Ocrelizumab · Neurology
Ocrevus (J2350) carries a median commercial contracted rate of 97.8 on the Medicare ASP=100 index — 4.8% below the 102.7 typical-acquisition benchmark and 6.2% below the 104.3 Medicare payment line. 58 insurers report contracted rates across 52 states (1,047 priced cells), covering $475M in modeled Part B spend. It ranks #8 of 25 on the CareCost Buy-and-Bill Risk List, with a risk score of 75.4 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 | 129.0 | +25.6% | 55 | 6 |
| BlueCross BlueShield of Wyoming | 121.1 | +17.9% | 44 | 7 |
| Premera Blue Cross | 115.5 | +12.5% | 102 | 9 |
| HMSA (BCBS Hawaii) | 114.4 | +11.4% | 69 | 4 |
| Regence Idaho | 111.4 | +8.5% | 45 | 6 |
| BlueCross BlueShield of Nebraska | 110.1 | +7.2% | 34 | 7 |
| Regence Utah | 108.8 | +5.9% | 50 | 5 |
| BlueCross BlueShield of Texas | 107.3 | +4.5% | 47 | 23 |
| Blue Cross of Idaho | 107.0 | +4.2% | 58 | 6 |
| Blue Shield of California | 105.9 | +3.1% | 118 | 4 |
| BlueCross BlueShield of Arkansas | 105.6 | +2.8% | 48 | 21 |
| BCBS North Dakota | 105.6 | +2.8% | 139 | 3 |
| BlueCross BlueShield of Louisiana | 104.3 | +1.6% | 54 | 7 |
| Blue Cross NC | 102.8 | +0.1% | 187 | 52 |
| Aetna | 102.2 | −0.5% | 714 | 51 |
| Anthem Massachusetts | 101.4 | −1.3% | 64 | 25 |
| BlueCross BlueShield of Kansas | 101.2 | −1.5% | 60 | 5 |
| Capital Blue Cross | 101.0 | −1.7% | 92 | 35 |
| Anthem Wisconsin | 97.8 | −4.8% | 139 | 6 |
| Anthem Kentucky | 97.8 | −4.8% | 85 | 9 |
| Harvard Pilgrim Health Care | 97.8 | −4.8% | 229 | 10 |
| BlueCross BlueShield of Massachusetts | 97.8 | −4.8% | 54 | 4 |
| Regence BlueCross BlueShield | 97.8 | −4.8% | 58 | 14 |
| Anthem Missouri | 97.8 | −4.8% | 47 | 10 |
| Anthem Virginia | 97.5 | −5.1% | 72 | 20 |
| Centene | 97.4 | −5.2% | 106 | 22 |
| BlueCross BlueShield of Tennessee | 97.4 | −5.2% | 61 | 10 |
| Anthem California | 97.4 | −5.2% | 64 | 4 |
| Wellmark BCBS (Iowa/South Dakota) | 97.4 | −5.2% | 78 | 10 |
| BlueCross BlueShield of Minnesota | 97.4 | −5.2% | 68 | 7 |
| Anthem Indiana | 97.3 | −5.3% | 136 | 25 |
| Regence Oregon | 97.3 | −5.3% | 64 | 7 |
| Anthem Nevada | 97.3 | −5.3% | 194 | 4 |
| Anthem Ohio | 97.3 | −5.3% | 78 | 13 |
| Anthem Connecticut | 97.3 | −5.3% | 66 | 5 |
| Anthem New York | 97.3 | −5.3% | 72 | 15 |
| UnitedHealthcare | 97.3 | −5.3% | 1,050 | 52 |
| Anthem New Hampshire | 97.3 | −5.3% | 49 | 7 |
| BlueCross BlueShield of Rhode Island | 97.3 | −5.3% | 291 | 3 |
| BlueCross BlueShield of Alabama | 97.3 | −5.3% | 91 | 6 |
| Anthem Maine | 97.3 | −5.3% | 65 | 5 |
| Kaiser Permanente | 97.3 | −5.3% | 312 | 8 |
| Cigna | 97.3 | −5.3% | 649 | 51 |
| Florida Blue | 97.3 | −5.3% | 32 | 5 |
| CareFirst BlueCross BlueShield | 97.3 | −5.3% | 58 | 19 |
| Anthem Georgia | 97.3 | −5.3% | 64 | 16 |
| Regence Washington | 97.3 | −5.3% | 75 | 5 |
| BlueCross BlueShield of Michigan | 94.2 | −8.3% | 63 | 7 |
| Horizon BCBS of New Jersey | 92.3 | −10.1% | 42 | 6 |
| BlueCross BlueShield of Arizona | 81.7 | −20.4% | 38 | 19 |
Medicare's payment limit for Ocrevus moved +1.2% 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 | $623M | 11.2 |
| 2020 | $619M | 11.2 |
| 2021 | $608M | 11.9 |
| 2022 | $694M | 12.0 |
| 2023 | $697M | 12.0 |
| 2024 | $669M | — |
| 2025 | $475M | — |
| Highest-paying states | Index | Insurers |
|---|---|---|
| Alaska (AK) | 119.1 | 7 |
| Hawaii (HI) | 111.3 | 7 |
| Idaho (ID) | 108.8 | 12 |
| Nebraska (NE) | 108.7 | 8 |
| Utah (UT) | 107.5 | 12 |
| Lowest-paying states | Index | Insurers |
|---|---|---|
| Alabama (AL) | 97.4 | 13 |
| Maryland (MD) | 97.4 | 14 |
| Arizona (AZ) | 97.3 | 21 |
| Delaware (DE) | 97.3 | 7 |
| Code | Brand | Index | Insurers | Part B spend |
|---|---|---|---|---|
| J2351 | Ocrevus Zunovo | 97.9 | 54 | $7M |
| J2350 | Ocrevus | 97.8 | 58 | $475M |
Within this family, Ocrevus Zunovo (J2351) contracts 0.1 points higher on the ASP=100 index than Ocrevus (J2350) — 97.9 vs. 97.8.
| Prior authorization required | 92% of policies |
| Site-of-care steering | 24% of policies |
| Pharmacy (white-bag) channel multiple | 1.170× |
| Drug class | CD20-directed cytolytic antibody |
At the median contracted rate, this code models a −$4,817 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 1,047 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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