Omalizumab · Allergy/ Immunology
Xolair (J2357) carries a median commercial contracted rate of 97.7 on the Medicare ASP=100 index — 4.9% below the 102.7 typical-acquisition benchmark and 6.3% below the 104.3 Medicare payment line. 58 insurers report contracted rates across 52 states (1,041 priced cells), covering $316M in modeled Part B spend. It ranks #10 of 25 on the CareCost Buy-and-Bill Risk List, with a risk score of 74.7 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 51 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 | 133.4 | +29.9% | 55 | 6 |
| BlueCross BlueShield of Wyoming | 113.4 | +10.4% | 44 | 7 |
| Regence Idaho | 111.8 | +8.9% | 45 | 6 |
| BlueCross BlueShield of Nebraska | 110.5 | +7.6% | 34 | 7 |
| Regence Utah | 109.2 | +6.3% | 50 | 5 |
| Blue Cross of Idaho | 107.4 | +4.6% | 58 | 6 |
| BCBS North Dakota | 106.0 | +3.2% | 139 | 3 |
| BlueCross BlueShield of Arkansas | 106.0 | +3.2% | 48 | 21 |
| Blue Shield of California | 105.4 | +2.6% | 118 | 4 |
| BlueCross BlueShield of Oklahoma | 105.3 | +2.5% | 83 | 2 |
| HMSA (BCBS Hawaii) | 105.0 | +2.2% | 80 | 3 |
| BlueCross BlueShield of Kansas | 103.5 | +0.8% | 60 | 5 |
| Premera Blue Cross | 102.7 | +0.0% | 102 | 9 |
| Aetna | 102.5 | −0.2% | 835 | 51 |
| Blue Cross NC | 101.4 | −1.3% | 187 | 52 |
| Capital Blue Cross | 101.4 | −1.3% | 92 | 35 |
| BlueCross BlueShield of Louisiana | 99.9 | −2.7% | 54 | 7 |
| Anthem Connecticut | 97.7 | −4.9% | 66 | 5 |
| UnitedHealthcare | 97.7 | −4.9% | 1,080 | 51 |
| Anthem Ohio | 97.7 | −4.9% | 78 | 13 |
| Anthem New Hampshire | 97.7 | −4.9% | 49 | 7 |
| Anthem Georgia | 97.7 | −4.9% | 64 | 16 |
| BlueCross BlueShield of Massachusetts | 97.7 | −4.9% | 51 | 5 |
| Anthem Indiana | 97.7 | −4.9% | 136 | 25 |
| BlueCross BlueShield of Alabama | 97.7 | −4.9% | 91 | 6 |
| BlueCross BlueShield of Rhode Island | 97.7 | −4.9% | 291 | 3 |
| Anthem Maine | 97.7 | −4.9% | 65 | 5 |
| Anthem New York | 97.7 | −4.9% | 72 | 15 |
| Regence Oregon | 97.7 | −4.9% | 62 | 7 |
| Anthem Nevada | 97.7 | −4.9% | 194 | 4 |
| Kaiser Permanente | 97.7 | −4.9% | 312 | 8 |
| Florida Blue | 97.7 | −4.9% | 32 | 5 |
| Regence Washington | 97.7 | −4.9% | 75 | 5 |
| CareFirst BlueCross BlueShield | 97.7 | −4.9% | 58 | 19 |
| Cigna | 97.7 | −4.9% | 636 | 52 |
| Anthem California | 96.7 | −5.8% | 64 | 4 |
| Centene | 96.2 | −6.3% | 424 | 28 |
| Wellmark BCBS (Iowa/South Dakota) | 95.7 | −6.8% | 78 | 10 |
| BlueCross BlueShield of Tennessee | 95.7 | −6.8% | 61 | 10 |
| BlueCross BlueShield of Minnesota | 95.7 | −6.8% | 68 | 7 |
| BlueCross BlueShield of Michigan | 94.5 | −8.0% | 63 | 7 |
| Anthem Virginia | 93.7 | −8.8% | 72 | 20 |
| BlueCross BlueShield of Texas | 93.4 | −9.1% | 44 | 10 |
| Anthem Massachusetts | 93.2 | −9.3% | 64 | 25 |
| Regence BlueCross BlueShield | 89.8 | −12.6% | 57 | 14 |
| Anthem Wisconsin | 89.8 | −12.6% | 140 | 5 |
| Harvard Pilgrim Health Care | 89.8 | −12.6% | 229 | 10 |
| Anthem Missouri | 89.8 | −12.6% | 44 | 10 |
| Anthem Kentucky | 89.8 | −12.6% | 66 | 10 |
| Horizon BCBS of New Jersey | 86.1 | −16.2% | 42 | 6 |
| BlueCross BlueShield of Arizona | 82.0 | −20.2% | 38 | 19 |
Medicare's payment limit for Xolair moved +11.5% 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 | $400M | 11.9 |
| 2020 | $400M | 11.6 |
| 2021 | $402M | 11.6 |
| 2022 | $420M | 11.4 |
| 2023 | $420M | 11.2 |
| 2024 | $415M | — |
| 2025 | $316M | — |
| Highest-paying states | Index | Insurers |
|---|---|---|
| Alaska (AK) | 111.5 | 7 |
| Arkansas (AR) | 105.5 | 9 |
| Nebraska (NE) | 104.0 | 9 |
| Oregon (OR) | 102.7 | 13 |
| Idaho (ID) | 102.6 | 12 |
| Lowest-paying states | Index | Insurers |
|---|---|---|
| Ohio (OH) | 97.7 | 17 |
| Wyoming (WY) | 97.7 | 5 |
| New Jersey (NJ) | 97.1 | 13 |
| Vermont (VT) | 97.1 | 9 |
| Prior authorization required | 93% of policies |
| Site-of-care steering | 30% of policies |
| Pharmacy (white-bag) channel multiple | 1.040× |
| Drug class | anti-IgE |
At the median contracted rate, this code models a −$4,903 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 1,041 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.
See also: Prolia · Nplate · Enhertu · report home · methodology