Lanreotide Acetate (J1930): what insurers contract to pay

Hematology-Oncology

CareCost Research · Reviewed by Erin Rose

Lanreotide Acetate (J1930) carries a median commercial contracted rate of 95.4 on the Medicare ASP=100 index — 7.1% below the 102.7 typical-acquisition benchmark and 8.5% below the 104.3 Medicare payment line. 56 insurers report contracted rates across 52 states (1,019 priced cells), covering $237M in modeled Part B spend. It ranks #4 of 25 on the CareCost Buy-and-Bill Risk List, with a risk score of 79.8 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
HMSA (BCBS Hawaii)	138.1	+34.5%	69	4
Blue Cross NC	131.5	+28.0%	187	52
Horizon BCBS of New Jersey	120.2	+17.0%	42	6
BlueCross BlueShield of Texas	119.5	+16.4%	38	17
BlueCross BlueShield of Nebraska	115.9	+12.9%	34	7
Premera Blue Cross	115.5	+12.5%	102	9
BlueCross BlueShield of Wyoming	111.8	+8.9%	44	7
Regence Idaho	108.2	+5.4%	45	6
Regence Utah	105.7	+2.9%	50	5
Blue Shield of California	104.1	+1.4%	118	4
Kaiser Permanente	104.0	+1.3%	312	8
Blue Cross of Idaho	104.0	+1.3%	58	6
BCBS North Dakota	102.6	−0.1%	139	3
BlueCross BlueShield of Arkansas	102.6	−0.1%	48	21
Aetna	99.3	−3.3%	715	51
Anthem Massachusetts	99.0	−3.6%	64	25
Capital Blue Cross	98.1	−4.5%	92	35
BlueCross BlueShield of Kansas	97.8	−4.8%	60	5
BlueCross BlueShield of Louisiana	97.3	−5.3%	54	7
BlueCross BlueShield of South Carolina	95.5	−7.0%	55	6
Anthem Wisconsin	95.4	−7.1%	93	6
Anthem Missouri	95.4	−7.1%	44	11
Regence BlueCross BlueShield	95.4	−7.1%	56	14
Anthem Kentucky	95.4	−7.1%	92	8
Harvard Pilgrim Health Care	95.4	−7.1%	229	10
Anthem Virginia	95.0	−7.5%	72	20
Anthem Maine	94.6	−7.9%	65	5
Anthem Indiana	94.6	−7.9%	136	25
BlueCross BlueShield of Rhode Island	94.6	−7.9%	291	3
Anthem Georgia	94.6	−7.9%	64	16
Anthem New Hampshire	94.6	−7.9%	42	7
Anthem Ohio	94.6	−7.9%	78	13
Cigna	94.6	−7.9%	649	51
UnitedHealthcare	94.6	−7.9%	1,080	51
BlueCross BlueShield of Alabama	94.6	−7.9%	91	6
Florida Blue	94.6	−7.9%	32	5
Anthem New York	94.6	−7.9%	72	15
Anthem Nevada	94.6	−7.9%	194	4
Anthem Connecticut	94.6	−7.9%	66	5
Centene	94.6	−7.9%	334	16
Regence Washington	94.6	−7.9%	75	5
Regence Oregon	94.6	−7.9%	58	7
CareFirst BlueCross BlueShield	94.5	−8.0%	58	19
Anthem California	92.8	−9.6%	64	4
Wellmark BCBS (Iowa/South Dakota)	91.0	−11.4%	78	10
BlueCross BlueShield of Tennessee	91.0	−11.4%	61	10
BlueCross BlueShield of Minnesota	91.0	−11.4%	68	7
BlueCross BlueShield of Arizona	79.4	−22.7%	38	19

The price history

Medicare's payment limit for Lanreotide Acetate moved -46.0% 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.

Part B utilization

Year	Part B spend	Dosage units (M)
2019	$263M	4.7
2020	$340M	5.5
2021	$399M	6.4
2022	$450M	7.0
2023	$368M	6.7
2024	$354M	—
2025	$237M	—

Where it pays most and least

Highest-paying states	Index	Insurers
Hawaii (HI)	138.1	7
Alaska (AK)	131.5	7
Nebraska (NE)	109.4	9
Idaho (ID)	108.8	12
Oregon (OR)	106.4	14

Lowest-paying states	Index	Insurers
Maryland (MD)	94.6	13
Alabama (AL)	94.6	13
Iowa (IA)	94.6	10
Florida (FL)	94.6	33
Delaware (DE)	94.6	7

The Lanreotide family

Code	Brand	Index	Insurers	Part B spend
J1932	Lanreotide Acetate	188.0	56	$21M
J1930	Lanreotide Acetate	95.4	56	$237M

Within this family, Lanreotide Acetate (J1932) contracts 92.6 points higher on the ASP=100 index than Lanreotide Acetate (J1930) — 188.0 vs. 95.4.

What this means in dollars

At the median contracted rate, this code models a −$7,072 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 1,019 priced contract cells across 56 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: Orencia · Syfovre · Enhertu · report home · methodology