Hizentra (J1559): what insurers contract to pay

Immun Glob G · Specialty pharmacy

CareCost Research · Reviewed by Erin Rose

Hizentra (J1559) carries a median commercial contracted rate of 97.7 on the Medicare ASP=100 index — 4.9% below the 102.7 typical-acquisition benchmark and 6.3% below the 104.3 Medicare payment line. 57 insurers report contracted rates across 52 states (1,001 priced cells), covering $247M in modeled Part B spend. It ranks #24 of 25 on the CareCost Buy-and-Bill Risk List, with a risk score of 67.2 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 South Carolina	175.4	+70.8%	56	6
BlueCross BlueShield of Wyoming	170.1	+65.6%	44	7
Regence Idaho	111.9	+9.0%	45	6
Premera Blue Cross	111.9	+9.0%	102	9
BlueCross BlueShield of Nebraska	110.6	+7.7%	34	7
Regence Utah	109.2	+6.3%	50	5
Blue Cross of Idaho	107.4	+4.6%	67	6
Blue Shield of California	106.2	+3.4%	118	4
BCBS North Dakota	106.0	+3.2%	139	3
BlueCross BlueShield of Arkansas	106.0	+3.2%	48	21
BlueCross BlueShield of Kansas	105.6	+2.8%	60	5
Anthem Georgia	105.3	+2.5%	63	16
Blue Cross NC	104.1	+1.4%	187	52
BlueCross BlueShield of Texas	103.8	+1.1%	42	10
BlueCross BlueShield of Louisiana	103.1	+0.4%	54	7
Capital Blue Cross	101.4	−1.3%	92	35
HMSA (BCBS Hawaii)	101.1	−1.6%	69	4
Anthem Massachusetts	101.1	−1.6%	64	25
Aetna	100.8	−1.9%	704	51
Cigna	97.7	−4.9%	636	52
Anthem New Hampshire	97.7	−4.9%	49	7
Anthem Nevada	97.7	−4.9%	194	4
Anthem Missouri	97.7	−4.9%	40	11
Anthem Maine	97.7	−4.9%	65	5
Regence Oregon	97.7	−4.9%	64	7
Kaiser Permanente	97.7	−4.9%	312	8
Anthem New York	97.7	−4.9%	72	15
Anthem Indiana	97.7	−4.9%	136	25
BlueCross BlueShield of Rhode Island	97.7	−4.9%	291	3
Anthem Connecticut	97.7	−4.9%	66	5
Anthem Ohio	97.7	−4.9%	80	12
Centene	97.7	−4.9%	43	9
UnitedHealthcare	97.7	−4.9%	1,080	51
Regence Washington	97.7	−4.9%	75	5
Florida Blue	97.7	−4.9%	32	5
CareFirst BlueCross BlueShield	97.7	−4.9%	58	19
Anthem Virginia	97.6	−5.0%	72	20
Anthem Kentucky	97.6	−5.0%	92	8
Anthem Wisconsin	97.6	−5.0%	146	6
Harvard Pilgrim Health Care	97.6	−5.0%	229	10
Regence BlueCross BlueShield	97.6	−5.0%	58	14
Anthem California	97.0	−5.6%	64	4
BlueCross BlueShield of Tennessee	96.4	−6.1%	61	10
Wellmark BCBS (Iowa/South Dakota)	96.4	−6.1%	78	10
BlueCross BlueShield of Minnesota	96.4	−6.1%	68	7
BlueCross BlueShield of Michigan	94.5	−8.0%	63	7
Horizon BCBS of New Jersey	91.6	−10.8%	42	6
BlueCross BlueShield of Arizona	82.1	−20.1%	38	19

The price history

Medicare's payment limit for Hizentra moved +23.2% 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.

Part B utilization

Year	Part B spend	Dosage units (M)
2019	$167M	16.6
2020	$202M	19.1
2021	$223M	19.8
2022	$270M	22.7
2023	$294M	23.6
2024	$318M	—
2025	$247M	—

Where it pays most and least

Highest-paying states	Index	Insurers
Alaska (AK)	125.3	7
Wyoming (WY)	118.0	5
Idaho (ID)	108.2	12
Nebraska (NE)	108.1	9
Utah (UT)	107.4	12

Lowest-paying states	Index	Insurers
New Jersey (NJ)	97.7	12
Kentucky (KY)	97.7	13
Rhode Island (RI)	97.7	8
South Dakota (SD)	97.7	8
Florida (FL)	97.7	33

What this means in dollars

At the median contracted rate, this code models a −$4,873 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 1,001 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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