Ocrevus (J2350): what insurers contract to pay

Ocrelizumab · Neurology

CareCost Research · Reviewed by Erin Rose

Ocrevus (J2350) carries a median commercial contracted rate of 97.8 on the Medicare ASP=100 index — 4.8% below the 102.7 typical-acquisition benchmark and 6.2% below the 104.3 Medicare payment line. 58 insurers report contracted rates across 52 states (1,047 priced cells), covering $475M in modeled Part B spend. It ranks #8 of 25 on the CareCost Buy-and-Bill Risk List, with a risk score of 75.4 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	129.0	+25.6%	55	6
BlueCross BlueShield of Wyoming	121.1	+17.9%	44	7
Premera Blue Cross	115.5	+12.5%	102	9
HMSA (BCBS Hawaii)	114.4	+11.4%	69	4
Regence Idaho	111.4	+8.5%	45	6
BlueCross BlueShield of Nebraska	110.1	+7.2%	34	7
Regence Utah	108.8	+5.9%	50	5
BlueCross BlueShield of Texas	107.3	+4.5%	47	23
Blue Cross of Idaho	107.0	+4.2%	58	6
Blue Shield of California	105.9	+3.1%	118	4
BlueCross BlueShield of Arkansas	105.6	+2.8%	48	21
BCBS North Dakota	105.6	+2.8%	139	3
BlueCross BlueShield of Louisiana	104.3	+1.6%	54	7
Blue Cross NC	102.8	+0.1%	187	52
Aetna	102.2	−0.5%	714	51
Anthem Massachusetts	101.4	−1.3%	64	25
BlueCross BlueShield of Kansas	101.2	−1.5%	60	5
Capital Blue Cross	101.0	−1.7%	92	35
Anthem Wisconsin	97.8	−4.8%	139	6
Anthem Kentucky	97.8	−4.8%	85	9
Harvard Pilgrim Health Care	97.8	−4.8%	229	10
BlueCross BlueShield of Massachusetts	97.8	−4.8%	54	4
Regence BlueCross BlueShield	97.8	−4.8%	58	14
Anthem Missouri	97.8	−4.8%	47	10
Anthem Virginia	97.5	−5.1%	72	20
Centene	97.4	−5.2%	106	22
BlueCross BlueShield of Tennessee	97.4	−5.2%	61	10
Anthem California	97.4	−5.2%	64	4
Wellmark BCBS (Iowa/South Dakota)	97.4	−5.2%	78	10
BlueCross BlueShield of Minnesota	97.4	−5.2%	68	7
Anthem Indiana	97.3	−5.3%	136	25
Regence Oregon	97.3	−5.3%	64	7
Anthem Nevada	97.3	−5.3%	194	4
Anthem Ohio	97.3	−5.3%	78	13
Anthem Connecticut	97.3	−5.3%	66	5
Anthem New York	97.3	−5.3%	72	15
UnitedHealthcare	97.3	−5.3%	1,050	52
Anthem New Hampshire	97.3	−5.3%	49	7
BlueCross BlueShield of Rhode Island	97.3	−5.3%	291	3
BlueCross BlueShield of Alabama	97.3	−5.3%	91	6
Anthem Maine	97.3	−5.3%	65	5
Kaiser Permanente	97.3	−5.3%	312	8
Cigna	97.3	−5.3%	649	51
Florida Blue	97.3	−5.3%	32	5
CareFirst BlueCross BlueShield	97.3	−5.3%	58	19
Anthem Georgia	97.3	−5.3%	64	16
Regence Washington	97.3	−5.3%	75	5
BlueCross BlueShield of Michigan	94.2	−8.3%	63	7
Horizon BCBS of New Jersey	92.3	−10.1%	42	6
BlueCross BlueShield of Arizona	81.7	−20.4%	38	19

The price history

Medicare's payment limit for Ocrevus moved +1.2% 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	$623M	11.2
2020	$619M	11.2
2021	$608M	11.9
2022	$694M	12.0
2023	$697M	12.0
2024	$669M	—
2025	$475M	—

Where it pays most and least

Highest-paying states	Index	Insurers
Alaska (AK)	119.1	7
Hawaii (HI)	111.3	7
Idaho (ID)	108.8	12
Nebraska (NE)	108.7	8
Utah (UT)	107.5	12

Lowest-paying states	Index	Insurers
Alabama (AL)	97.4	13
Maryland (MD)	97.4	14
Arizona (AZ)	97.3	21
Delaware (DE)	97.3	7

The Ocrelizumab family

Code	Brand	Index	Insurers	Part B spend
J2351	Ocrevus Zunovo	97.9	54	$7M
J2350	Ocrevus	97.8	58	$475M

Within this family, Ocrevus Zunovo (J2351) contracts 0.1 points higher on the ASP=100 index than Ocrevus (J2350) — 97.9 vs. 97.8.

Getting paid for it

Prior authorization required	92% of policies
Site-of-care steering	24% of policies
Pharmacy (white-bag) channel multiple	1.170×
Drug class	CD20-directed cytolytic antibody

What this means in dollars

At the median contracted rate, this code models a −$4,817 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 1,047 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.

See also: Imfinzi · Prolia · Enhertu · report home · methodology