Privigen (J1459): what insurers contract to pay

Immun Glob G · Neurology

CareCost Research · Reviewed by Erin Rose

Privigen (J1459) carries a median commercial contracted rate of 99.1 on the Medicare ASP=100 index — 3.5% below the 102.7 typical-acquisition benchmark and 5.0% below the 104.3 Medicare payment line. 57 insurers report contracted rates across 52 states (1,016 priced cells), covering $360M in modeled Part B spend. It ranks #25 of 25 on the CareCost Buy-and-Bill Risk List, with a risk score of 67.1 out of 100.

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 48 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 Wyoming	196.8	+91.6%	44	7
BlueCross BlueShield of South Carolina	186.1	+81.2%	55	6
BlueCross BlueShield of Alabama	125.0	+21.7%	91	6
HMSA (BCBS Hawaii)	119.1	+16.0%	69	4
Premera Blue Cross	116.1	+13.0%	102	9
Regence Idaho	112.4	+9.4%	45	6
BlueCross BlueShield of Nebraska	111.1	+8.2%	34	7
Regence Utah	109.7	+6.8%	50	5
BlueCross BlueShield of Texas	108.7	+5.8%	45	22
Blue Shield of California	108.0	+5.2%	118	4
Blue Cross of Idaho	108.0	+5.2%	67	6
Anthem Georgia	107.2	+4.4%	64	16
BlueCross BlueShield of Arkansas	106.5	+3.7%	48	21
BCBS North Dakota	106.5	+3.7%	139	3
BlueCross BlueShield of Kansas	106.4	+3.6%	60	5
BlueCross BlueShield of Louisiana	106.0	+3.2%	54	7
Blue Cross NC	104.7	+1.9%	187	52
Aetna	103.1	+0.4%	758	51
Capital Blue Cross	101.9	−0.8%	92	35
Anthem Massachusetts	100.4	−2.2%	64	25
BlueCross BlueShield of Minnesota	99.1	−3.5%	54	6
BlueCross BlueShield of Tennessee	99.1	−3.5%	61	10
Wellmark BCBS (Iowa/South Dakota)	99.1	−3.5%	78	10
Anthem California	98.6	−4.0%	64	4
Florida Blue	98.2	−4.4%	32	5
Regence Washington	98.2	−4.4%	75	5
UnitedHealthcare	98.2	−4.4%	1,080	51
CareFirst BlueCross BlueShield	98.2	−4.4%	58	19
Anthem Connecticut	98.2	−4.4%	66	5
Anthem Indiana	98.2	−4.4%	136	25
Anthem Ohio	98.2	−4.4%	78	13
Anthem New York	98.2	−4.4%	72	15
Anthem Nevada	98.2	−4.4%	194	4
Regence Oregon	98.2	−4.4%	64	7
Anthem New Hampshire	98.2	−4.4%	49	7
BlueCross BlueShield of Rhode Island	98.2	−4.4%	291	3
Anthem Maine	98.2	−4.4%	65	5
Cigna	98.2	−4.4%	649	51
Kaiser Permanente	98.2	−4.4%	312	8
Anthem Virginia	97.4	−5.2%	72	20
Anthem Missouri	97.4	−5.2%	48	10
Harvard Pilgrim Health Care	96.7	−5.8%	229	10
Anthem Kentucky	96.7	−5.8%	92	8
Regence BlueCross BlueShield	96.7	−5.8%	58	14
Anthem Wisconsin	96.7	−5.8%	92	6
Horizon BCBS of New Jersey	95.4	−7.1%	41	6
BlueCross BlueShield of Michigan	95.0	−7.5%	63	7
BlueCross BlueShield of Arizona	82.5	−19.7%	38	19

The price history

Medicare's payment limit for Privigen moved +10.1% 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	$330M	9.5
2020	$334M	9.4
2021	$312M	8.3
2022	$339M	7.6
2023	$377M	8.1
2024	$440M	—
2025	$360M	—

Where it pays most and least

Highest-paying states	Index	Insurers
Alaska (AK)	126.0	7
Wyoming (WY)	118.5	5
Hawaii (HI)	115.5	7
Nebraska (NE)	110.3	8
Idaho (ID)	108.7	12

Lowest-paying states	Index	Insurers
Georgia (GA)	98.2	23
New Jersey (NJ)	98.2	13
Kentucky (KY)	98.2	12
Tennessee (TN)	98.2	18
Rhode Island (RI)	98.2	8

What this means in dollars

At the median contracted rate, this code models a −$3,538 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 1,016 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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