Botox (J0585): what insurers contract to pay

Onabotulinumtoxina · Neurology

CareCost Research · Reviewed by Erin Rose

Botox (J0585) carries a median commercial contracted rate of 100.1 on the Medicare ASP=100 index — 2.5% below the 102.7 typical-acquisition benchmark and 4.0% below the 104.3 Medicare payment line. 59 insurers report contracted rates across 52 states (1,063 priced cells), covering $395M in modeled Part B spend.

Contracted rate range across insurers

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).

What each insurer contracts to pay

All 52 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 Texas	122.0	+18.8%	46	17
Regence Idaho	120.0	+16.8%	45	6
BlueCross BlueShield of South Carolina	120.0	+16.8%	57	6
BlueCross BlueShield of New Mexico	117.7	+14.6%	210	3
BlueCross BlueShield of Nebraska	113.3	+10.3%	34	7
BlueCross BlueShield of Oklahoma	113.3	+10.3%	83	2
Regence Utah	110.1	+7.2%	46	5
BlueCross BlueShield of Arkansas	108.5	+5.6%	48	21
BCBS North Dakota	108.5	+5.6%	139	3
BlueCross BlueShield of Kansas	107.6	+4.8%	60	5
Premera Blue Cross	105.6	+2.8%	102	9
Aetna	104.7	+1.9%	762	51
HMSA (BCBS Hawaii)	104.4	+1.7%	80	3
Capital Blue Cross	103.9	+1.2%	92	35
Anthem Massachusetts	103.8	+1.1%	64	25
Blue Shield of California	102.8	+0.1%	120	4
Blue Cross NC	102.8	+0.1%	187	52
Blue Cross of Idaho	102.1	−0.6%	58	6
BlueCross BlueShield of Wyoming	102.1	−0.6%	44	7
BlueCross BlueShield of Louisiana	100.8	−1.9%	54	7
Kaiser Permanente	100.1	−2.5%	312	8
UnitedHealthcare	100.1	−2.5%	1,080	51
Anthem Kentucky	100.1	−2.5%	85	9
Anthem Georgia	100.1	−2.5%	72	15
Anthem Ohio	100.1	−2.5%	80	12
Anthem New Hampshire	100.1	−2.5%	78	7
BlueCross BlueShield of Alabama	100.1	−2.5%	91	6
Anthem Wisconsin	100.1	−2.5%	154	5
Anthem Maine	100.1	−2.5%	76	5
BlueCross BlueShield of Rhode Island	100.1	−2.5%	291	3
Regence Washington	100.1	−2.5%	74	5
Florida Blue	100.1	−2.5%	32	5
Centene	100.1	−2.5%	510	37
Anthem Virginia	100.1	−2.5%	74	20
BlueCross BlueShield of Massachusetts	100.1	−2.5%	57	10
Anthem Indiana	100.1	−2.5%	141	24
Anthem New York	100.1	−2.5%	72	15
Regence Oregon	100.1	−2.5%	58	7
Regence BlueCross BlueShield	100.1	−2.5%	56	14
Anthem Nevada	100.1	−2.5%	194	4
Anthem Missouri	100.1	−2.5%	44	11
Anthem Connecticut	100.1	−2.5%	66	5
Harvard Pilgrim Health Care	100.1	−2.5%	229	10
CareFirst BlueCross BlueShield	100.1	−2.5%	59	18
Anthem California	100.0	−2.6%	64	4
Wellmark BCBS (Iowa/South Dakota)	99.9	−2.7%	78	10
BlueCross BlueShield of Minnesota	99.9	−2.7%	79	8
BlueCross BlueShield of Tennessee	99.9	−2.7%	61	10
Horizon BCBS of New Jersey	99.6	−3.0%	42	6
Cigna	96.2	−6.3%	636	52
BlueCross BlueShield of Michigan	95.1	−7.4%	63	7
BlueCross BlueShield of Arizona	84.1	−18.1%	38	19

The price history

Medicare's payment limit for Botox moved +5.5% 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.

Part B utilization

Year	Part B spend	Dosage units (M)
2019	$367M	63.8
2020	$331M	57.0
2021	$366M	63.3
2022	$415M	68.3
2023	$445M	71.8
2024	$479M	—
2025	$395M	—

Where it pays most and least

Highest-paying states	Index	Insurers
Alaska (AK)	119.1	7
Nebraska (NE)	110.4	9
Idaho (ID)	110.1	13
Oklahoma (OK)	107.6	9
Arkansas (AR)	107.6	10

Lowest-paying states	Index	Insurers
South Carolina (SC)	100.1	9
New Jersey (NJ)	100.1	15
Rhode Island (RI)	100.1	9
North Dakota (ND)	100.1	7
Florida (FL)	100.1	35

Getting paid for it

Selected for Medicare drug price negotiation. The negotiated Maximum Fair Price (MFP) takes effect 2028-01-01; from that date CMS publishes only 106% of MFP as the benchmark for this drug, replacing ASP+6%. The figures on this page are the commercial baseline before that change.

What this means in dollars

At the median contracted rate, this code models a −$2,532 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 1,063 priced contract cells across 59 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.

See also: Privigen · Cimzia · Enhertu · report home · methodology