Octreotide Acetate Er (J2353): what insurers contract to pay

Octreotide Acetate,mi-spheres · Hematology-Oncology

CareCost Research · Reviewed by Erin Rose

Octreotide Acetate Er (J2353) carries a median commercial contracted rate of 96.6 on the Medicare ASP=100 index — 5.9% below the 102.7 typical-acquisition benchmark and 7.4% below the 104.3 Medicare payment line. 58 insurers report contracted rates across 52 states (1,017 priced cells), covering $343M in modeled Part B spend. It ranks #2 of 25 on the CareCost Buy-and-Bill Risk List, with a risk score of 82.2 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), 146.4 (NADAC-measured acquisition, see below).

What each insurer contracts to pay

All 49 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 Nebraska	117.4	+14.3%	34	7
BlueCross BlueShield of South Carolina	114.8	+11.8%	55	6
BlueCross BlueShield of Texas	111.3	+8.4%	42	10
HMSA (BCBS Hawaii)	111.0	+8.1%	69	4
Regence Idaho	109.6	+6.7%	45	6
Premera Blue Cross	107.7	+4.9%	103	9
Regence Utah	107.0	+4.2%	50	5
Blue Cross of Idaho	105.3	+2.5%	58	6
BlueCross BlueShield of Louisiana	104.7	+1.9%	54	7
BlueCross BlueShield of Arkansas	103.8	+1.1%	48	21
BCBS North Dakota	103.8	+1.1%	139	3
Aetna	100.5	−2.1%	715	51
Capital Blue Cross	99.3	−3.3%	92	35
BlueCross BlueShield of Kansas	99.0	−3.6%	60	5
Blue Cross NC	98.4	−4.2%	187	52
Horizon BCBS of New Jersey	98.3	−4.3%	42	6
BlueCross BlueShield of Wyoming	97.8	−4.8%	44	7
Centene	97.8	−4.8%	142	18
Wellmark BCBS (Iowa/South Dakota)	97.8	−4.8%	78	10
BlueCross BlueShield of Tennessee	97.8	−4.8%	61	10
BlueCross BlueShield of Minnesota	97.8	−4.8%	68	7
Blue Shield of California	97.5	−5.1%	61	4
Anthem California	96.8	−5.7%	64	4
Anthem Connecticut	95.7	−6.8%	66	5
Anthem Ohio	95.7	−6.8%	78	13
BlueCross BlueShield of Alabama	95.7	−6.8%	91	6
Anthem Maine	95.7	−6.8%	65	5
Florida Blue	95.7	−6.8%	32	5
Anthem Georgia	95.7	−6.8%	64	16
Anthem New York	95.7	−6.8%	72	15
BlueCross BlueShield of Rhode Island	95.7	−6.8%	291	3
Anthem Nevada	95.7	−6.8%	194	4
Anthem Indiana	95.7	−6.8%	136	25
CareFirst BlueCross BlueShield	95.7	−6.8%	58	19
Anthem New Hampshire	95.7	−6.8%	42	7
Regence Oregon	95.7	−6.8%	58	7
Regence Washington	95.7	−6.8%	75	5
UnitedHealthcare	95.7	−6.8%	1,080	51
Cigna	95.7	−6.8%	636	52
Kaiser Permanente	95.7	−6.8%	312	8
Anthem Massachusetts	93.9	−8.6%	64	25
Anthem Virginia	93.1	−9.3%	72	20
Anthem Wisconsin	90.5	−11.9%	154	5
Anthem Kentucky	90.5	−11.9%	92	8
Anthem Missouri	90.5	−11.9%	37	10
Regence BlueCross BlueShield	90.5	−11.9%	56	14
Harvard Pilgrim Health Care	90.5	−11.9%	229	10
BlueCross BlueShield of Arizona	80.4	−21.7%	38	19
BlueCross BlueShield of Michigan	76.0	−26.0%	63	7

The price history

Medicare's payment limit for Octreotide Acetate Er moved -8.8% 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	$432M	2.4
2020	$445M	2.4
2021	$433M	2.4
2022	$458M	2.3
2023	$447M	2.2
2024	$451M	—
2025	$343M	—

The margin picture

NADAC-measured acquisition cost for Octreotide Acetate Er runs $260.07/unit as of 2026-03-18 — an acquisition index of 146.4 (ASP = 100).

At the median contracted index of 96.6, that implies a modeled gross margin of -49.8 points per ASP-unit — roughly −$97.77/unit at the latest ASP of $196.32.

Modeled from NADAC acquisition, medium confidence — your invoice price governs.

Where it pays most and least

Highest-paying states	Index	Insurers
Hawaii (HI)	108.7	7
Alaska (AK)	106.7	7
Oregon (OR)	105.3	13
Idaho (ID)	104.5	12
Arkansas (AR)	103.8	9

Lowest-paying states	Index	Insurers
Massachusetts (MA)	95.7	18
District of Columbia (DC)	95.7	9
Illinois (IL)	95.7	28
Arizona (AZ)	95.7	21
Delaware (DE)	95.7	7

The Octreotide family

Code	Brand	Index	Insurers	Part B spend
J2354	Octreotide Acetate	110.7	55	$0M
J2353	Octreotide Acetate Er	96.6	58	$343M

Within this family, Octreotide Acetate (J2354) contracts 14.1 points higher on the ASP=100 index than Octreotide Acetate Er (J2353) — 110.7 vs. 96.6.

What this means in dollars

At the median contracted rate, this code models a −$5,925 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 1,017 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.

See also: Enhertu · Orencia · report home · methodology