a year, and cancer antibodies often cost more than \$100,000. Across antibodies approved between 1997 and 2016, the average annual list price was about **\$96,700**. Single doses span a much wider range: a preventive antibody for infants costs under \$600, while one dose of the cancer drug Keytruda lists at \$12,517. The COVID-19 antibody cocktails were an exception for patients. The US government bought them for \$1,250 to \$2,100 per dose and gave them out without charging for the drug. These prices bear little relation to the cost of making the molecules. Monoclonal antibodies are produced in engineered mammalian cells, and modern plants make them for roughly \$16 to \$200 per gram, so the antibody in a typical dose costs a few dollars to a few hundred. Our analysis of Medicare's payment rates puts the median antibody at about \$33,000 per gram, roughly 170 times the top of that range. The sections below follow the money from the price on the label to the cost in the bioreactor, then explain what fills the gap and what patients actually pay. ## How much do monoclonal antibodies cost? In the US, the median price of a monoclonal antibody treatment ranges from about \$15,000 to \$200,000 a year, depending on the disease it treats. Hernandez and colleagues priced every [monoclonal antibody](/guides/what-are-monoclonal-antibodies) approved by the FDA from 1997 to 2016 and found an average annual price of \$96,731 and a median of \$58,968. Their prices are average wholesale prices, a list price that sits above what insurers usually pay after discounts. Antibodies for cancer and blood disorders were the most expensive group, with a median of \$142,833 a year, against \$53,969 for antibodies that treat immune diseases such as rheumatoid arthritis. The cost of a single dose depends on how much antibody it contains and how the manufacturer prices it. Keytruda (pembrolizumab), a cancer antibody used across many tumor types, lists at \$12,517.44 for a 200-milligram dose given every three weeks. A year of three-weekly doses therefore comes to about \$218,000 at list price, by our calculation. Antibodies for chronic diseases are usually quoted per year: Ocrevus (ocrelizumab) for multiple sclerosis lists at \$78,858, Dupixent (dupilumab) for eczema and asthma at \$4,193.03 per two-injection carton, and the Alzheimer's antibodies Leqembi and Kisunla at \$26,500 and \$32,000 for a year of infusions. Table 1. US list prices of selected monoclonal antibodies. Wholesale acquisition cost (the manufacturer's list price before discounts and rebates) unless noted. What insurers and patients pay is usually lower. Zinplava has been discontinued. Sources: Merck (2026), Genentech (2024), Regeneron and Sanofi (2026), Eisai (2023), Myshko (2024), CDC (2026), Invivyd (2025), Lee et al. (2017). Antibody (brand) Used for US list price Pembrolizumab (Keytruda) Many cancers \$12,517 per dose every 3 weeks Ocrelizumab (Ocrevus) Multiple sclerosis \$78,858 per year Dupilumab (Dupixent) Eczema, asthma \$4,193 per carton of 2 injections Donanemab (Kisunla) Early Alzheimer's disease \$32,000 for 12 months Lecanemab (Leqembi) Early Alzheimer's disease \$26,500 per year Pemivibart (Pemgarda) COVID-19 prevention \$6,350 per dose Bezlotoxumab (Zinplava) Recurrent C. difficile infection \$4,560 per vial (2017 average wholesale price) Nirsevimab (Beyfortus) RSV prevention in infants \$595 per dose (private sector) Some antibodies are given once rather than for years, which changes how their price reads. Zinplava (bezlotoxumab), a single infusion that reduced the return of *Clostridioides difficile* infection, cost \$4,560 per vial at average wholesale price in 2017. The FDA now lists it as discontinued. At the bottom of the range, the infant RSV antibody Beyfortus (nirsevimab) costs \$595 per dose on the private market and \$444 through the CDC's vaccine program. ## How much does it cost to make a monoclonal antibody? Manufacturing a monoclonal antibody at commercial scale costs roughly \$16 to \$200 per gram of purified drug, depending on the process and on how much antibody each liter of cell culture yields. The antibodies are made by Chinese hamster ovary cells grown in steel or single-use bioreactors of up to about 15,000 liters, then purified through a series of chromatography steps. Wellcome Trust and IAVI reported that marketed antibodies cost \$95 to \$200 per gram to produce, before research costs, while noting that smaller companies pay more. In 2009, Kelley put the cost of then-current processes at \$50 to \$100 per gram once cultures produce at least 2 grams of antibody per liter. Yield, known as titer, matters because most manufacturing costs are fixed. A plant costs the same to build, staff and depreciate whether a batch yields half a gram per liter or five. In Kelley's model of a six-bioreactor plant, raising the titer from 0.5 to 5 grams per liter cut the cost of the drug substance from \$124 to \$16 per gram, mostly by spreading depreciation and labor over more product. Chen and colleagues estimated that capital and facility costs account for about 59% of the cost of goods in a standard process, compared with 18% for materials and 15% for labor. Table 2. Modeled cost to produce a monoclonal antibody at three titers. Drug substance only, for a plant with six 15,000-liter bioreactors, in 2009 US dollars. Vial costs add about \$10 per vial for filling and finishing. Source: Kelley (2009). Titer (grams per liter) Cost per gram of antibody Cost of a 100 mg vial Cost of a 1 g vial 0.5 \$124 \$22 \$134 2 \$33 \$13 \$43 5 \$16 \$12 \$26 A therapeutic dose contains between a few tens of milligrams and about a gram of antibody, so the antibody in a dose is cheap. At Kelley's \$16 to \$124 per gram, the 200 milligrams in a Keytruda dose would cost about \$3 to \$25 to produce. Gotham compared manufacturing cost estimates with the lowest prices paid in the US, by the Veterans Affairs system, and found that a 420-milligram dose of the breast cancer antibody trastuzumab cost \$8 to \$126 to make but \$2,878 to buy. Across five widely used antibodies, manufacturing amounted to no more than 6% of these US prices. Kelley reached a similar conclusion from the other direction: in 2008, the best-selling antibodies sold for a median of about \$8,000 per gram, so production accounted for perhaps 1% to 5% of the price. Costs keep falling. Continuous processing, in which cells grow and antibody is purified without stopping between batches, could bring costs to about \$25 per gram, and researchers working on access to infectious disease antibodies have set a target of about \$10 per gram. ## How much does Medicare pay per gram of antibody? Medicare pays a median of about **\$33,000 per gram** for the monoclonal antibodies it covers in clinics, roughly 170 times the top of the reported manufacturing range. We calculated this from the payment limits Medicare set for October to December 2026, which give a price per billing unit for every drug paid under Part B, the part of Medicare that covers drugs given by a doctor or clinic. For most of these drugs the limit is 106% of the manufacturer's average sales price, which is net of most discounts, so it comes closer to what providers actually pay than a list price does. We divided each limit by the milligrams of antibody in its billing unit and counted each of 108 antibodies once, at the original manufacturer's product. The [per-antibody results](/data/guides/monoclonal-antibody-cost/medicare-price-per-gram.csv), [methods](/data/guides/monoclonal-antibody-cost/README.md) and [analysis script](/data/guides/monoclonal-antibody-cost/analyze.py) record every inclusion and classification. ![Horizontal bars on a logarithmic axis: a research antibody at \$5.6 million per gram, Keytruda at \$62,253 and the median antibody at \$33,261 in Medicare payments, a COVID cocktail at \$1,750, reported production costs of \$95 to \$200 and modeled production at \$16 per gram.](/images/charts/monoclonal-antibody-price-per-gram-comparison.webp '**Figure 1. What a gram of monoclonal antibody costs, from production to sale.** The axis is logarithmic, so each gridline marks a tenfold increase. Production costs are for purified drug substance: the Kelley model at a titer of 5 grams per liter and the \$95 to \$200 range reported by Wellcome Trust and IAVI. The COVID cocktail is REGEN-COV at \$2,100 per 1,200-milligram dose. Medicare values are October 2026 payment limits, and the median covers 108 antibodies in a ProteinIQ analysis. The research antibody is a catalog anti-GAPDH antibody at \$560 per 100 micrograms. Sources: [Kelley (2009)](https://pmc.ncbi.nlm.nih.gov/articles/PMC2759494/), [Wellcome Trust and IAVI (2020)](https://cms.wellcome.org/sites/default/files/expanding-access-to-monoclonal-antibody-based-products.pdf), [Regeneron (2021)](https://www.prnewswire.com/news-releases/regeneron-announces-new-us-government-agreement-to-purchase-additional-doses-of-regen-cov-casirivimab-and-imdevimab-antibody-cocktail-301376898.html), [CMS (2026)](https://www.cms.gov/medicare/payment/part-b-drugs/asp-pricing-files), [Abcam (2026)](https://www.abcam.com/en-us/products/primary-antibodies/gapdh-antibody-6c5-loading-control-ab8245).') Half of the antibodies are paid between \$11,900 and \$175,000 per gram, and 37 of the 108 exceed \$100,000. Even the cheapest, the Alzheimer's antibody lecanemab at \$1,361 per gram, is paid about seven times the top of the manufacturing range. Price per gram mostly reflects how much antibody a treatment needs. Antibodies infused in large doses, such as lecanemab and the arthritis and bowel disease antibody infliximab at \$2,986 per gram, are cheap per gram, whereas blinatumomab, a leukemia drug dosed in micrograms, is paid \$173 million per gram. The same arithmetic reconciles Medicare's data with the annual prices above. Among conventional antibodies, the median for cancer drugs was \$15,280 per gram, lower than the \$20,949 for drugs that treat immune diseases, even though cancer antibodies cost far more per year. Cancer treatment uses more antibody, not more expensive antibody. Newer antibody formats are paid far more per gram. Antibody-drug conjugates, which carry a toxic drug into cancer cells, have a median of \$146,140 per gram, and bispecific antibodies, which bind two targets at once, \$250,602, compared with \$22,263 for conventional antibodies. Most of these are recent cancer drugs given in small doses. The three antibody fragments in the file, which lack part of the full antibody structure, range from \$3,140 per gram for the arthritis drug certolizumab pegol to \$360,439 for the eye drug brolucizumab. ![Horizontal bars of median Medicare payment per gram: bispecific antibodies \$250,602, antibody-drug conjugates \$146,140 and conventional antibodies \$22,263.](/images/charts/monoclonal-antibody-medicare-price-per-gram-by-format.webp '**Figure 2. Median Medicare payment per gram by antibody format.** The number of antibodies in each group is in parentheses. Payment limits apply from October to December 2026, and antibody-drug conjugate prices include the attached drug. ProteinIQ analysis. Source: [CMS (2026)](https://www.cms.gov/medicare/payment/part-b-drugs/asp-pricing-files).') ## Why are monoclonal antibodies so expensive? Monoclonal antibodies are expensive because their prices recover the cost of developing them and reflect the value payers will accept, not the cost of making them. Each approved antibody begins as one of many candidates, now often proposed and refined with computational [antibody design](/use-cases/antibody-design) before any are made, and most of the development money goes to candidates that never reach patients. Farid and colleagues estimated that each successful antibody requires about \$1.88 billion in research and development once failures and the cost of capital are included, of which process development and manufacturing make up 13% to 17%. Wouters and colleagues found a median of \$2.77 billion for cancer and immune-system drugs, the classes most antibodies belong to. Our guide to [drug development cost](/guides/drug-development-cost) explains why these estimates vary so much, and the [clinical trial failure rate](/guides/clinical-trial-failure-rate) is the main reason they are so high. Part of that failure is avoidable. An antibody that clumps, binds itself, or becomes too thick to inject at the high concentrations needed for a small subcutaneous dose can stall late in development. Screening candidates early for these developability problems, for example with [TAP2](/app/tap2), which flags unusual surface charge and hydrophobic patches, or [DeepViscosity](/app/deepviscosity), which predicts whether an antibody will exceed 20 centipoise at 150 milligrams per milliliter, helps teams drop risky sequences before they reach expensive cell-line and clinical work. Prices also stay high because competition arrives slowly. Biosimilars, the near-copies of off-patent antibodies, are harder and costlier to develop than generic pills, and they have usually been only 10% to 35% cheaper than the original antibody. Humira (adalimumab) shows how long a protected antibody can hold its price. Its US list price rose from \$1,153 per 40-milligram dose in 2013 to \$2,784 in 2020, and the lower-priced version of Amjevita, the first biosimilar launched in 2023, still cost \$1,558 per dose, more than double Humira's own launch price. Some later biosimilars, such as Yusimry, launched at about 85% below Humira's list price. In the first year of competition, the net price paid per adalimumab prescription fell 43%, from \$5,007 to \$2,837. Our guide to [how long a drug patent lasts](/guides/how-long-does-a-drug-patent-last) explains why that competition took two decades to arrive. Medicare's payment limits show where competition has cut prices most. In our analysis, biosimilars of the cancer antibodies rituximab, bevacizumab and trastuzumab are paid a median of 54% to 71% less per gram than the originals, whereas biosimilars of four antibodies for immune, blood and bone diseases are paid 15% to 18% less. Infliximab biosimilars are paid only 5% less, but the original is itself among the cheapest antibodies per gram, at \$2,986. ![Paired horizontal bars of Medicare payment per gram for eight original antibodies and the median of their biosimilars, with the largest gaps for rituximab, bevacizumab and trastuzumab.](/images/charts/biosimilar-vs-reference-antibody-price-per-gram.webp '**Figure 3. Medicare payment per gram for original antibodies and their biosimilars.** Payment limits apply from October to December 2026. Biosimilar bars show the median across the biosimilars of each antibody, and the limit for a biosimilar includes an add-on of 6% or 8% of the average sales price of the original. ProteinIQ analysis. Source: [CMS (2026)](https://www.cms.gov/medicare/payment/part-b-drugs/asp-pricing-files).') ## How much do patients pay for monoclonal antibody treatment? What a patient pays depends far more on insurance than on the list price. Most antibodies are infused or injected in a clinic, so in traditional Medicare they are covered under Part B, where patients pay 20% of the approved amount after the deductible. Traditional Medicare has no annual cap on that 20%, and about 6 million beneficiaries have no supplemental coverage to absorb it. For Keytruda, KFF estimated that the 20% share comes to about \$2,500 per claim and roughly \$15,000 a year. Merck reports that 55% of commercially insured Keytruda patients paid nothing out of pocket in 2024, whereas most traditional Medicare patients without supplemental coverage paid \$1,500 to \$2,400 per infusion. Antibodies account for much of what Medicare spends on drugs given in clinics. Keytruda was the largest Part B drug in 2024, with \$6.0 billion in Medicare spending, or \$78,900 per user. Fifteen of the top 20 Part B products were biologics, many of them antibodies. Without insurance, a patient faces the full price of the drug plus the clinic's charge for infusing it. That would be about \$12,500 for a single Keytruda dose before administration fees, and \$26,500 to \$32,000 a year for an Alzheimer's antibody, before scans and infusion visits. Manufacturers run assistance programs for uninsured and underinsured patients, and their terms vary by drug. ## How much did COVID monoclonal antibodies cost? COVID-19 antibody treatments cost the US government \$1,250 to \$2,100 per dose, and patients paid nothing for the drug itself. Eli Lilly's first contract supplied 300,000 vials of bamlanivimab for \$375 million, or \$1,250 per 700-milligram dose. Later purchases of antibody cocktails, which combine two antibodies so the virus is less likely to escape both, settled at \$2,100 per dose. The government paid Lilly \$210 million for 100,000 doses of bamlanivimab with etesevimab. Regeneron's REGEN-COV cocktail of casirivimab and imdevimab also sold for \$2,100 per 1,200-milligram dose, with nearly 3 million doses bought in total. Per gram of antibody, the cocktails were cheap by US standards. Chen and colleagues put the \$2,100 cocktails at about \$2,000 per gram, compared with a production cost in the tens to hundreds of dollars. At \$2,100 for 1.2 grams, REGEN-COV cost about \$1,750 per gram, less than all but one of the 108 antibodies in our Medicare analysis. Large guaranteed orders made that price possible, and they also made the cocktails lucrative: REGEN-COV brought Regeneron \$5.83 billion in US sales in 2021. Table 3. What the US government paid for COVID-19 monoclonal antibodies. Price per dose is the contract total divided by the number of doses, unless the company stated the price directly. Sotrovimab's per-dose price was not disclosed; the value shown is the course price used by ICER. Sources: Eli Lilly (2020, 2021, 2022), Regeneron (2021), GSK (2021), ICER (2022), CMS (2026). Antibody treatment Dose US government purchase Price per dose Bamlanivimab (Lilly) 700 mg 300,000 doses for \$375 million (October 2020) \$1,250 Bamlanivimab with etesevimab (Lilly) 700 mg + 1,400 mg 100,000 doses for \$210 million (February 2021) \$2,100 REGEN-COV, casirivimab with imdevimab (Regeneron) 600 mg + 600 mg 1.4 million doses (September 2021) \$2,100 Sotrovimab (GSK and Vir) 500 mg About \$1 billion (November 2021) About \$2,100 Bebtelovimab (Lilly) 175 mg Up to 600,000 doses for at least \$720 million (February 2022) \$1,200 Because the government owned the supply, Medicare paid providers only to give the drug. The payment for an infusion was about \$310 at first and rose to \$450 in May 2021, or \$750 when the infusion was given at home. People with Medicare paid no cost sharing for the antibodies or their administration. Privately insured and uninsured patients were not always so lucky. CNN found clinics charging or quoting patients roughly \$400 to \$1,100 to receive Evusheld, a preventive COVID antibody the government had supplied free. The situation changed when government supply ended. From August 15, 2022, providers bought bebtelovimab commercially, and Medicare paid \$2,394 for each 175-milligram dose. None of these treatment antibodies is authorized in the US today, because newer Omicron variants escaped them. The only COVID antibody still available is Pemgarda (pemivibart), a preventive infusion for people with weakened immune systems, which launched at \$5,775 per dose and now lists at \$6,350. Its emergency authorization is scheduled to end on June 29, 2027. Prices elsewhere were set differently. In India, Roche and Cipla launched the casirivimab and imdevimab cocktail in May 2021 at Rs 59,750 per patient dose, sold in a pack for two patients at Rs 1,19,500. Tocilizumab (Actemra), an antibody that calms the immune overreaction in hospitalized COVID patients rather than targeting the virus, cost about \$3,684 at US list price in 2023 for one dose for a 70-kilogram adult. ## Are there cheap monoclonal antibodies? Antibodies developed for low-income markets show how far prices can fall. Survival after a severe bite from a rabid animal depends on prompt treatment with vaccine and with antibodies that neutralize the virus at the wound. Human rabies immunoglobulin, purified from the blood of vaccinated donors, has long been scarce and costly. In one Indian study, only 21 of 783 patients with severe bites were prescribed it, and only 10 could afford it. Rabishield, a rabies monoclonal antibody from the Serum Institute of India, was priced at about \$20 a vial. In India, a course of antibody treatment for an average adult costs about \$285 with human immunoglobulin, \$55 with monoclonal antibodies and \$13 with immunoglobulin from horses. In a randomized phase 2/3 trial, Rabishield performed as well as human immunoglobulin. The WHO encourages using rabies monoclonal antibodies instead of immunoglobulin and added them to its Essential Medicines List in 2021. ![Horizontal bars of the cost of one rabies antibody course for an adult in India: \$285 with human immunoglobulin, \$55 with monoclonal antibodies and \$13 with equine immunoglobulin.](/images/charts/rabies-antibody-course-cost-india.webp '**Figure 4. Cost of rabies antibody treatment for one adult in India.** A routine post-exposure antibody course for an average adult. Equine immunoglobulin is purified from the blood of immunized horses. Source: [WHO (2021)](https://cdn.who.int/media/docs/default-source/essential-medicines/2021-eml-expert-committee/applications-for-addition-of-new-medicines/a.26_rabies-mabs.pdf).') Such examples remain rare. About 80% of monoclonal antibody sales are in the US, Canada and Europe, although 85% of the world's population lives in low- and middle-income countries. More than 130 antibodies are [approved in the US](/guides/how-many-monoclonal-antibodies-are-fda-approved), but only 16 appear on the WHO Essential Medicines List, and pembrolizumab costs about \$6,000 per cycle in India. Reaching those markets at scale would require production near the \$10 per gram target, enough for a 1-gram dose to cost about \$10 to make. ## How much do research antibodies cost? Antibodies bought for laboratory research cost far more per gram than therapeutic ones, because they are sold in microgram quantities. Abcam sells its monoclonal antibody against GAPDH, a primary antibody widely used to check protein loading on western blots, at \$560 for 100 micrograms. By our conversion, that is \$5.6 million per gram, about 170 times what Medicare pays per gram for the median therapeutic antibody. Researchers spend about \$1.6 billion a year on protein-binding reagents, and Bradbury and Plückthun estimated that about half of it, \$800 million, goes on antibodies that do not perform as claimed. ## Why the price of an antibody is not the cost of the molecule The cost of a monoclonal antibody depends on who is buying and why, far more than on the protein itself. The molecule in a typical dose costs a few dollars to a few hundred to make. Medicare pays a median of about \$33,000 per gram for therapeutic antibodies, the US government bought COVID cocktails for under \$2,000 per gram, and a rabies antibody made for Indian clinics costs a small fraction of either. The difference pays for the research, failures and risk behind each approved antibody, and it persists for as long as patents and slow biosimilar competition allow. For patients, what matters is the last step in the chain: insurance design, which decides whether the \$12,500 dose costs them nothing or thousands of dollars.