Luspatercept-aamt · Hematology-Oncology
Reblozyl (J0896) carries a median commercial contracted rate of 98.3 on the Medicare ASP=100 index — 4.3% below the 102.7 typical-acquisition benchmark and 5.8% below the 104.3 Medicare payment line. 57 insurers report contracted rates across 52 states (976 priced cells), covering $727M in modeled Part B spend. It ranks #18 of 25 on the CareCost Buy-and-Bill Risk List, with a risk score of 68.9 out of 100.
Shaded band: 10th–90th percentile across insurers. Darker band: 25th–75th percentile. Solid tick: median. Dashed lines: 100 (Medicare ASP), 102.7 (typical acquisition cost), 104.3 (Medicare payment after sequestration).
All 46 insurers with published rates for this code, ranked highest to lowest. Index is a multiple of Medicare ASP (ASP=100).
| Insurer | Index | vs. acquisition | Practices | States |
|---|---|---|---|---|
| BlueCross BlueShield of South Carolina | 115.7 | +12.7% | 55 | 6 |
| Regence Idaho | 112.5 | +9.5% | 45 | 6 |
| BlueCross BlueShield of Nebraska | 111.3 | +8.4% | 34 | 7 |
| Regence Utah | 109.9 | +7.0% | 50 | 5 |
| BCBS North Dakota | 106.6 | +3.8% | 139 | 3 |
| BlueCross BlueShield of Arkansas | 106.6 | +3.8% | 48 | 21 |
| Blue Cross NC | 103.9 | +1.2% | 164 | 48 |
| BlueCross BlueShield of Louisiana | 103.2 | +0.5% | 54 | 7 |
| Capital Blue Cross | 102.0 | −0.7% | 92 | 35 |
| Premera Blue Cross | 101.9 | −0.8% | 102 | 9 |
| Anthem Massachusetts | 101.9 | −0.8% | 64 | 25 |
| BlueCross BlueShield of Kansas | 101.6 | −1.1% | 60 | 5 |
| Aetna | 101.1 | −1.6% | 704 | 51 |
| Blue Shield of California | 100.2 | −2.4% | 112 | 4 |
| BlueCross BlueShield of Rhode Island | 98.3 | −4.3% | 291 | 3 |
| Florida Blue | 98.3 | −4.3% | 32 | 5 |
| Anthem New Hampshire | 98.3 | −4.3% | 42 | 7 |
| Anthem Ohio | 98.3 | −4.3% | 78 | 13 |
| Anthem Georgia | 98.3 | −4.3% | 64 | 16 |
| Regence Washington | 98.3 | −4.3% | 75 | 5 |
| Anthem Virginia | 98.3 | −4.3% | 72 | 20 |
| Anthem Connecticut | 98.3 | −4.3% | 66 | 5 |
| Anthem Maine | 98.3 | −4.3% | 65 | 5 |
| BlueCross BlueShield of Alabama | 98.3 | −4.3% | 91 | 6 |
| Cigna | 98.3 | −4.3% | 721 | 51 |
| Kaiser Permanente | 98.3 | −4.3% | 312 | 8 |
| UnitedHealthcare | 98.3 | −4.3% | 1,080 | 51 |
| Anthem Indiana | 98.3 | −4.3% | 136 | 25 |
| Anthem New York | 98.3 | −4.3% | 72 | 15 |
| Regence Oregon | 98.3 | −4.3% | 64 | 7 |
| Anthem Nevada | 98.3 | −4.3% | 194 | 4 |
| CareFirst BlueCross BlueShield | 98.3 | −4.3% | 59 | 18 |
| Anthem Wisconsin | 98.2 | −4.4% | 100 | 7 |
| Regence BlueCross BlueShield | 98.2 | −4.4% | 58 | 14 |
| Harvard Pilgrim Health Care | 98.2 | −4.4% | 229 | 10 |
| Anthem Kentucky | 98.2 | −4.4% | 92 | 8 |
| Anthem Missouri | 98.2 | −4.4% | 42 | 9 |
| Anthem California | 97.4 | −5.2% | 64 | 4 |
| BlueCross BlueShield of Minnesota | 96.5 | −6.0% | 57 | 7 |
| Wellmark BCBS (Iowa/South Dakota) | 96.5 | −6.0% | 78 | 10 |
| BlueCross BlueShield of Tennessee | 96.5 | −6.0% | 61 | 10 |
| Blue Cross of Idaho | 96.4 | −6.1% | 67 | 6 |
| HMSA (BCBS Hawaii) | 93.6 | −8.9% | 84 | 4 |
| BlueCross BlueShield of Texas | 93.5 | −9.0% | 42 | 7 |
| Horizon BCBS of New Jersey | 92.7 | −9.7% | 42 | 6 |
| BlueCross BlueShield of Arizona | 82.5 | −19.7% | 38 | 19 |
Medicare's payment limit for Reblozyl moved +14.3% between Q1 2022 and Q2 2026. Because contracted rates are set as a multiple of ASP, a rising denominator lifts every contracted rate tied to it.
Solid dots: finalized CMS ASP quarters. Hollow dots: preliminary. Values are the Medicare payment limit (ASP + 6%, pre-sequestration) per billing unit.
| Year | Part B spend | Dosage units (M) |
|---|---|---|
| 2020 | $108M | 2.8 |
| 2021 | $266M | 7.3 |
| 2022 | $333M | 9.0 |
| 2023 | $451M | 11.9 |
| 2024 | $756M | — |
| 2025 | $727M | — |
| Highest-paying states | Index | Insurers |
|---|---|---|
| Nebraska (NE) | 107.6 | 8 |
| Alaska (AK) | 107.5 | 7 |
| Arkansas (AR) | 106.4 | 8 |
| Kansas (KS) | 105.9 | 10 |
| Montana (MT) | 105.7 | 5 |
| Lowest-paying states | Index | Insurers |
|---|---|---|
| Wyoming (WY) | 98.3 | 5 |
| New York (NY) | 98.3 | 22 |
| Minnesota (MN) | 98.3 | 13 |
| California (CA) | 98.3 | 41 |
| Indiana (IN) | 98.3 | 13 |
At the median contracted rate, this code models a −$4,294 shortfall per $100,000 of acquisition-benchmark drug cost purchased — illustrative modeled margin exposure, not a claim about any single practice's actual reimbursement.
Based on 976 priced contract cells across 57 insurers and 52 states. These are insurers' contracted rates from published machine-readable files — not amounts actually paid on a claim, and not a guarantee of coverage or reimbursement. CareCost Estimate Infusion Reimbursement Index, Issue 01 (Q2 2026), v2.0. CC-BY 4.0. A drug-specific acquisition estimate exists in our warehouse but derives from ASP itself, so we do not print it — the flat 102.7 ODACS benchmark is the honest comparator here.
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