Daratumumab-hyaluronidase-fihj · Hematology-Oncology
Darzalex Faspro (J9144) carries a median commercial contracted rate of 98.6 on the Medicare ASP=100 index — 4.0% below the 102.7 typical-acquisition benchmark and 5.5% below the 104.3 Medicare payment line. 58 insurers report contracted rates across 52 states (1,020 priced cells), covering $2.31B in modeled Part B spend. It ranks #19 of 25 on the CareCost Buy-and-Bill Risk List, with a risk score of 68.7 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), 100.2 (NADAC-measured acquisition, see below).
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 | 124.7 | +21.4% | 55 | 6 |
| BlueCross BlueShield of Nebraska | 118.3 | +15.2% | 34 | 7 |
| Regence Idaho | 110.5 | +7.6% | 45 | 6 |
| Regence Utah | 107.9 | +5.1% | 50 | 5 |
| Wellmark BCBS (Iowa/South Dakota) | 106.6 | +3.8% | 78 | 10 |
| BlueCross BlueShield of Texas | 106.6 | +3.8% | 39 | 8 |
| Regence Washington | 106.2 | +3.4% | 75 | 5 |
| Blue Shield of California | 106.2 | +3.4% | 124 | 4 |
| Regence BlueCross BlueShield | 106.1 | +3.3% | 56 | 14 |
| Blue Cross of Idaho | 105.0 | +2.2% | 58 | 6 |
| BlueCross BlueShield of Arkansas | 104.7 | +1.9% | 48 | 21 |
| BCBS North Dakota | 104.7 | +1.9% | 139 | 3 |
| Blue Cross NC | 102.9 | +0.2% | 164 | 48 |
| BlueCross BlueShield of Minnesota | 102.3 | −0.4% | 68 | 7 |
| Aetna | 101.3 | −1.4% | 546 | 51 |
| Premera Blue Cross | 101.2 | −1.5% | 102 | 9 |
| HMSA (BCBS Hawaii) | 101.0 | −1.7% | 69 | 4 |
| BlueCross BlueShield of Kansas | 100.7 | −1.9% | 60 | 5 |
| Anthem California | 100.6 | −2.0% | 64 | 4 |
| Capital Blue Cross | 100.2 | −2.4% | 92 | 35 |
| Anthem Massachusetts | 100.1 | −2.5% | 64 | 25 |
| BlueCross BlueShield of Louisiana | 100.1 | −2.5% | 54 | 7 |
| Centene | 97.4 | −5.2% | 166 | 25 |
| BlueCross BlueShield of Tennessee | 97.4 | −5.2% | 61 | 10 |
| Florida Blue | 96.5 | −6.0% | 32 | 5 |
| CareFirst BlueCross BlueShield | 96.5 | −6.0% | 58 | 19 |
| BlueCross BlueShield of Rhode Island | 96.5 | −6.0% | 291 | 3 |
| Anthem Ohio | 96.5 | −6.0% | 78 | 13 |
| Anthem Georgia | 96.5 | −6.0% | 64 | 16 |
| Anthem New Hampshire | 96.5 | −6.0% | 49 | 7 |
| Anthem Wisconsin | 96.5 | −6.0% | 139 | 5 |
| Cigna | 96.5 | −6.0% | 721 | 51 |
| Kaiser Permanente | 96.5 | −6.0% | 312 | 8 |
| UnitedHealthcare | 96.5 | −6.0% | 1,080 | 51 |
| Anthem Virginia | 96.5 | −6.0% | 72 | 20 |
| Anthem Connecticut | 96.5 | −6.0% | 66 | 5 |
| Anthem Kentucky | 96.5 | −6.0% | 85 | 9 |
| BlueCross BlueShield of Massachusetts | 96.5 | −6.0% | 43 | 4 |
| BlueCross BlueShield of Alabama | 96.5 | −6.0% | 91 | 6 |
| Anthem New York | 96.5 | −6.0% | 72 | 15 |
| Regence Oregon | 96.5 | −6.0% | 58 | 7 |
| Anthem Missouri | 96.5 | −6.0% | 41 | 10 |
| Anthem Nevada | 96.5 | −6.0% | 194 | 4 |
| Anthem Maine | 96.5 | −6.0% | 65 | 5 |
| Harvard Pilgrim Health Care | 96.5 | −6.0% | 229 | 10 |
| Anthem Indiana | 96.5 | −6.0% | 136 | 25 |
| BlueCross BlueShield of Michigan | 93.4 | −9.1% | 63 | 7 |
| Horizon BCBS of New Jersey | 89.7 | −12.7% | 42 | 6 |
| BlueCross BlueShield of Arizona | 81.1 | −21.0% | 38 | 19 |
Medicare's payment limit for Darzalex Faspro moved +22.2% 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) |
|---|---|---|
| 2021 | $1.05B | 23.6 |
| 2022 | $1.58B | 34.9 |
| 2023 | $2.08B | 43.8 |
| 2024 | $2.53B | — |
| 2025 | $2.31B | — |
NADAC-measured acquisition cost for Darzalex Faspro runs $52.03/unit as of n/a — an acquisition index of 100.2 (ASP = 100).
At the median contracted index of 98.6, that implies a modeled gross margin of -1.6 points per ASP-unit — roughly −$0.86/unit at the latest ASP of $53.82.
Modeled from NADAC acquisition, high confidence — your invoice price governs.
| Highest-paying states | Index | Insurers |
|---|---|---|
| Alaska (AK) | 114.8 | 7 |
| Idaho (ID) | 107.9 | 11 |
| Utah (UT) | 105.6 | 11 |
| South Dakota (SD) | 105.2 | 8 |
| Nebraska (NE) | 104.7 | 9 |
| Lowest-paying states | Index | Insurers |
|---|---|---|
| Maryland (MD) | 96.5 | 13 |
| Kentucky (KY) | 96.5 | 13 |
| Rhode Island (RI) | 96.5 | 9 |
| New Jersey (NJ) | 96.5 | 13 |
| Maine (ME) | 96.5 | 10 |
At the median contracted rate, this code models a −$3,988 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 1,020 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.
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