Vedolizumab · Gastroenterology
Entyvio (J3380) carries a median commercial contracted rate of 98.8 on the Medicare ASP=100 index — 3.8% below the 102.7 typical-acquisition benchmark and 5.3% below the 104.3 Medicare payment line. 59 insurers report contracted rates across 52 states (1,053 priced cells), covering $574M in modeled Part B spend. It ranks #14 of 25 on the CareCost Buy-and-Bill Risk List, with a risk score of 72.3 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 Wyoming | 158.9 | +54.7% | 44 | 7 |
| BlueCross BlueShield of South Carolina | 144.7 | +40.9% | 55 | 6 |
| HMSA (BCBS Hawaii) | 144.3 | +40.5% | 80 | 3 |
| Premera Blue Cross | 120.3 | +17.1% | 102 | 9 |
| Regence Idaho | 113.2 | +10.2% | 45 | 6 |
| BlueCross BlueShield of Nebraska | 111.9 | +9.0% | 34 | 7 |
| Regence Utah | 110.5 | +7.6% | 50 | 5 |
| Blue Shield of California | 108.7 | +5.8% | 118 | 4 |
| Blue Cross of Idaho | 108.7 | +5.8% | 58 | 6 |
| BlueCross BlueShield of Texas | 108.4 | +5.6% | 46 | 22 |
| BCBS North Dakota | 107.3 | +4.5% | 139 | 3 |
| BlueCross BlueShield of Arkansas | 107.2 | +4.4% | 48 | 21 |
| BlueCross BlueShield of Louisiana | 105.4 | +2.6% | 54 | 7 |
| Blue Cross NC | 104.4 | +1.7% | 187 | 52 |
| Aetna | 103.8 | +1.1% | 668 | 51 |
| Capital Blue Cross | 102.6 | −0.1% | 92 | 35 |
| BlueCross BlueShield of Kansas | 102.2 | −0.5% | 60 | 5 |
| Anthem Massachusetts | 100.6 | −2.0% | 64 | 25 |
| Anthem Indiana | 98.8 | −3.8% | 136 | 25 |
| Anthem New York | 98.8 | −3.8% | 72 | 15 |
| Centene | 98.8 | −3.8% | 188 | 26 |
| Cigna | 98.8 | −3.8% | 649 | 51 |
| Kaiser Permanente | 98.8 | −3.8% | 312 | 8 |
| BlueCross BlueShield of Rhode Island | 98.8 | −3.8% | 291 | 3 |
| Florida Blue | 98.8 | −3.8% | 32 | 5 |
| Anthem Maine | 98.8 | −3.8% | 65 | 5 |
| Regence Washington | 98.8 | −3.8% | 75 | 5 |
| Anthem New Hampshire | 98.8 | −3.8% | 49 | 7 |
| Anthem Georgia | 98.8 | −3.8% | 64 | 16 |
| Anthem Ohio | 98.8 | −3.8% | 78 | 13 |
| BlueCross BlueShield of Alabama | 98.8 | −3.8% | 91 | 6 |
| Regence Oregon | 98.8 | −3.8% | 64 | 7 |
| CareFirst BlueCross BlueShield | 98.8 | −3.8% | 58 | 19 |
| Anthem Missouri | 98.8 | −3.8% | 44 | 8 |
| Anthem Connecticut | 98.8 | −3.8% | 66 | 5 |
| Anthem Nevada | 98.8 | −3.8% | 194 | 4 |
| UnitedHealthcare | 98.8 | −3.8% | 1,080 | 51 |
| Anthem California | 98.7 | −3.9% | 64 | 4 |
| BlueCross BlueShield of Minnesota | 98.6 | −4.0% | 68 | 7 |
| BlueCross BlueShield of Tennessee | 98.6 | −4.0% | 61 | 10 |
| Wellmark BCBS (Iowa/South Dakota) | 98.6 | −4.0% | 78 | 10 |
| Anthem Virginia | 97.9 | −4.7% | 72 | 20 |
| Horizon BCBS of New Jersey | 97.9 | −4.7% | 42 | 6 |
| Harvard Pilgrim Health Care | 97.0 | −5.6% | 229 | 10 |
| Anthem Kentucky | 97.0 | −5.6% | 85 | 9 |
| Regence BlueCross BlueShield | 97.0 | −5.6% | 58 | 14 |
| BlueCross BlueShield of Massachusetts | 97.0 | −5.6% | 55 | 6 |
| Anthem Wisconsin | 97.0 | −5.6% | 140 | 5 |
| BlueCross BlueShield of Michigan | 95.6 | −6.9% | 63 | 7 |
| BlueCross BlueShield of Arizona | 82.1 | −20.1% | 38 | 19 |
Medicare's payment limit for Entyvio moved -1.5% 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 | $334M | 18.7 |
| 2020 | $434M | 23.6 |
| 2021 | $527M | 27.8 |
| 2022 | $674M | 31.2 |
| 2023 | $728M | 33.6 |
| 2024 | $770M | — |
| 2025 | $574M | — |
| Highest-paying states | Index | Insurers |
|---|---|---|
| Alaska (AK) | 148.3 | 7 |
| Hawaii (HI) | 114.5 | 7 |
| Idaho (ID) | 110.8 | 12 |
| Utah (UT) | 108.5 | 12 |
| Oregon (OR) | 108.5 | 14 |
| Lowest-paying states | Index | Insurers |
|---|---|---|
| New Jersey (NJ) | 98.8 | 14 |
| Rhode Island (RI) | 98.8 | 9 |
| Tennessee (TN) | 98.8 | 19 |
| South Dakota (SD) | 98.8 | 8 |
| Texas (TX) | 98.8 | 36 |
| Prior authorization required | 94% of policies |
| Site-of-care steering | 39% of policies |
| Pharmacy (white-bag) channel multiple | 1.520× |
| Drug class | integrin (alpha4beta7) inhibitor |
At the median contracted rate, this code models a −$3,764 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 1,053 priced contract cells across 59 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: Kyprolis · Krystexxa · Enhertu · report home · methodology