Brentuximab Vedotin · Specialty pharmacy
Adcetris (J9042) carries a median commercial contracted rate of 96.2 on the Medicare ASP=100 index — 6.3% below the 102.7 typical-acquisition benchmark and 7.8% below the 104.3 Medicare payment line. 58 insurers report contracted rates across 52 states (1,010 priced cells), covering $142M in modeled Part B spend. It ranks #22 of 25 on the CareCost Buy-and-Bill Risk List, with a risk score of 68.2 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).
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 |
|---|---|---|---|---|
| Regence Idaho | 110.1 | +7.2% | 45 | 6 |
| BlueCross BlueShield of Nebraska | 108.8 | +5.9% | 34 | 7 |
| Regence Utah | 107.5 | +4.7% | 50 | 5 |
| BlueCross BlueShield of South Carolina | 107.5 | +4.7% | 55 | 6 |
| Regence BlueCross BlueShield | 105.9 | +3.1% | 56 | 14 |
| Regence Washington | 105.8 | +3.0% | 75 | 5 |
| BlueCross BlueShield of Arkansas | 104.3 | +1.6% | 48 | 21 |
| BCBS North Dakota | 104.3 | +1.6% | 139 | 3 |
| Wellmark BCBS (Iowa/South Dakota) | 101.4 | −1.3% | 78 | 10 |
| Anthem Massachusetts | 99.9 | −2.7% | 58 | 25 |
| Capital Blue Cross | 99.8 | −2.8% | 92 | 35 |
| Aetna | 99.5 | −3.1% | 622 | 51 |
| BlueCross BlueShield of Kansas | 99.4 | −3.2% | 60 | 5 |
| Blue Cross NC | 98.9 | −3.7% | 187 | 52 |
| Blue Shield of California | 98.0 | −4.6% | 61 | 4 |
| Anthem California | 98.0 | −4.6% | 64 | 4 |
| Premera Blue Cross | 97.8 | −4.8% | 103 | 9 |
| BlueCross BlueShield of Minnesota | 97.3 | −5.3% | 68 | 7 |
| Anthem Virginia | 96.2 | −6.3% | 72 | 20 |
| UnitedHealthcare | 96.2 | −6.3% | 1,068 | 52 |
| Anthem Wisconsin | 96.2 | −6.3% | 140 | 5 |
| BlueCross BlueShield of Wyoming | 96.2 | −6.3% | 44 | 7 |
| Anthem Missouri | 96.2 | −6.3% | 44 | 10 |
| CareFirst BlueCross BlueShield | 96.2 | −6.3% | 58 | 19 |
| Anthem Kentucky | 96.2 | −6.3% | 85 | 9 |
| BlueCross BlueShield of Massachusetts | 96.2 | −6.3% | 43 | 4 |
| Harvard Pilgrim Health Care | 96.2 | −6.3% | 229 | 10 |
| Anthem Nevada | 96.1 | −6.4% | 194 | 4 |
| Cigna | 96.1 | −6.4% | 636 | 52 |
| Kaiser Permanente | 96.1 | −6.4% | 312 | 8 |
| BlueCross BlueShield of Rhode Island | 96.1 | −6.4% | 291 | 3 |
| Regence Oregon | 96.1 | −6.4% | 58 | 7 |
| Anthem New York | 96.1 | −6.4% | 72 | 15 |
| BlueCross BlueShield of Alabama | 96.1 | −6.4% | 91 | 6 |
| Anthem Maine | 96.1 | −6.4% | 65 | 5 |
| Anthem Ohio | 96.1 | −6.4% | 78 | 13 |
| Anthem Georgia | 96.1 | −6.4% | 64 | 16 |
| Anthem New Hampshire | 96.1 | −6.4% | 49 | 7 |
| Anthem Connecticut | 96.1 | −6.4% | 66 | 5 |
| Florida Blue | 96.1 | −6.4% | 32 | 5 |
| Anthem Indiana | 96.1 | −6.4% | 136 | 25 |
| BlueCross BlueShield of Michigan | 93.1 | −9.3% | 63 | 7 |
| Centene | 92.6 | −9.8% | 47 | 12 |
| Blue Cross of Idaho | 92.6 | −9.8% | 58 | 6 |
| BlueCross BlueShield of Louisiana | 92.6 | −9.8% | 54 | 7 |
| BlueCross BlueShield of Tennessee | 92.6 | −9.8% | 61 | 10 |
| HMSA (BCBS Hawaii) | 88.8 | −13.5% | 69 | 4 |
| BlueCross BlueShield of Texas | 86.5 | −15.8% | 35 | 6 |
| Horizon BCBS of New Jersey | 85.6 | −16.7% | 42 | 6 |
| BlueCross BlueShield of Arizona | 80.8 | −21.3% | 38 | 19 |
Medicare's payment limit for Adcetris moved +36.7% 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 | $155M | 1.1 |
| 2020 | $161M | 1.1 |
| 2021 | $164M | 1.0 |
| 2022 | $186M | 0.9 |
| 2023 | $193M | 0.9 |
| 2024 | $187M | — |
| 2025 | $142M | — |
| Highest-paying states | Index | Insurers |
|---|---|---|
| Nebraska (NE) | 108.8 | 8 |
| Alaska (AK) | 104.9 | 7 |
| Idaho (ID) | 104.2 | 12 |
| South Dakota (SD) | 101.4 | 8 |
| Arkansas (AR) | 100.7 | 9 |
| Lowest-paying states | Index | Insurers |
|---|---|---|
| Maryland (MD) | 96.2 | 13 |
| Mississippi (MS) | 96.1 | 11 |
| Florida (FL) | 96.1 | 34 |
| New York (NY) | 96.1 | 22 |
| Alabama (AL) | 96.1 | 12 |
At the median contracted rate, this code models a −$6,283 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 1,010 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.
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