Medications
Acalabrutinib (Calquence)
A targeted cancer tablet (a BTK blocker) taken twice a day for mantle cell lymphoma and chronic lymphocytic leukemia (CLL).
How Medicare covers it
Part D (forms used at home). Part A during a covered inpatient stay. No Part B clinician-administered form in the CMS Part B spending file.
| Coverage details | |
|---|---|
| Part B status | No acalabrutinib row in the CMS Part B Spending by Drug HCPCS file (RY26, data through 2024) — no J-code basis; coverage path is Part D. |
| Medicare Advantage | Most Medicare Advantage plans that include drug coverage (MAPD plans) use the same formulary-and-tier system; the plan's own drug list decides coverage and copay — check the plan's formulary. |
| Medicare Supplement (Medigap) | Medicare Supplement (Medigap) plans sold today do not include prescription drug coverage; drug coverage comes from Part D or an MAPD plan. |
What it treats
Calquence treats adult patients with mantle cell lymphoma (MCL) in two settings: together with bendamustine and rituximab for previously untreated MCL in patients who cannot receive an autologous stem cell transplant, and on its own labeling for MCL patients who have received at least one prior therapy. It also treats adult patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL).
What it is for, in depth
The label's Indications section lists three adult uses, all cancers that start in B cells of the immune system. First, mantle cell lymphoma (MCL) that has not been treated before, where Calquence is used in combination with bendamustine and rituximab for patients who are ineligible for autologous hematopoietic stem cell transplantation (HSCT) — that is, patients who cannot receive a transplant of their own stem cells. Second, MCL in patients who have received at least one prior therapy, so the label places it after earlier treatment in that path. Third, chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) in adult patients. Calquence comes as one strength: a 100 mg film-coated tablet (orange, oval, marked 'ACA100'), supplied in a 60-count bottle with a child-resistant closure, taken as one tablet about every 12 hours.
How it works
Acalabrutinib is a kinase inhibitor. It is a small molecule that blocks Bruton's tyrosine kinase (BTK) by forming a permanent (covalent) bond in the enzyme's active site — its active breakdown product, ACP-5862, does the same. BTK carries signals from the B-cell receptor that B cells need to multiply, travel, and survive, so blocking it slows malignant B-cell growth.
How it is taken
The recommended dose is 100 mg by mouth about every 12 hours, swallowed whole with water, with or without food. Do not chew, crush, dissolve, or cut the tablets. If side effects become a problem, the label directs managing them with treatment interruption, a dose reduction, or stopping the drug.
Common side effects
The FDA label extract for Calquence does not list common side effects with how-often numbers. Its adverse-reactions section points readers to the serious problems detailed in its Warnings section — infections, bleeding, low blood counts, second cancers, heart rhythm problems, and liver injury — which are covered under serious warnings on this page.
Serious warnings
The label warns about serious and opportunistic infections (watch for signs and symptoms of infection and treat promptly); bleeding (monitor for bleeding and manage it appropriately); cytopenias — low blood counts (complete blood counts should be monitored regularly); second primary malignancies — other cancers, including skin cancers and other solid tumors, have occurred, and patients are advised to use sun protection; heart rhythm problems (cardiac arrhythmias — monitor for symptoms and manage); and liver injury, including drug-induced liver injury (liver function should be monitored throughout treatment).
Who should be careful
Patients with severe liver (hepatic) impairment should avoid Calquence. The label states acalabrutinib may cause fetal harm and dystocia (difficult labor), so pregnancy needs the label's precautions, and it advises not to breastfeed. People with infections, bleeding problems, heart rhythm problems, or liver problems need the monitoring described in the Warnings section.
Major interactions
The label's interaction rules center on CYP3A medicines. Strong CYP3A inhibitors: avoid using them together with Calquence. Moderate CYP3A inhibitors: reduce the Calquence dosage. Strong CYP3A inducers: avoid using them together with Calquence, and if combined use cannot be avoided, increase the Calquence dosage. This is general information only — your care team checks your own medicine list.
Cost and saving notes
Calquence is a brand-name drug, and there is no generic version of acalabrutinib — do not let anyone sell you a claimed generic. Because it is brand-only, your plan's tier and cost share matter a lot, so check your own plan's drug list. Under Part D, your total drug costs are capped each year — once your out-of-pocket spending reaches the annual Part D cap, you pay nothing for covered drugs for the rest of that year. If you have limited income, Extra Help (the Part D Low-Income Subsidy) can lower premiums, deductibles, and copays if you qualify. You can also ask your plan for a tier exception — a request to cover your drug at a lower cost-sharing tier when your doctor shows a medical reason — and the plan's answer can be appealed.
Why it is in its tier
Acalabrutinib (Calquence) sits on Tier 5 in 96.91% of the plans that list it (5325 of 5495 listing plans). Tier 5 is the specialty tier — instead of a flat copay, patients usually pay a percentage of the drug's cost (coinsurance), which is why specialty drugs feel expensive even with coverage. The data-visible drivers: It is a brand-only product with no generic version in the formulary data, and the CMS dashboard puts its average Part D spending at about $113,043 per beneficiary for 2024 — among the highest-cost drugs in the program, which matches where plans place it. It is listed by 100.0% of Part D plans. The tier shown is the most common one; individual plans vary.
Sources
- CALQUENCE (ACALABRUTINIB) TABLET, FILM COATED [ASTRAZENECA PHARMACEUTICALS LP] — DailyMed
- MedlinePlus — National Library of Medicine
- MedlinePlus — Acalabrutinib: MedlinePlus Drug Information
What official patient guides say
MedlinePlus says acalabrutinib is usually taken with or without food every 12 hours (twice a day), at about the same times every day, for as long as your doctor recommends, and the tablets are swallowed whole with a glass of water — do not chew, crush, dissolve, or cut them. If you miss a dose and more than 3 hours have passed since it was due, skip it and take the next dose at the regular time; do not take a double dose. Store it in its container at room temperature, away from excess heat and moisture (not in the bathroom), and plan to limit sun exposure and wear protective clothing, sunglasses, and sunscreen.
Source: MedlinePlus — Acalabrutinib: MedlinePlus Drug Information
Part D formulary coverage
| Formulary summary | |
|---|---|
| Most common tier | 5 |
| Plans listing this drug | 5495 |
| Total Part D plans | 5495 |
| Share of plans listing it | 100 |
| Formularies listing it | 286 |
| Tier | Plans |
|---|---|
| Tier 1 | 123 plans |
| Tier 2 | 1 plans |
| Tier 4 | 46 plans |
| Tier 5 | 5325 plans |
Source: CMS Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files — Monthly file 2026-10-15 (plan year 2027), file 2027_20261008.zip (data.cms.gov dataset ed1496ea-23e7-41f1-9292-172fa842ccfb): basic drugs formulary file + plan information file, both dated 20261031 inside the zip; downloaded and aggregated 2026-10-30. Medication RxCUI sets resolved through the NLM RxNav (RxNorm) API.
What you pay
| With Medicare Part D | |
|---|---|
| Most common tier | Tier 5 |
| Typical copay | $0 — half of plans charge between $0 and $0 |
| Typical coinsurance | 26.0% of the price |
| Based on | 5237 plans that cover this drug · 2027 plan year |
A tier is not a price; what you pay depends on your plan, pharmacy, and benefit stage; Extra Help or Medicaid can lower it further.
Sources: CMS Plan Benefit Package + formulary data; CMS NADAC · Checked 2026-11-07
Similar medications
Other medications in the same FDA pharmacologic class (Kinase Inhibitor):
Read next
Part D spending averages (2024)
| Brand name | Generic name | Total claims 2024 | Total spending 2024 | Total beneficiaries 2024 | Rank by beneficiaries 2024 |
|---|---|---|---|---|---|
| Calquence | Acalabrutinib Maleate | 122356 | 1.70197e+09 | 15056 | 875 |
Source: CMS Medicare Part D Spending by Drug (Drug Spending Dashboard), release RY26 P04 V10, data through 2024 (DSD_PTD_RY26_P04_V10_DY24_BGM.csv), downloaded 2026-10-30
Companies covering this drug
5,495 plans from 509 companies list this drug on a formulary for 2027. Search by company or plan name, or filter by tier. Cost sharing is the plan's published amount for this drug's tier in the initial coverage stage (1-month retail supply), where the plan publishes it; a blank means the plan does not publish it.
| Company | Plan | Tier | Copay | Coinsurance |
|---|
A tier is not a price; what you pay depends on your plan, pharmacy, and benefit stage; Extra Help or Medicaid can lower it further.
Coverage and costs change. Drug lists (formularies), tiers, and copays can change during the year and differ by plan. Always check with your insurance company or plan directly to confirm what is covered and what you will pay.
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