Octreotide Acetate,mi-spheres · Hematology-Oncology
Octreotide Acetate Er (J2353) carries a median commercial contracted rate of 96.6 on the Medicare ASP=100 index — 5.9% below the 102.7 typical-acquisition benchmark and 7.4% below the 104.3 Medicare payment line. 58 insurers report contracted rates across 52 states (1,017 priced cells), covering $343M in modeled Part B spend. It ranks #2 of 25 on the CareCost Buy-and-Bill Risk List, with a risk score of 82.2 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), 146.4 (NADAC-measured acquisition, see below).
All 49 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 Nebraska | 117.4 | +14.3% | 34 | 7 |
| BlueCross BlueShield of South Carolina | 114.8 | +11.8% | 55 | 6 |
| BlueCross BlueShield of Texas | 111.3 | +8.4% | 42 | 10 |
| HMSA (BCBS Hawaii) | 111.0 | +8.1% | 69 | 4 |
| Regence Idaho | 109.6 | +6.7% | 45 | 6 |
| Premera Blue Cross | 107.7 | +4.9% | 103 | 9 |
| Regence Utah | 107.0 | +4.2% | 50 | 5 |
| Blue Cross of Idaho | 105.3 | +2.5% | 58 | 6 |
| BlueCross BlueShield of Louisiana | 104.7 | +1.9% | 54 | 7 |
| BlueCross BlueShield of Arkansas | 103.8 | +1.1% | 48 | 21 |
| BCBS North Dakota | 103.8 | +1.1% | 139 | 3 |
| Aetna | 100.5 | −2.1% | 715 | 51 |
| Capital Blue Cross | 99.3 | −3.3% | 92 | 35 |
| BlueCross BlueShield of Kansas | 99.0 | −3.6% | 60 | 5 |
| Blue Cross NC | 98.4 | −4.2% | 187 | 52 |
| Horizon BCBS of New Jersey | 98.3 | −4.3% | 42 | 6 |
| BlueCross BlueShield of Wyoming | 97.8 | −4.8% | 44 | 7 |
| Centene | 97.8 | −4.8% | 142 | 18 |
| Wellmark BCBS (Iowa/South Dakota) | 97.8 | −4.8% | 78 | 10 |
| BlueCross BlueShield of Tennessee | 97.8 | −4.8% | 61 | 10 |
| BlueCross BlueShield of Minnesota | 97.8 | −4.8% | 68 | 7 |
| Blue Shield of California | 97.5 | −5.1% | 61 | 4 |
| Anthem California | 96.8 | −5.7% | 64 | 4 |
| Anthem Connecticut | 95.7 | −6.8% | 66 | 5 |
| Anthem Ohio | 95.7 | −6.8% | 78 | 13 |
| BlueCross BlueShield of Alabama | 95.7 | −6.8% | 91 | 6 |
| Anthem Maine | 95.7 | −6.8% | 65 | 5 |
| Florida Blue | 95.7 | −6.8% | 32 | 5 |
| Anthem Georgia | 95.7 | −6.8% | 64 | 16 |
| Anthem New York | 95.7 | −6.8% | 72 | 15 |
| BlueCross BlueShield of Rhode Island | 95.7 | −6.8% | 291 | 3 |
| Anthem Nevada | 95.7 | −6.8% | 194 | 4 |
| Anthem Indiana | 95.7 | −6.8% | 136 | 25 |
| CareFirst BlueCross BlueShield | 95.7 | −6.8% | 58 | 19 |
| Anthem New Hampshire | 95.7 | −6.8% | 42 | 7 |
| Regence Oregon | 95.7 | −6.8% | 58 | 7 |
| Regence Washington | 95.7 | −6.8% | 75 | 5 |
| UnitedHealthcare | 95.7 | −6.8% | 1,080 | 51 |
| Cigna | 95.7 | −6.8% | 636 | 52 |
| Kaiser Permanente | 95.7 | −6.8% | 312 | 8 |
| Anthem Massachusetts | 93.9 | −8.6% | 64 | 25 |
| Anthem Virginia | 93.1 | −9.3% | 72 | 20 |
| Anthem Wisconsin | 90.5 | −11.9% | 154 | 5 |
| Anthem Kentucky | 90.5 | −11.9% | 92 | 8 |
| Anthem Missouri | 90.5 | −11.9% | 37 | 10 |
| Regence BlueCross BlueShield | 90.5 | −11.9% | 56 | 14 |
| Harvard Pilgrim Health Care | 90.5 | −11.9% | 229 | 10 |
| BlueCross BlueShield of Arizona | 80.4 | −21.7% | 38 | 19 |
| BlueCross BlueShield of Michigan | 76.0 | −26.0% | 63 | 7 |
Medicare's payment limit for Octreotide Acetate Er moved -8.8% 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 | $432M | 2.4 |
| 2020 | $445M | 2.4 |
| 2021 | $433M | 2.4 |
| 2022 | $458M | 2.3 |
| 2023 | $447M | 2.2 |
| 2024 | $451M | — |
| 2025 | $343M | — |
NADAC-measured acquisition cost for Octreotide Acetate Er runs $260.07/unit as of 2026-03-18 — an acquisition index of 146.4 (ASP = 100).
At the median contracted index of 96.6, that implies a modeled gross margin of -49.8 points per ASP-unit — roughly −$97.77/unit at the latest ASP of $196.32.
Modeled from NADAC acquisition, medium confidence — your invoice price governs.
| Highest-paying states | Index | Insurers |
|---|---|---|
| Hawaii (HI) | 108.7 | 7 |
| Alaska (AK) | 106.7 | 7 |
| Oregon (OR) | 105.3 | 13 |
| Idaho (ID) | 104.5 | 12 |
| Arkansas (AR) | 103.8 | 9 |
| Lowest-paying states | Index | Insurers |
|---|---|---|
| Massachusetts (MA) | 95.7 | 18 |
| District of Columbia (DC) | 95.7 | 9 |
| Illinois (IL) | 95.7 | 28 |
| Arizona (AZ) | 95.7 | 21 |
| Delaware (DE) | 95.7 | 7 |
| Code | Brand | Index | Insurers | Part B spend |
|---|---|---|---|---|
| J2354 | Octreotide Acetate | 110.7 | 55 | $0M |
| J2353 | Octreotide Acetate Er | 96.6 | 58 | $343M |
Within this family, Octreotide Acetate (J2354) contracts 14.1 points higher on the ASP=100 index than Octreotide Acetate Er (J2353) — 110.7 vs. 96.6.
At the median contracted rate, this code models a −$5,925 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 1,017 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.
See also: Enhertu · Orencia · report home · methodology