Pluvicto cost in 2026: the list price, the Medicare Part B math, and what a family actually pays

What changed on July 31, 2026, and why the bill changed with it

On July 31, 2026, the FDA approved Pluvicto for a second group of men. Before that date, the label covered one setting, which earlier versions called metastatic castration-resistant prostate cancer. Some coverage summaries online still describe only that older use.

Payer policies tie coverage to the label, so here is its exact wording. The label was revised in July 2026, and DailyMed posted it on August 12, 2026.

The schedule sets the bill. Both uses list the same dose: 7.4 GBq (200 mCi) every 6 weeks for 6 doses, or until the disease progresses or side effects are unacceptable. So each dose is billed separately, and a course can end before the sixth.

Six doses at six-week intervals span 30 weeks. A course that starts this fall will cross January 1. So the coverage you choose during open enrollment pays for the doses given in 2027.

The Medicare Part B math, one dose at a time

Pluvicto is billed under HCPCS code A9607. One unit is one millicurie, so a standard dose is 200 units. In a hospital outpatient department, Medicare pays from a quarterly CMS file called Addendum B.

In the July 2026 file, A9607 pays $267.32 per millicurie. That makes $53,464 per standard dose. Twenty percent of that is $10,692.80.

In a hospital outpatient department, Original Medicare does not charge you that full 20%. Under the hospital outpatient payment system, coinsurance for one service cannot exceed the Part A inpatient deductible. In 2026 that deductible is $1,736.

The cap applies line by line, and drugs count. MedPAC, the commission that advises Congress on Medicare, lists a drug as an example of a service the cap covers. So Original Medicare coinsurance on each Pluvicto line stops at $1,736.

The cap has limits of its own:

• It applies to hospitals paid under the outpatient payment system. MedPAC notes that critical access hospitals have no such cap.
• It does not apply in a physician's office or freestanding clinic. There, Part B coinsurance is a flat 20% with no per-service limit.
• It covers the drug line only. The infusion, visits, labs, and scans each carry their own coinsurance.
• It resets with the Part A deductible each January. The 2027 amount replaces $1,736 for doses given in 2027.

In a doctor's office, the number is set locally

If a dose is given in a physician's office or freestanding center instead of a hospital, different rules apply. Medicare publishes payment limits for drugs given in offices in a separate quarterly file. The October 2026 file, posted September 17, lists no payment limit for A9607. Neither does the July file.

That is by design. CMS's drug manual says radiopharmaceuticals given outside a hospital outpatient department are not priced by that method. The local Medicare contractor sets the limit, and it may use invoice pricing. In New Jersey, that contractor is Novitas Solutions. You owe 20% of whatever it allows, with no per-service cap.

For scale only: if an office were paid the hospital rate, 20% would be $10,692.80 per dose and $64,156.80 over six. Ask the office for its Medicare-allowed amount for A9607 before the first dose.

Original Medicare, Medigap, or Medicare Advantage: what the October 15 to December 7 choice changes

Medicare's open enrollment runs from October 15 to December 7. It is when you can move between Original Medicare and Medicare Advantage, and changes take effect January 1. Medigap has its own buying rules, covered below. For a family facing a 30-week course, these choices matter more than the list price.

Original Medicare alone has no yearly out-of-pocket limit. At about $1,811 per dose, six doses cost about $10,866 in drug and infusion coinsurance. Visits, labs, and scans come on top.

Medigap plans A, B, C, D, F, G, M, and N pay the full Part B coinsurance. With one of those plans, the Pluvicto and infusion lines cost you at most the $283 Part B deductible, plus any Plan N copays. Plans K and L pay part of it, up to a yearly limit.

A Medicare Advantage plan works differently. It sets its own cost sharing for Part B drugs, may require prior authorization, and may limit you to its network. In exchange, it has a yearly cap. In 2026 the in-network cap cannot exceed $9,250.

Check four things before anyone switches:

• Medigap has one guaranteed window: the 6 months that start when you are 65 or older and enrolled in Part B. Outside that window and special situations, no federal rule forces an insurer to sell you a policy. It may also cost more because of health problems.
• You cannot buy Medigap to cover a Medicare Advantage plan's costs. The two do not combine.
• A Medicare Advantage cap resets every January 1. A course that crosses the new year can meet two years' caps.
• Check the treatment site is in the plan's network, and read the plan's Evidence of Coverage under Part B drugs.

Why the $2,100 Part D cap does not cover Pluvicto

Part D pays for drugs you pick up at a pharmacy. In 2026, its out-of-pocket cap is $2,100. Pluvicto is a radioactive infusion. The label limits its use to people licensed to handle radiopharmaceuticals, and the treatment site bills it under Part B as code A9607.

Medicare puts it plainly: Part B usually covers drugs you would not give yourself, such as those given in a doctor's office or hospital outpatient setting. That is why the Part D cap does not limit what Pluvicto costs you.

The new July 31 use pairs Pluvicto with an androgen receptor pathway inhibitor, or ARPI. In the approval study, those were abiraterone, apalutamide, enzalutamide, or darolutamide. These are pharmacy prescriptions, which usually fall under Part D. So one household can face two separate tracks in the same year: Part D with its $2,100 yearly cap, and Part B with no yearly cap.

Coverage requirements: the PSMA PET scan, Novitas, and prior authorization

Coverage starts from the label. It says to select patients with Locametz or another approved PSMA PET product. So a PSMA PET scan usually comes before the first dose, and it arrives as its own bill. Our PSMA PET scan guide covers that scan's 2026 Medicare math.

Original Medicare has no national coverage decision for Pluvicto. We searched CMS's Medicare Coverage Database for A9607 on September 22, 2026. It returned no national policy and no local policy or billing article from any contractor, Novitas included.

That does not mean no coverage. It means each claim is judged on its own. CMS states that contractors determine whether a drug meets all program requirements for coverage. Ask the treating team to document the label indication and the PSMA PET result.

Prior authorization depends on the plan:

• Original Medicare: in most cases, no prior authorization is needed.
• Medicare Advantage: the plan may require it. Since 2026, plans must decide standard requests within 7 calendar days and urgent ones within 72 hours, and must give a specific reason for any denial.
• Commercial plans: most publish a drug policy. Blue Cross Blue Shield of Michigan's, for example, asks for chart notes and at least one PSMA-positive lesion with no PSMA-negative lesions on the scan. It approves at least 60 days and up to 6 months at a time.
• Timing: six doses span about 30 weeks, which is longer than six months. Ask how the plan handles doses after the first approval ends.
• Label changes: a policy written before July 31, 2026 may not yet list the new use. Ask whether the plan's policy was updated after that date.

The rest of the bill: the infusion, the scan, labs, and visits

The drug line is the largest line, but it is not the only one. Expect these on or around each dose day:

• The infusion itself, CPT 79101. Medicare's 2026 national average in a hospital outpatient department is $380, with about $75 owed by the patient.
• The PSMA PET scan before treatment. It includes a separately billed tracer. The July 2026 hospital rate for Locametz (A9800) is $362.50 per millicurie.
• Blood tests. The label calls for complete blood counts before and during treatment, and kidney function tests. Each is billed separately.
• Visits with the treating team. Each is billed separately and carries its own Part B coinsurance.
• The companion ARPI prescription for the new use, usually billed through Part D.

Help paying: who qualifies, and what was open on September 24, 2026

Assistance splits sharply by insurance type. Novartis's co-pay program is for private insurance only. It is not valid for Medicare, Medicaid, TRICARE, VA, or other government programs. It pays up to $15,000 over the course of treatment. Novartis says about 80% of insured patients pay $0 per infusion.

Medicare patients depend on independent charities. We checked the main prostate cancer funds on September 24, 2026. Every one was closed to new patients. Funds open and close through the year, so register for alerts and check again before each dose.

Other ways to lower the bill

Charity funds are not the only route. The first three below follow fixed rules, so they do not close when donations run out:

• Qualified Medicare Beneficiary program: it pays Part B deductibles, coinsurance, and copayments. The 2026 federal income limit is $1,350 a month for one person and $1,824 for a couple. States may allow more.
• Hospital financial assistance: nonprofit hospitals must post a written policy, an application, and a plain-language summary. Ask for it before the first dose, not after the bill.
• Good Faith Estimate: if you pay without insurance, the provider must give a written estimate on request. You need that estimate to dispute a bill later.
• Novartis Patient Support at 1-844-638-7222: ask what it offers if you have no insurance or your plan denies coverage.

What this page will not tell you

This page covers cost and coverage only. It does not say whether Pluvicto works, how well, what side effects it has, or whether it is worth it. It does not compare Pluvicto with any other treatment. Those are clinical questions for the treating oncology team.

Modern Prostate Institute does not administer Pluvicto and has no financial relationship with Novartis or any treatment center. Every figure is national and dated. Your plan, your site of care, and the date of each dose will change the real number.