How Much Does Leucovorin Cost?

Published on September 23, 2025 | Prices Last Reviewed for Freshness: January 2026
Written by Alec Pow - Economic & Pricing Investigator | Medical Review by Sarah Nguyen, MD

Educational content; not medical advice. Prices are typical estimates and may exclude insurance benefits; confirm with a licensed clinician and your insurer.

Leucovorin, also called folinic acid, is used with methotrexate in oncology, with fluorouracil in colorectal cancer regimens, and in a few non-cancer protocols. For patients and caregivers, leucovorin cost drives decisions about where to fill a prescription, which strength to choose, and whether to use retail, mail order, or a hospital infusion pharmacy. As of 2024–2025, patients will see very different prices for tablets versus injection, and insurance rules add another layer, per Cancer.gov.

What follows is a clear look at typical U.S. cash prices for tablets and vials, Medicare payment benchmarks for infusions, and practical ways to lower the bill. Short version, generic oral tablets can be inexpensive at scale, while injectable dosing billed through a hospital or infusion center is priced off national fee schedules and local markups, a pattern reflected in the Drugs.com price guide.

A quick news note helps explain renewed interest. In September 2025 the FDA announced actions related to leucovorin’s use for cerebral folate deficiency, a move expected to expand coverage and awareness, although the agency stressed this is not a cure for autism. New attention can nudge demand and pharmacy pricing.

Article Highlights

• Oral leucovorin often prices under $1 per 5 mg tablet at modest counts, with deeper discounts at larger bottles. Drugs.com
• GoodRx coupon offers can drop a local fill to as low as $7.63 for some orders.
• Medicare’s 2025 allowance for J0640 is $3.95 per 50 mg in Q3, plus facility and administration fees. CMS ASP Table III
• Combo pyrimethamine-leucovorin runs about $148.70 for 30 capsules with a discount card in 2025. SingleCare
• New FDA attention around cerebral folate deficiency may broaden coverage conversations and demand. FDA

What it costs right now

For oral tablets, public price guides show cash prices that change with strength and quantity. On Drugs.com, examples include $26.85 for 30 tablets of 5 mg (about $0.90 each) and $40.18 for 12 tablets of 10 mg. Higher strengths, such as 25 mg, list $104.45 for 20 tablets. These are starting points that often drop with larger quantities or discount cards.

Discount platforms list even lower out-of-pocket amounts in some markets. GoodRx shows prices starting at $7.63 with a coupon, and PharmacyChecker has historical lows near $0.35 per 5 mg tablet when buying 120 tablets. Real totals depend on pharmacy contracts and local stock. Prices move.

Injectable leucovorin for infusions is billed differently. Medicare’s Average Sales Price plus 6 percent sets a national benchmark, coded as J0640 per 50 mg. In Quarter 3 of 2025, the CMS ASP Table III lists $3.95 per 50 mg, after $4.16 in Q1 and $3.51 in Q2. Commercial plans negotiate off similar references, then add facility and administration charges.

Levoleucovorin, the single-isomer alternative sometimes used when shortages or payer preferences arise, typically runs higher per unit in retail comparisons. A Drugs.com comparison page shows levoleucovorin per-unit injectable prices above standard leucovorin in like strengths. Value depends on payer rules and regimen.

Real bills and examples

Uninsured retail purchase. A caregiver in Phoenix is quoted $79.58 for 100 tablets of 5 mg at a national chain using the posted Drugs.com per-unit of roughly $0.80, then uses a discount card to bring the total down a few dollars. This example mirrors the public price ladder where unit costs fall as quantities increase. It is a realistic cash register bill for a common strength.

Commercial insurance at a community pharmacy. A patient in Columbus receives 30 tablets of 10 mg with a plan that applies a tier-2 copay of $15 after the pharmacy contract adjudicates a negotiated rate. Without the plan, GoodRx shows a local coupon price in the teens to low twenties in that zip for a comparable order, which is consistent with the national “from $7.63” language for some fills. Savings vary by chain and coupon availability.

Hospital infusion billing. A Vermont hospital’s public chargemaster shows legacy line items for leucovorin injection at multiple vial sizes, for example an SDV 100 mg line in older files. Chargemasters are list prices, not the final allowed amount, but they illustrate how hospitals assign a sticker rate that is then adjusted by payer contracts. When Medicare pays for J0640 at about $3.95 per 50 mg in Q3 2025, the facility also bills infusion administration codes and pharmacy handling, which explains why a day-of-service statement can be much higher than the drug line alone.

Combination capsule for toxoplasmosis protocols. Some prescribers use a pyrimethamine-leucovorin combo to simplify dispensing. SingleCare lists a card price near $148.70 for 30 capsules in 2025, which can be cheaper than buying each component separately at retail in specific markets, though it is not always on every pharmacy shelf.

Line item breakdown

The tablet bill has three parts. First is the base drug price, which slides with strength and count. Generic 5 mg bottles trend under $1 per tablet at modest counts and lower with bulk, while 10 mg and 25 mg prices vary more due to supply and demand. Second is the pharmacy’s professional fee, the per-prescription charge that covers verification and dispensing. Third are optional shipping charges for mail-order fills, all reflected in the Drugs.com price guide.

Infusion billing adds layers. The medication itself is billed as J0640 in 50 mg units, then the facility charges infusion administration time codes, IV tubing and supplies, pharmacy compounding or handling fees, and sometimes a separate professional fee for the clinician who supervises therapy. Medicare’s ASP plus 6 percent creates a drug payment anchor, but the final patient share depends on plan design and whether the site of care is hospital outpatient or physician office. A community hospital may also publish a gross charge that looks high compared with the allowed amount. It is a list price, not the final negotiated rate, as summarized in the CMS ASP Table III.

Also check out our articles about the costs of adult autism assessment, a service dog, or speech therapy.

Tablets are simple. Infusions are complex. The path you choose changes the math.

Home delivery or specialty pharmacy can add shipping and handling. Some plans waive fees above a minimum order, others charge a flat $5 to $15 per shipment. Cold-chain is not usually required for tablets, so costs stay low compared with injectables that need controlled storage and delivery when sent directly to a clinic. Plan documents outline these charges, and they can matter over a long cycle of treatment, as plans like Horizon Blue describe.

Why prices move

Manufacturer pricing and the raw-material market set the floor for generic makers. With multiple approved manufacturers, competition has kept folinic acid relatively stable compared with branded oncology drugs, but intermittent shortages or demand spikes do move retail tags, a trend discussed in a PMC review.

Regulatory status matters. Wider clinical use supported by federal agencies, like the National Cancer Institute and recent FDA communications about cerebral folate deficiency, shape coverage policies and awareness, which can expand utilization and affect pharmacy acquisition costs. Policy shifts ripple into household budgets when a drug becomes a first-line option or gains new off-label momentum.

Payer rules drive patient expense. Formularies determine tier and copay, prior authorization slows some starts, and site-of-care programs steer patients to office-based infusions where negotiated rates may be lower than hospital outpatient departments. Regional fee schedule updates from large insurers also bend trend lines, with some plans announcing 2025 fee reductions for injectable medications in specialty networks, as reflected in Horizon Blue updates.

Supply chain turbulence changes price quotes. Periodic API shortages and surges in demand for methotrexate rescue can tighten inventory, then coupon prices rise until wholesalers refill. Cross-border pharmacy comparisons show why shopping by strength and quantity helps, since the largest bottle sizes often yield the best unit rate when safe and permitted, a pattern visible in the Drugs.com price data.

Alternatives and comparable options

Levoleucovorin, marketed generically and as Khapzory in recent years, is an alternative in many protocols. It is the L-isomer and is dose-adjusted versus racemic leucovorin, with some payers preferring one over the other based on contracts and literature. Public price pages reflect a higher per-unit retail price for levoleucovorin injections compared with standard leucovorin in like volumes, as shown on the Drugs.com comparison.

Combination therapy pricing can help. The pyrimethamine-leucovorin capsule offers convenience in certain infections. SingleCare shows about $148.70 for 30 with a discount card in early 2025, a number that lets patients compare two separate bottles against a single combo product for the same course of therapy. Pharmacies differ on stocking, so call ahead.

Care setting is an alternative in itself. Some regimens can be delivered in a physician office or infusion suite rather than a hospital outpatient department, which changes the facility fee. Medicare’s drug allowance is the same nationwide for J0640, yet the site fee and administration code pricing vary, which the CMS ASP Table III helps anchor.

Quick price table

The summary below captures common U.S. price anchors patients use to compare options.

Extras many people miss

• Pharmacy dispensing fee per fill $1–$15
• Mail-order shipping per package $5–$15
• Infusion add-ons like IV tubing and chair time $50–$300
• Coinsurance on allowed amounts varies by plan

Several insurers published 2025 specialty-pharmacy fee updates that adjusted injectable schedules, which can flow through to patient statements, as seen in Horizon Blue’s fee schedule update.

Worked example, tablets and infusion

Tablets. A caregiver fills 90 tablets of 10 mg for supportive care in Seattle. Using the Drugs.com per-unit examples for small to mid-size counts, a reasonable cash total is around $0.84–$0.90 per tablet, so $75–$81 before any coupon. With a GoodRx price available in the area, the register total falls to the teens or twenties for the same quantity. The savings difference is material when refilling every month.

Infusion. A clinic prepares 200 mg of leucovorin for rescue. Medicare’s allowance in Q3 2025 values J0640 at $3.95 per 50 mg, so the drug line is 4 units × $3.95 = $15.80. Add a typical hospital outpatient infusion code in the first hour, pharmacy handling, and supplies, and the gross charge may post in the hundreds, yet the allowed amount after contracts is far lower. Patient coinsurance is then calculated on the allowed total, a flow anchored by the CMS ASP Table III.

Safety and eligibility sources

Patients can confirm approved cancer uses on the National Cancer Institute drug page and review consumer guidance on MedlinePlus. These pages do not list prices, but they help set expectations for where leucovorin fits in a treatment plan and why dose and schedule can change costs.

Answers to common questions

Is oral leucovorin cheaper than injection?

Usually yes for the drug itself. Tablets can be under a dollar per low-dose unit at retail, while injections are billed by 50 mg units and add facility and administration fees in infusion settings, per the Drugs.com price guide.

Can I switch to levoleucovorin if leucovorin is back-ordered?

This is a clinical decision. Plans sometimes prefer one product over the other, and per-unit pricing for levoleucovorin is often higher in retail comparisons. Ask the prescriber and check coverage, and consult the Drugs.com comparison.

Where can I see a reliable benchmark for infusion pricing?

CMS publishes quarterly Average Sales Price tables that set Medicare allowances for J codes such as J0640. Those values are a good anchor when estimating a hospital outpatient bill, and they are posted in the CMS ASP Table III.

Are there programs to reduce my out-of-pocket cost?

Yes. Discount cards and state aid programs can lower retail totals, and plan case management can address site-of-care changes for infusions when appropriate. Platforms like GoodRx and SingleCare list current coupon offers.

Does the new FDA action change my price today?

Coverage policies take time to update. The announcement improves awareness and may expand eligibility over time, but pharmacy and payer pricing updates lag as contracts refresh, according to the FDA.

Updated: September 23, 2025

Sources used here include Drugs.com price guides, GoodRx coupon listings, SingleCare savings pages, CMS Medicare ASP fee schedules, National Cancer Institute drug information, and FDA communications. Dates and values reflect pages accessed through September 2025.