Secukinumab · Rheumatology
Cosentyx (J3247) carries a median commercial contracted rate of 99.1 on the Medicare ASP=100 index — 3.5% below the 102.7 typical-acquisition benchmark and 5.0% below the 104.3 Medicare payment line. 50 insurers report contracted rates across 52 states (928 priced cells), covering $127M in modeled Part B spend.
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 42 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 | 118.2 | +15.1% | 55 | 6 |
| BlueCross BlueShield of Nebraska | 112.2 | +9.3% | 34 | 7 |
| BCBS North Dakota | 107.6 | +4.8% | 139 | 3 |
| BlueCross BlueShield of Arkansas | 107.6 | +4.8% | 48 | 21 |
| BlueCross BlueShield of Kansas | 107.2 | +4.4% | 60 | 5 |
| Kaiser Permanente | 106.3 | +3.5% | 308 | 8 |
| Blue Cross NC | 104.8 | +2.0% | 164 | 48 |
| Premera Blue Cross | 103.4 | +0.7% | 102 | 9 |
| Capital Blue Cross | 102.9 | +0.2% | 92 | 35 |
| Anthem Massachusetts | 102.7 | +0.0% | 64 | 25 |
| Aetna | 101.1 | −1.6% | 730 | 51 |
| Blue Shield of California | 101.0 | −1.7% | 112 | 4 |
| Florida Blue | 99.1 | −3.5% | 32 | 5 |
| BlueCross BlueShield of Rhode Island | 99.1 | −3.5% | 291 | 3 |
| Anthem New York | 99.1 | −3.5% | 72 | 15 |
| Anthem Nevada | 99.1 | −3.5% | 194 | 4 |
| Anthem Georgia | 99.1 | −3.5% | 66 | 16 |
| Anthem New Hampshire | 99.1 | −3.5% | 42 | 7 |
| Anthem Indiana | 99.1 | −3.5% | 136 | 25 |
| CareFirst BlueCross BlueShield | 99.1 | −3.5% | 58 | 19 |
| Anthem Ohio | 99.1 | −3.5% | 78 | 13 |
| BlueCross BlueShield of Alabama | 99.1 | −3.5% | 91 | 6 |
| Cigna | 99.1 | −3.5% | 1,243 | 51 |
| Anthem Connecticut | 99.1 | −3.5% | 66 | 5 |
| UnitedHealthcare | 99.1 | −3.5% | 1,080 | 51 |
| Anthem Virginia | 99.0 | −3.6% | 72 | 20 |
| Anthem Missouri | 99.0 | −3.6% | 42 | 9 |
| Anthem Kentucky | 98.9 | −3.7% | 85 | 9 |
| Anthem Wisconsin | 98.9 | −3.7% | 139 | 5 |
| Harvard Pilgrim Health Care | 98.9 | −3.7% | 229 | 10 |
| Blue Cross of Idaho | 98.5 | −4.1% | 58 | 6 |
| Anthem California | 98.5 | −4.1% | 64 | 4 |
| 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% | 57 | 7 |
| BlueCross BlueShield of Texas | 97.5 | −5.1% | 42 | 9 |
| Horizon BCBS of New Jersey | 97.2 | −5.4% | 42 | 6 |
| Anthem Maine | 96.7 | −5.8% | 65 | 5 |
| BlueCross BlueShield of Louisiana | 95.0 | −7.5% | 54 | 7 |
| HMSA (BCBS Hawaii) | 94.7 | −7.8% | 69 | 4 |
| BlueCross BlueShield of Michigan | 85.8 | −16.5% | 68 | 10 |
| BlueCross BlueShield of Arizona | 83.3 | −18.9% | 38 | 19 |
Medicare's payment limit for Cosentyx moved +2.7% between Q3 2024 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) |
|---|---|---|
| 2024 | $54M | — |
| 2025 | $127M | — |
| Highest-paying states | Index | Insurers |
|---|---|---|
| Alaska (AK) | 113.6 | 6 |
| Nebraska (NE) | 109.7 | 8 |
| Arkansas (AR) | 107.5 | 8 |
| Kansas (KS) | 107.3 | 9 |
| Oklahoma (OK) | 104.8 | 8 |
| Lowest-paying states | Index | Insurers |
|---|---|---|
| Pennsylvania (PA) | 99.1 | 16 |
| New York (NY) | 99.1 | 22 |
| Massachusetts (MA) | 99.1 | 18 |
| Texas (TX) | 99.1 | 29 |
| Louisiana (LA) | 99.0 | 8 |
| Prior authorization required | 88% of policies |
| Site-of-care steering | 28% of policies |
| Pharmacy (white-bag) channel multiple | 0.920× |
| Drug class | IL-17A inhibitor |
At the median contracted rate, this code models a −$3,505 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 928 priced contract cells across 50 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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