Polatuzumab Vedotin-piiq · Specialty pharmacy
Polivy (J9309) carries a median commercial contracted rate of 95.6 on the Medicare ASP=100 index — 6.9% below the 102.7 typical-acquisition benchmark and 8.3% below the 104.3 Medicare payment line. 57 insurers report contracted rates across 52 states (994 priced cells), covering $188M in modeled Part B spend. It ranks #16 of 25 on the CareCost Buy-and-Bill Risk List, with a risk score of 69.6 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), 93.3 (NADAC-measured acquisition, see below).
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 Nebraska | 116.8 | +13.7% | 34 | 7 |
| BlueCross BlueShield of South Carolina | 111.9 | +9.0% | 55 | 6 |
| Regence Idaho | 109.1 | +6.2% | 45 | 6 |
| Regence Utah | 106.5 | +3.7% | 50 | 5 |
| Regence BlueCross BlueShield | 105.1 | +2.3% | 56 | 14 |
| Regence Washington | 104.8 | +2.0% | 75 | 5 |
| Wellmark BCBS (Iowa/South Dakota) | 104.1 | +1.4% | 78 | 10 |
| BCBS North Dakota | 103.3 | +0.6% | 139 | 3 |
| BlueCross BlueShield of Arkansas | 103.3 | +0.6% | 48 | 21 |
| Blue Cross of Idaho | 102.2 | −0.5% | 58 | 6 |
| Blue Cross NC | 100.6 | −2.0% | 168 | 48 |
| Premera Blue Cross | 100.2 | −2.4% | 103 | 9 |
| BlueCross BlueShield of Wyoming | 100.1 | −2.5% | 44 | 7 |
| BlueCross BlueShield of Minnesota | 99.9 | −2.7% | 69 | 6 |
| Aetna | 99.6 | −3.0% | 624 | 51 |
| Anthem Massachusetts | 99.2 | −3.4% | 64 | 25 |
| Anthem California | 98.8 | −3.8% | 64 | 4 |
| Capital Blue Cross | 98.8 | −3.8% | 92 | 35 |
| BlueCross BlueShield of Kansas | 98.4 | −4.2% | 60 | 5 |
| Blue Shield of California | 97.0 | −5.6% | 124 | 4 |
| Harvard Pilgrim Health Care | 95.6 | −6.9% | 229 | 10 |
| Anthem Missouri | 95.6 | −6.9% | 40 | 10 |
| BlueCross BlueShield of Massachusetts | 95.6 | −6.9% | 43 | 4 |
| Anthem Kentucky | 95.6 | −6.9% | 92 | 8 |
| UnitedHealthcare | 95.6 | −6.9% | 1,080 | 51 |
| Anthem Wisconsin | 95.6 | −6.9% | 139 | 5 |
| Anthem Virginia | 95.4 | −7.1% | 72 | 20 |
| BlueCross BlueShield of Rhode Island | 95.2 | −7.3% | 291 | 3 |
| Anthem Ohio | 95.2 | −7.3% | 78 | 13 |
| Anthem New Hampshire | 95.2 | −7.3% | 115 | 5 |
| Cigna | 95.2 | −7.3% | 721 | 51 |
| Kaiser Permanente | 95.2 | −7.3% | 312 | 8 |
| Anthem New York | 95.2 | −7.3% | 72 | 15 |
| Anthem Georgia | 95.2 | −7.3% | 72 | 15 |
| Centene | 95.2 | −7.3% | 212 | 12 |
| BlueCross BlueShield of Tennessee | 95.2 | −7.3% | 61 | 10 |
| Anthem Connecticut | 95.2 | −7.3% | 66 | 5 |
| CareFirst BlueCross BlueShield | 95.2 | −7.3% | 58 | 19 |
| Florida Blue | 95.2 | −7.3% | 32 | 5 |
| Anthem Indiana | 95.2 | −7.3% | 136 | 25 |
| Anthem Nevada | 95.2 | −7.3% | 194 | 4 |
| Regence Oregon | 95.2 | −7.3% | 58 | 7 |
| BlueCross BlueShield of Alabama | 95.2 | −7.3% | 91 | 6 |
| Anthem Maine | 95.2 | −7.3% | 61 | 5 |
| BlueCross BlueShield of Texas | 94.4 | −8.1% | 134 | 3 |
| BlueCross BlueShield of Louisiana | 93.5 | −9.0% | 54 | 7 |
| BlueCross BlueShield of Michigan | 92.2 | −10.2% | 63 | 7 |
| HMSA (BCBS Hawaii) | 91.1 | −11.3% | 84 | 4 |
| Horizon BCBS of New Jersey | 89.6 | −12.8% | 42 | 6 |
| BlueCross BlueShield of Arizona | 80.0 | −22.1% | 38 | 19 |
Medicare's payment limit for Polivy moved +20.8% 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) |
|---|---|---|
| 2020 | $48M | 0.4 |
| 2021 | $42M | 0.4 |
| 2022 | $66M | 0.6 |
| 2023 | $119M | 1.0 |
| 2024 | $202M | — |
| 2025 | $188M | — |
NADAC-measured acquisition cost for Polivy runs $120.83/unit as of n/a — an acquisition index of 93.3 (ASP = 100).
At the median contracted index of 95.6, that implies a modeled gross margin of +2.3 points per ASP-unit — roughly +$3.12/unit at the latest ASP of $135.48.
Modeled from NADAC acquisition, high confidence — your invoice price governs.
| Highest-paying states | Index | Insurers |
|---|---|---|
| Alaska (AK) | 108.1 | 7 |
| South Dakota (SD) | 104.1 | 8 |
| Iowa (IA) | 104.1 | 8 |
| Nebraska (NE) | 103.8 | 8 |
| Idaho (ID) | 103.5 | 12 |
| Lowest-paying states | Index | Insurers |
|---|---|---|
| Florida (FL) | 95.3 | 34 |
| Louisiana (LA) | 95.2 | 8 |
| Mississippi (MS) | 95.2 | 12 |
| Alabama (AL) | 95.2 | 13 |
At the median contracted rate, this code models a −$6,955 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 994 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.
See also: Krystexxa · Gammagard Liquid · Enhertu · report home · methodology