Hematology-Oncology
Lanreotide Acetate (J1930) carries a median commercial contracted rate of 95.4 on the Medicare ASP=100 index — 7.1% below the 102.7 typical-acquisition benchmark and 8.5% below the 104.3 Medicare payment line. 56 insurers report contracted rates across 52 states (1,019 priced cells), covering $237M in modeled Part B spend. It ranks #4 of 25 on the CareCost Buy-and-Bill Risk List, with a risk score of 79.8 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 |
|---|---|---|---|---|
| HMSA (BCBS Hawaii) | 138.1 | +34.5% | 69 | 4 |
| Blue Cross NC | 131.5 | +28.0% | 187 | 52 |
| Horizon BCBS of New Jersey | 120.2 | +17.0% | 42 | 6 |
| BlueCross BlueShield of Texas | 119.5 | +16.4% | 38 | 17 |
| BlueCross BlueShield of Nebraska | 115.9 | +12.9% | 34 | 7 |
| Premera Blue Cross | 115.5 | +12.5% | 102 | 9 |
| BlueCross BlueShield of Wyoming | 111.8 | +8.9% | 44 | 7 |
| Regence Idaho | 108.2 | +5.4% | 45 | 6 |
| Regence Utah | 105.7 | +2.9% | 50 | 5 |
| Blue Shield of California | 104.1 | +1.4% | 118 | 4 |
| Kaiser Permanente | 104.0 | +1.3% | 312 | 8 |
| Blue Cross of Idaho | 104.0 | +1.3% | 58 | 6 |
| BCBS North Dakota | 102.6 | −0.1% | 139 | 3 |
| BlueCross BlueShield of Arkansas | 102.6 | −0.1% | 48 | 21 |
| Aetna | 99.3 | −3.3% | 715 | 51 |
| Anthem Massachusetts | 99.0 | −3.6% | 64 | 25 |
| Capital Blue Cross | 98.1 | −4.5% | 92 | 35 |
| BlueCross BlueShield of Kansas | 97.8 | −4.8% | 60 | 5 |
| BlueCross BlueShield of Louisiana | 97.3 | −5.3% | 54 | 7 |
| BlueCross BlueShield of South Carolina | 95.5 | −7.0% | 55 | 6 |
| Anthem Wisconsin | 95.4 | −7.1% | 93 | 6 |
| Anthem Missouri | 95.4 | −7.1% | 44 | 11 |
| Regence BlueCross BlueShield | 95.4 | −7.1% | 56 | 14 |
| Anthem Kentucky | 95.4 | −7.1% | 92 | 8 |
| Harvard Pilgrim Health Care | 95.4 | −7.1% | 229 | 10 |
| Anthem Virginia | 95.0 | −7.5% | 72 | 20 |
| Anthem Maine | 94.6 | −7.9% | 65 | 5 |
| Anthem Indiana | 94.6 | −7.9% | 136 | 25 |
| BlueCross BlueShield of Rhode Island | 94.6 | −7.9% | 291 | 3 |
| Anthem Georgia | 94.6 | −7.9% | 64 | 16 |
| Anthem New Hampshire | 94.6 | −7.9% | 42 | 7 |
| Anthem Ohio | 94.6 | −7.9% | 78 | 13 |
| Cigna | 94.6 | −7.9% | 649 | 51 |
| UnitedHealthcare | 94.6 | −7.9% | 1,080 | 51 |
| BlueCross BlueShield of Alabama | 94.6 | −7.9% | 91 | 6 |
| Florida Blue | 94.6 | −7.9% | 32 | 5 |
| Anthem New York | 94.6 | −7.9% | 72 | 15 |
| Anthem Nevada | 94.6 | −7.9% | 194 | 4 |
| Anthem Connecticut | 94.6 | −7.9% | 66 | 5 |
| Centene | 94.6 | −7.9% | 334 | 16 |
| Regence Washington | 94.6 | −7.9% | 75 | 5 |
| Regence Oregon | 94.6 | −7.9% | 58 | 7 |
| CareFirst BlueCross BlueShield | 94.5 | −8.0% | 58 | 19 |
| Anthem California | 92.8 | −9.6% | 64 | 4 |
| Wellmark BCBS (Iowa/South Dakota) | 91.0 | −11.4% | 78 | 10 |
| BlueCross BlueShield of Tennessee | 91.0 | −11.4% | 61 | 10 |
| BlueCross BlueShield of Minnesota | 91.0 | −11.4% | 68 | 7 |
| BlueCross BlueShield of Arizona | 79.4 | −22.7% | 38 | 19 |
Medicare's payment limit for Lanreotide Acetate moved -46.0% between Q1 2022 and Q2 2026. Because contracted rates are set as a multiple of ASP, a falling denominator drags every contracted rate down with it, typically with a two-quarter lag as CMS updates the published benchmark.
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 | $263M | 4.7 |
| 2020 | $340M | 5.5 |
| 2021 | $399M | 6.4 |
| 2022 | $450M | 7.0 |
| 2023 | $368M | 6.7 |
| 2024 | $354M | — |
| 2025 | $237M | — |
| Highest-paying states | Index | Insurers |
|---|---|---|
| Hawaii (HI) | 138.1 | 7 |
| Alaska (AK) | 131.5 | 7 |
| Nebraska (NE) | 109.4 | 9 |
| Idaho (ID) | 108.8 | 12 |
| Oregon (OR) | 106.4 | 14 |
| Lowest-paying states | Index | Insurers |
|---|---|---|
| Maryland (MD) | 94.6 | 13 |
| Alabama (AL) | 94.6 | 13 |
| Iowa (IA) | 94.6 | 10 |
| Florida (FL) | 94.6 | 33 |
| Delaware (DE) | 94.6 | 7 |
| Code | Brand | Index | Insurers | Part B spend |
|---|---|---|---|---|
| J1932 | Lanreotide Acetate | 188.0 | 56 | $21M |
| J1930 | Lanreotide Acetate | 95.4 | 56 | $237M |
Within this family, Lanreotide Acetate (J1932) contracts 92.6 points higher on the ASP=100 index than Lanreotide Acetate (J1930) — 188.0 vs. 95.4.
At the median contracted rate, this code models a −$7,072 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 1,019 priced contract cells across 56 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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