Carfilzomib · Hematology-Oncology
Kyprolis (J9047) carries a median commercial contracted rate of 94.5 on the Medicare ASP=100 index — 8.0% below the 102.7 typical-acquisition benchmark and 9.4% below the 104.3 Medicare payment line. 57 insurers report contracted rates across 52 states (1,009 priced cells), covering $291M in modeled Part B spend. It ranks #13 of 25 on the CareCost Buy-and-Bill Risk List, with a risk score of 73.3 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 49 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 | 119.3 | +16.2% | 55 | 6 |
| BlueCross BlueShield of Nebraska | 113.1 | +10.1% | 34 | 7 |
| BlueCross BlueShield of Wyoming | 106.7 | +3.9% | 44 | 7 |
| Regence Idaho | 105.6 | +2.8% | 45 | 6 |
| Regence Utah | 103.1 | +0.4% | 50 | 5 |
| Regence BlueCross BlueShield | 102.6 | −0.1% | 56 | 14 |
| Blue Shield of California | 101.5 | −1.2% | 118 | 4 |
| Regence Washington | 101.5 | −1.2% | 75 | 5 |
| BlueCross BlueShield of Texas | 101.2 | −1.5% | 39 | 8 |
| Wellmark BCBS (Iowa/South Dakota) | 101.0 | −1.7% | 78 | 10 |
| BCBS North Dakota | 100.1 | −2.5% | 139 | 3 |
| BlueCross BlueShield of Arkansas | 100.1 | −2.5% | 48 | 21 |
| Blue Cross of Idaho | 99.7 | −2.9% | 58 | 6 |
| BlueCross BlueShield of Louisiana | 98.8 | −3.8% | 54 | 7 |
| BlueCross BlueShield of Minnesota | 96.9 | −5.6% | 68 | 7 |
| Centene | 96.8 | −5.7% | 150 | 10 |
| Aetna | 96.8 | −5.7% | 582 | 51 |
| Anthem Massachusetts | 96.8 | −5.7% | 64 | 25 |
| Premera Blue Cross | 96.5 | −6.0% | 102 | 9 |
| Anthem California | 95.8 | −6.7% | 64 | 4 |
| Capital Blue Cross | 95.7 | −6.8% | 92 | 35 |
| Blue Cross NC | 95.7 | −6.8% | 187 | 52 |
| HMSA (BCBS Hawaii) | 95.6 | −6.9% | 80 | 3 |
| BlueCross BlueShield of Kansas | 95.4 | −7.1% | 60 | 5 |
| Anthem Wisconsin | 93.3 | −9.2% | 100 | 7 |
| Harvard Pilgrim Health Care | 93.3 | −9.2% | 229 | 10 |
| Anthem Kentucky | 93.3 | −9.2% | 85 | 9 |
| UnitedHealthcare | 93.3 | −9.2% | 1,068 | 52 |
| Anthem Missouri | 93.3 | −9.2% | 40 | 9 |
| Anthem Virginia | 92.8 | −9.6% | 72 | 20 |
| BlueCross BlueShield of Tennessee | 92.3 | −10.1% | 61 | 10 |
| Cigna | 92.2 | −10.2% | 608 | 52 |
| CareFirst BlueCross BlueShield | 92.2 | −10.2% | 58 | 19 |
| Anthem New York | 92.2 | −10.2% | 69 | 15 |
| Regence Oregon | 92.2 | −10.2% | 58 | 7 |
| Anthem Nevada | 92.2 | −10.2% | 194 | 4 |
| BlueCross BlueShield of Alabama | 92.2 | −10.2% | 91 | 6 |
| Kaiser Permanente | 92.2 | −10.2% | 312 | 8 |
| Florida Blue | 92.2 | −10.2% | 32 | 5 |
| BlueCross BlueShield of Rhode Island | 92.2 | −10.2% | 291 | 3 |
| Anthem Georgia | 92.2 | −10.2% | 64 | 16 |
| Anthem New Hampshire | 92.2 | −10.2% | 42 | 7 |
| Anthem Ohio | 92.2 | −10.2% | 78 | 13 |
| Anthem Indiana | 92.2 | −10.2% | 136 | 25 |
| Anthem Maine | 92.2 | −10.2% | 65 | 5 |
| Anthem Connecticut | 92.2 | −10.2% | 66 | 5 |
| BlueCross BlueShield of Michigan | 89.3 | −13.0% | 63 | 7 |
| Horizon BCBS of New Jersey | 86.0 | −16.3% | 42 | 6 |
| BlueCross BlueShield of Arizona | 77.5 | −24.5% | 38 | 19 |
Medicare's payment limit for Kyprolis moved +36.8% 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 | $276M | 8.3 |
| 2020 | $293M | 8.5 |
| 2021 | $308M | 8.5 |
| 2022 | $367M | 8.8 |
| 2023 | $401M | 8.9 |
| 2024 | $397M | — |
| 2025 | $291M | — |
| Highest-paying states | Index | Insurers |
|---|---|---|
| Alaska (AK) | 110.0 | 7 |
| Nebraska (NE) | 105.4 | 9 |
| Idaho (ID) | 104.4 | 12 |
| Utah (UT) | 102.6 | 12 |
| South Dakota (SD) | 100.9 | 8 |
| Lowest-paying states | Index | Insurers |
|---|---|---|
| Tennessee (TN) | 92.5 | 18 |
| Mississippi (MS) | 92.3 | 11 |
| Massachusetts (MA) | 92.2 | 18 |
| Maryland (MD) | 92.2 | 13 |
At the median contracted rate, this code models a −$7,944 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 1,009 priced contract cells across 57 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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