Romiplostim · Specialty pharmacy
Nplate (J2802) carries a median commercial contracted rate of 95.6 on the Medicare ASP=100 index — 6.9% below the 102.7 typical-acquisition benchmark and 8.3% below the 104.3 Medicare payment line. 55 insurers report contracted rates across 52 states (967 priced cells), covering $316M in modeled Part B spend. It ranks #11 of 25 on the CareCost Buy-and-Bill Risk List, with a risk score of 73.8 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 47 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 | 119.5 | +16.4% | 55 | 6 |
| Regence Idaho | 108.8 | +5.9% | 45 | 6 |
| BlueCross BlueShield of Nebraska | 107.7 | +4.9% | 34 | 7 |
| Anthem Georgia | 107.0 | +4.2% | 66 | 16 |
| Regence Utah | 106.3 | +3.5% | 50 | 5 |
| BCBS North Dakota | 103.2 | +0.5% | 139 | 3 |
| BlueCross BlueShield of Arkansas | 103.1 | +0.4% | 48 | 21 |
| BlueCross BlueShield of Kansas | 102.4 | −0.3% | 60 | 5 |
| Blue Cross NC | 100.5 | −2.1% | 164 | 48 |
| Premera Blue Cross | 100.0 | −2.6% | 124 | 9 |
| Anthem Massachusetts | 99.2 | −3.4% | 64 | 25 |
| Capital Blue Cross | 98.6 | −4.0% | 92 | 35 |
| Kaiser Permanente | 98.3 | −4.3% | 308 | 8 |
| Blue Shield of California | 96.9 | −5.6% | 112 | 4 |
| BlueCross BlueShield of Michigan | 96.8 | −5.7% | 66 | 10 |
| Blue Cross of Idaho | 96.7 | −5.8% | 58 | 6 |
| Aetna | 96.1 | −6.4% | 666 | 51 |
| BlueCross BlueShield of Texas | 95.7 | −6.8% | 41 | 8 |
| Harvard Pilgrim Health Care | 95.6 | −6.9% | 229 | 10 |
| Regence BlueCross BlueShield | 95.6 | −6.9% | 56 | 14 |
| Anthem Kentucky | 95.6 | −6.9% | 85 | 9 |
| Anthem Wisconsin | 95.6 | −6.9% | 139 | 5 |
| Anthem Missouri | 95.6 | −6.9% | 47 | 8 |
| Anthem Virginia | 95.4 | −7.1% | 72 | 20 |
| UnitedHealthcare | 95.1 | −7.4% | 1,080 | 51 |
| Anthem Connecticut | 95.1 | −7.4% | 66 | 5 |
| Anthem New Hampshire | 95.1 | −7.4% | 49 | 7 |
| Anthem Ohio | 95.1 | −7.4% | 78 | 13 |
| CareFirst BlueCross BlueShield | 95.1 | −7.4% | 59 | 18 |
| Regence Washington | 95.1 | −7.4% | 75 | 5 |
| Florida Blue | 95.1 | −7.4% | 32 | 5 |
| Regence Oregon | 95.1 | −7.4% | 58 | 7 |
| Anthem New York | 95.1 | −7.4% | 72 | 15 |
| Anthem Nevada | 95.1 | −7.4% | 194 | 4 |
| BlueCross BlueShield of Alabama | 95.1 | −7.4% | 91 | 6 |
| Anthem Maine | 95.1 | −7.4% | 65 | 5 |
| Anthem Indiana | 95.1 | −7.4% | 136 | 25 |
| Cigna | 95.1 | −7.4% | 1,225 | 51 |
| BlueCross BlueShield of Rhode Island | 95.1 | −7.4% | 291 | 3 |
| Anthem California | 94.9 | −7.6% | 64 | 4 |
| BlueCross BlueShield of Minnesota | 94.8 | −7.7% | 57 | 7 |
| Wellmark BCBS (Iowa/South Dakota) | 94.8 | −7.7% | 78 | 10 |
| BlueCross BlueShield of Tennessee | 94.8 | −7.7% | 61 | 10 |
| HMSA (BCBS Hawaii) | 92.7 | −9.7% | 69 | 4 |
| BlueCross BlueShield of Louisiana | 92.1 | −10.3% | 54 | 7 |
| Horizon BCBS of New Jersey | 90.6 | −11.8% | 42 | 6 |
| BlueCross BlueShield of Arizona | 79.9 | −22.2% | 38 | 19 |
Medicare's payment limit for Nplate moved +5.3% between Q1 2025 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) |
|---|---|---|
| 2025 | $316M | — |
| Highest-paying states | Index | Insurers |
|---|---|---|
| Alaska (AK) | 107.1 | 7 |
| Nebraska (NE) | 105.0 | 8 |
| Idaho (ID) | 103.4 | 11 |
| Arkansas (AR) | 103.1 | 8 |
| Kansas (KS) | 102.7 | 9 |
| Lowest-paying states | Index | Insurers |
|---|---|---|
| Alabama (AL) | 95.1 | 12 |
| Iowa (IA) | 95.1 | 9 |
| Pennsylvania (PA) | 95.1 | 16 |
| Maryland (MD) | 95.1 | 13 |
| Delaware (DE) | 95.1 | 7 |
At the median contracted rate, this code models a −$6,879 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 967 priced contract cells across 55 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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