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Truxima (Q5115) carries a median commercial contracted rate of 89.8 on the Medicare ASP=100 index — 12.6% below the 102.7 typical-acquisition benchmark and 13.9% below the 104.3 Medicare payment line. 57 insurers report contracted rates across 52 states (1,005 priced cells), covering $98M in modeled Part B spend. It ranks #21 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 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 |
|---|---|---|---|---|
| Premera Blue Cross | 136.2 | +32.6% | 102 | 9 |
| BlueCross BlueShield of Arkansas | 136.2 | +32.6% | 48 | 21 |
| HMSA (BCBS Hawaii) | 127.4 | +24.1% | 84 | 4 |
| UnitedHealthcare | 123.1 | +19.9% | 1,080 | 51 |
| BlueCross BlueShield of Alabama | 122.3 | +19.1% | 91 | 6 |
| BlueCross BlueShield of Michigan | 120.6 | +17.4% | 63 | 7 |
| BlueCross BlueShield of Nebraska | 106.9 | +4.1% | 34 | 7 |
| Blue Shield of California | 102.2 | −0.5% | 118 | 4 |
| Regence BlueCross BlueShield | 99.6 | −3.0% | 56 | 14 |
| BlueCross BlueShield of Kansas | 98.4 | −4.2% | 60 | 5 |
| BlueCross BlueShield of Texas | 96.5 | −6.0% | 41 | 10 |
| Regence Washington | 96.0 | −6.5% | 75 | 5 |
| Blue Cross of Idaho | 95.9 | −6.6% | 58 | 6 |
| Anthem Massachusetts | 93.9 | −8.6% | 56 | 25 |
| CareFirst BlueCross BlueShield | 91.3 | −11.1% | 58 | 19 |
| BlueCross BlueShield of South Carolina | 90.5 | −11.9% | 56 | 6 |
| Anthem Kentucky | 90.5 | −11.9% | 85 | 9 |
| BlueCross BlueShield of Massachusetts | 90.5 | −11.9% | 45 | 4 |
| Anthem Missouri | 90.5 | −11.9% | 47 | 10 |
| Anthem Wisconsin | 90.5 | −11.9% | 145 | 4 |
| Harvard Pilgrim Health Care | 90.5 | −11.9% | 229 | 10 |
| Aetna | 89.7 | −12.7% | 514 | 51 |
| Anthem Virginia | 88.9 | −13.4% | 72 | 20 |
| Capital Blue Cross | 88.8 | −13.5% | 92 | 35 |
| Horizon BCBS of New Jersey | 87.9 | −14.4% | 44 | 6 |
| Anthem Georgia | 87.2 | −15.1% | 64 | 16 |
| Anthem Maine | 87.2 | −15.1% | 65 | 5 |
| Anthem Connecticut | 87.2 | −15.1% | 66 | 5 |
| Anthem New Hampshire | 87.2 | −15.1% | 49 | 7 |
| Centene | 87.2 | −15.1% | 163 | 27 |
| Anthem Indiana | 87.2 | −15.1% | 133 | 24 |
| Regence Oregon | 87.2 | −15.1% | 56 | 7 |
| Anthem Nevada | 87.2 | −15.1% | 194 | 4 |
| Florida Blue | 87.2 | −15.1% | 32 | 5 |
| Cigna | 87.2 | −15.1% | 721 | 51 |
| Kaiser Permanente | 87.2 | −15.1% | 312 | 8 |
| Anthem New York | 87.2 | −15.1% | 72 | 15 |
| BlueCross BlueShield of Rhode Island | 87.2 | −15.1% | 291 | 3 |
| Anthem Ohio | 87.2 | −15.1% | 80 | 12 |
| Anthem California | 86.1 | −16.2% | 64 | 4 |
| Regence Utah | 86.0 | −16.3% | 50 | 5 |
| Regence Idaho | 86.0 | −16.3% | 45 | 6 |
| Wellmark BCBS (Iowa/South Dakota) | 85.0 | −17.2% | 78 | 10 |
| BlueCross BlueShield of Minnesota | 85.0 | −17.2% | 68 | 7 |
| BlueCross BlueShield of Tennessee | 83.4 | −18.8% | 61 | 10 |
| BlueCross BlueShield of Louisiana | 82.1 | −20.1% | 54 | 7 |
| BCBS North Dakota | 81.5 | −20.6% | 139 | 3 |
| Blue Cross NC | 79.4 | −22.7% | 164 | 48 |
| BlueCross BlueShield of Arizona | 73.3 | −28.6% | 38 | 19 |
Medicare's payment limit for Truxima moved -45.5% 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 | $0M | 0.0 |
| 2020 | $186M | 2.5 |
| 2021 | $234M | 3.7 |
| 2022 | $196M | 3.7 |
| 2023 | $175M | 4.1 |
| 2024 | $127M | — |
| 2025 | $98M | — |
| Highest-paying states | Index | Insurers |
|---|---|---|
| Alaska (AK) | 130.8 | 7 |
| Wyoming (WY) | 114.7 | 5 |
| Nebraska (NE) | 99.7 | 9 |
| Kansas (KS) | 99.5 | 11 |
| Arkansas (AR) | 98.1 | 9 |
| Lowest-paying states | Index | Insurers |
|---|---|---|
| South Dakota (SD) | 87.2 | 9 |
| Louisiana (LA) | 87.2 | 9 |
| Vermont (VT) | 87.2 | 8 |
| Iowa (IA) | 87.0 | 10 |
| North Dakota (ND) | 86.1 | 6 |
At the median contracted rate, this code models a −$12,526 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 1,005 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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