Immun Glob G · Neurology
Privigen (J1459) carries a median commercial contracted rate of 99.1 on the Medicare ASP=100 index — 3.5% below the 102.7 typical-acquisition benchmark and 5.0% below the 104.3 Medicare payment line. 57 insurers report contracted rates across 52 states (1,016 priced cells), covering $360M in modeled Part B spend. It ranks #25 of 25 on the CareCost Buy-and-Bill Risk List, with a risk score of 67.1 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 48 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 Wyoming | 196.8 | +91.6% | 44 | 7 |
| BlueCross BlueShield of South Carolina | 186.1 | +81.2% | 55 | 6 |
| BlueCross BlueShield of Alabama | 125.0 | +21.7% | 91 | 6 |
| HMSA (BCBS Hawaii) | 119.1 | +16.0% | 69 | 4 |
| Premera Blue Cross | 116.1 | +13.0% | 102 | 9 |
| Regence Idaho | 112.4 | +9.4% | 45 | 6 |
| BlueCross BlueShield of Nebraska | 111.1 | +8.2% | 34 | 7 |
| Regence Utah | 109.7 | +6.8% | 50 | 5 |
| BlueCross BlueShield of Texas | 108.7 | +5.8% | 45 | 22 |
| Blue Shield of California | 108.0 | +5.2% | 118 | 4 |
| Blue Cross of Idaho | 108.0 | +5.2% | 67 | 6 |
| Anthem Georgia | 107.2 | +4.4% | 64 | 16 |
| BlueCross BlueShield of Arkansas | 106.5 | +3.7% | 48 | 21 |
| BCBS North Dakota | 106.5 | +3.7% | 139 | 3 |
| BlueCross BlueShield of Kansas | 106.4 | +3.6% | 60 | 5 |
| BlueCross BlueShield of Louisiana | 106.0 | +3.2% | 54 | 7 |
| Blue Cross NC | 104.7 | +1.9% | 187 | 52 |
| Aetna | 103.1 | +0.4% | 758 | 51 |
| Capital Blue Cross | 101.9 | −0.8% | 92 | 35 |
| Anthem Massachusetts | 100.4 | −2.2% | 64 | 25 |
| BlueCross BlueShield of Minnesota | 99.1 | −3.5% | 54 | 6 |
| BlueCross BlueShield of Tennessee | 99.1 | −3.5% | 61 | 10 |
| Wellmark BCBS (Iowa/South Dakota) | 99.1 | −3.5% | 78 | 10 |
| Anthem California | 98.6 | −4.0% | 64 | 4 |
| Florida Blue | 98.2 | −4.4% | 32 | 5 |
| Regence Washington | 98.2 | −4.4% | 75 | 5 |
| UnitedHealthcare | 98.2 | −4.4% | 1,080 | 51 |
| CareFirst BlueCross BlueShield | 98.2 | −4.4% | 58 | 19 |
| Anthem Connecticut | 98.2 | −4.4% | 66 | 5 |
| Anthem Indiana | 98.2 | −4.4% | 136 | 25 |
| Anthem Ohio | 98.2 | −4.4% | 78 | 13 |
| Anthem New York | 98.2 | −4.4% | 72 | 15 |
| Anthem Nevada | 98.2 | −4.4% | 194 | 4 |
| Regence Oregon | 98.2 | −4.4% | 64 | 7 |
| Anthem New Hampshire | 98.2 | −4.4% | 49 | 7 |
| BlueCross BlueShield of Rhode Island | 98.2 | −4.4% | 291 | 3 |
| Anthem Maine | 98.2 | −4.4% | 65 | 5 |
| Cigna | 98.2 | −4.4% | 649 | 51 |
| Kaiser Permanente | 98.2 | −4.4% | 312 | 8 |
| Anthem Virginia | 97.4 | −5.2% | 72 | 20 |
| Anthem Missouri | 97.4 | −5.2% | 48 | 10 |
| Harvard Pilgrim Health Care | 96.7 | −5.8% | 229 | 10 |
| Anthem Kentucky | 96.7 | −5.8% | 92 | 8 |
| Regence BlueCross BlueShield | 96.7 | −5.8% | 58 | 14 |
| Anthem Wisconsin | 96.7 | −5.8% | 92 | 6 |
| Horizon BCBS of New Jersey | 95.4 | −7.1% | 41 | 6 |
| BlueCross BlueShield of Michigan | 95.0 | −7.5% | 63 | 7 |
| BlueCross BlueShield of Arizona | 82.5 | −19.7% | 38 | 19 |
Medicare's payment limit for Privigen moved +10.1% 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) |
|---|---|---|
| 2019 | $330M | 9.5 |
| 2020 | $334M | 9.4 |
| 2021 | $312M | 8.3 |
| 2022 | $339M | 7.6 |
| 2023 | $377M | 8.1 |
| 2024 | $440M | — |
| 2025 | $360M | — |
| Highest-paying states | Index | Insurers |
|---|---|---|
| Alaska (AK) | 126.0 | 7 |
| Wyoming (WY) | 118.5 | 5 |
| Hawaii (HI) | 115.5 | 7 |
| Nebraska (NE) | 110.3 | 8 |
| Idaho (ID) | 108.7 | 12 |
| Lowest-paying states | Index | Insurers |
|---|---|---|
| Georgia (GA) | 98.2 | 23 |
| New Jersey (NJ) | 98.2 | 13 |
| Kentucky (KY) | 98.2 | 12 |
| Tennessee (TN) | 98.2 | 18 |
| Rhode Island (RI) | 98.2 | 8 |
At the median contracted rate, this code models a −$3,538 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 1,016 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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