Immun Glob G · Hematology-Oncology
Gammagard Liquid (J1569) carries a median commercial contracted rate of 99.5 on the Medicare ASP=100 index — 3.1% below the 102.7 typical-acquisition benchmark and 4.6% below the 104.3 Medicare payment line. 58 insurers report contracted rates across 52 states (1,034 priced cells), covering $570M in modeled Part B spend. It ranks #17 of 25 on the CareCost Buy-and-Bill Risk List, with a risk score of 69.3 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 50 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 | 183.7 | +78.9% | 55 | 6 |
| BlueCross BlueShield of Wyoming | 180.6 | +75.9% | 44 | 7 |
| BlueCross BlueShield of Nebraska | 117.6 | +14.5% | 34 | 7 |
| Anthem Georgia | 115.2 | +12.2% | 64 | 16 |
| HMSA (BCBS Hawaii) | 114.8 | +11.8% | 69 | 4 |
| Premera Blue Cross | 114.3 | +11.3% | 102 | 9 |
| Regence Idaho | 109.8 | +6.9% | 45 | 6 |
| Regence BlueCross BlueShield | 109.5 | +6.6% | 58 | 14 |
| Regence Utah | 107.2 | +4.4% | 50 | 5 |
| Blue Shield of California | 106.3 | +3.5% | 118 | 4 |
| Blue Cross of Idaho | 105.5 | +2.7% | 67 | 6 |
| Regence Washington | 105.5 | +2.7% | 75 | 5 |
| BlueCross BlueShield of Arkansas | 104.1 | +1.4% | 48 | 21 |
| BCBS North Dakota | 104.1 | +1.4% | 139 | 3 |
| BlueCross BlueShield of Kansas | 103.7 | +1.0% | 60 | 5 |
| BlueCross BlueShield of Texas | 103.6 | +0.9% | 36 | 13 |
| Anthem Massachusetts | 103.3 | +0.6% | 64 | 25 |
| Blue Cross NC | 101.3 | −1.4% | 187 | 52 |
| Aetna | 100.7 | −1.9% | 736 | 51 |
| Harvard Pilgrim Health Care | 99.5 | −3.1% | 229 | 10 |
| Anthem Kentucky | 99.5 | −3.1% | 85 | 9 |
| Anthem Wisconsin | 99.5 | −3.1% | 140 | 5 |
| Anthem Missouri | 99.5 | −3.1% | 42 | 9 |
| Capital Blue Cross | 99.5 | −3.1% | 92 | 35 |
| BlueCross BlueShield of Louisiana | 98.3 | −4.3% | 54 | 7 |
| Anthem Virginia | 97.7 | −4.9% | 72 | 20 |
| Anthem Nevada | 95.9 | −6.6% | 194 | 4 |
| Anthem Connecticut | 95.9 | −6.6% | 66 | 5 |
| Anthem New York | 95.9 | −6.6% | 72 | 15 |
| BlueCross BlueShield of Rhode Island | 95.9 | −6.6% | 291 | 3 |
| Regence Oregon | 95.9 | −6.6% | 64 | 7 |
| Anthem Ohio | 95.9 | −6.6% | 83 | 12 |
| Anthem New Hampshire | 95.9 | −6.6% | 49 | 7 |
| CareFirst BlueCross BlueShield | 95.9 | −6.6% | 58 | 19 |
| BlueCross BlueShield of Massachusetts | 95.9 | −6.6% | 70 | 1 |
| UnitedHealthcare | 95.9 | −6.6% | 1,080 | 51 |
| Centene | 95.9 | −6.6% | 218 | 26 |
| Florida Blue | 95.9 | −6.6% | 32 | 5 |
| Anthem Indiana | 95.9 | −6.6% | 136 | 25 |
| BlueCross BlueShield of Alabama | 95.9 | −6.6% | 91 | 6 |
| Anthem Maine | 95.9 | −6.6% | 65 | 5 |
| Kaiser Permanente | 95.9 | −6.6% | 312 | 8 |
| Cigna | 95.9 | −6.6% | 636 | 52 |
| Horizon BCBS of New Jersey | 94.2 | −8.3% | 42 | 6 |
| Anthem California | 93.9 | −8.6% | 64 | 4 |
| BlueCross BlueShield of Michigan | 92.8 | −9.6% | 63 | 7 |
| BlueCross BlueShield of Minnesota | 91.9 | −10.5% | 73 | 6 |
| BlueCross BlueShield of Tennessee | 91.9 | −10.5% | 61 | 10 |
| Wellmark BCBS (Iowa/South Dakota) | 91.9 | −10.5% | 78 | 10 |
| BlueCross BlueShield of Arizona | 80.2 | −21.9% | 38 | 19 |
Medicare's payment limit for Gammagard Liquid moved +5.2% 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 | $359M | 9.8 |
| 2020 | $389M | 10.4 |
| 2021 | $505M | 12.3 |
| 2022 | $632M | 14.3 |
| 2023 | $740M | 16.5 |
| 2024 | $765M | — |
| 2025 | $570M | — |
| Highest-paying states | Index | Insurers |
|---|---|---|
| Alaska (AK) | 126.7 | 7 |
| Wyoming (WY) | 117.6 | 5 |
| Hawaii (HI) | 109.8 | 7 |
| Idaho (ID) | 107.9 | 12 |
| Utah (UT) | 107.2 | 12 |
| Lowest-paying states | Index | Insurers |
|---|---|---|
| Massachusetts (MA) | 95.9 | 18 |
| Delaware (DE) | 95.9 | 7 |
| Maryland (MD) | 95.9 | 13 |
| Nevada (NV) | 95.9 | 12 |
At the median contracted rate, this code models a −$3,069 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 1,034 priced contract cells across 58 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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