Gammagard Liquid (J1569): what insurers contract to pay

Immun Glob G · Hematology-Oncology

CareCost Research · Reviewed by Erin Rose

Gammagard Liquid (J1569) carries a median commercial contracted rate of 99.5 on the Medicare ASP=100 index — 3.1% below the 102.7 typical-acquisition benchmark and 4.6% below the 104.3 Medicare payment line. 58 insurers report contracted rates across 52 states (1,034 priced cells), covering $570M in modeled Part B spend. It ranks #17 of 25 on the CareCost Buy-and-Bill Risk List, with a risk score of 69.3 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 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 South Carolina	183.7	+78.9%	55	6
BlueCross BlueShield of Wyoming	180.6	+75.9%	44	7
BlueCross BlueShield of Nebraska	117.6	+14.5%	34	7
Anthem Georgia	115.2	+12.2%	64	16
HMSA (BCBS Hawaii)	114.8	+11.8%	69	4
Premera Blue Cross	114.3	+11.3%	102	9
Regence Idaho	109.8	+6.9%	45	6
Regence BlueCross BlueShield	109.5	+6.6%	58	14
Regence Utah	107.2	+4.4%	50	5
Blue Shield of California	106.3	+3.5%	118	4
Blue Cross of Idaho	105.5	+2.7%	67	6
Regence Washington	105.5	+2.7%	75	5
BlueCross BlueShield of Arkansas	104.1	+1.4%	48	21
BCBS North Dakota	104.1	+1.4%	139	3
BlueCross BlueShield of Kansas	103.7	+1.0%	60	5
BlueCross BlueShield of Texas	103.6	+0.9%	36	13
Anthem Massachusetts	103.3	+0.6%	64	25
Blue Cross NC	101.3	−1.4%	187	52
Aetna	100.7	−1.9%	736	51
Harvard Pilgrim Health Care	99.5	−3.1%	229	10
Anthem Kentucky	99.5	−3.1%	85	9
Anthem Wisconsin	99.5	−3.1%	140	5
Anthem Missouri	99.5	−3.1%	42	9
Capital Blue Cross	99.5	−3.1%	92	35
BlueCross BlueShield of Louisiana	98.3	−4.3%	54	7
Anthem Virginia	97.7	−4.9%	72	20
Anthem Nevada	95.9	−6.6%	194	4
Anthem Connecticut	95.9	−6.6%	66	5
Anthem New York	95.9	−6.6%	72	15
BlueCross BlueShield of Rhode Island	95.9	−6.6%	291	3
Regence Oregon	95.9	−6.6%	64	7
Anthem Ohio	95.9	−6.6%	83	12
Anthem New Hampshire	95.9	−6.6%	49	7
CareFirst BlueCross BlueShield	95.9	−6.6%	58	19
BlueCross BlueShield of Massachusetts	95.9	−6.6%	70	1
UnitedHealthcare	95.9	−6.6%	1,080	51
Centene	95.9	−6.6%	218	26
Florida Blue	95.9	−6.6%	32	5
Anthem Indiana	95.9	−6.6%	136	25
BlueCross BlueShield of Alabama	95.9	−6.6%	91	6
Anthem Maine	95.9	−6.6%	65	5
Kaiser Permanente	95.9	−6.6%	312	8
Cigna	95.9	−6.6%	636	52
Horizon BCBS of New Jersey	94.2	−8.3%	42	6
Anthem California	93.9	−8.6%	64	4
BlueCross BlueShield of Michigan	92.8	−9.6%	63	7
BlueCross BlueShield of Minnesota	91.9	−10.5%	73	6
BlueCross BlueShield of Tennessee	91.9	−10.5%	61	10
Wellmark BCBS (Iowa/South Dakota)	91.9	−10.5%	78	10
BlueCross BlueShield of Arizona	80.2	−21.9%	38	19

The price history

Medicare's payment limit for Gammagard Liquid moved +5.2% 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	$359M	9.8
2020	$389M	10.4
2021	$505M	12.3
2022	$632M	14.3
2023	$740M	16.5
2024	$765M	—
2025	$570M	—

Where it pays most and least

Highest-paying states	Index	Insurers
Alaska (AK)	126.7	7
Wyoming (WY)	117.6	5
Hawaii (HI)	109.8	7
Idaho (ID)	107.9	12
Utah (UT)	107.2	12

Lowest-paying states	Index	Insurers
Massachusetts (MA)	95.9	18
Delaware (DE)	95.9	7
Maryland (MD)	95.9	13
Nevada (NV)	95.9	12

What this means in dollars

At the median contracted rate, this code models a −$3,069 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 1,034 priced contract cells across 58 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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