Xolair (J2357): what insurers contract to pay

Omalizumab · Allergy/ Immunology

CareCost Research · Reviewed by Erin Rose

Xolair (J2357) 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. 58 insurers report contracted rates across 52 states (1,041 priced cells), covering $316M in modeled Part B spend. It ranks #10 of 25 on the CareCost Buy-and-Bill Risk List, with a risk score of 74.7 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 51 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	133.4	+29.9%	55	6
BlueCross BlueShield of Wyoming	113.4	+10.4%	44	7
Regence Idaho	111.8	+8.9%	45	6
BlueCross BlueShield of Nebraska	110.5	+7.6%	34	7
Regence Utah	109.2	+6.3%	50	5
Blue Cross of Idaho	107.4	+4.6%	58	6
BCBS North Dakota	106.0	+3.2%	139	3
BlueCross BlueShield of Arkansas	106.0	+3.2%	48	21
Blue Shield of California	105.4	+2.6%	118	4
BlueCross BlueShield of Oklahoma	105.3	+2.5%	83	2
HMSA (BCBS Hawaii)	105.0	+2.2%	80	3
BlueCross BlueShield of Kansas	103.5	+0.8%	60	5
Premera Blue Cross	102.7	+0.0%	102	9
Aetna	102.5	−0.2%	835	51
Blue Cross NC	101.4	−1.3%	187	52
Capital Blue Cross	101.4	−1.3%	92	35
BlueCross BlueShield of Louisiana	99.9	−2.7%	54	7
Anthem Connecticut	97.7	−4.9%	66	5
UnitedHealthcare	97.7	−4.9%	1,080	51
Anthem Ohio	97.7	−4.9%	78	13
Anthem New Hampshire	97.7	−4.9%	49	7
Anthem Georgia	97.7	−4.9%	64	16
BlueCross BlueShield of Massachusetts	97.7	−4.9%	51	5
Anthem Indiana	97.7	−4.9%	136	25
BlueCross BlueShield of Alabama	97.7	−4.9%	91	6
BlueCross BlueShield of Rhode Island	97.7	−4.9%	291	3
Anthem Maine	97.7	−4.9%	65	5
Anthem New York	97.7	−4.9%	72	15
Regence Oregon	97.7	−4.9%	62	7
Anthem Nevada	97.7	−4.9%	194	4
Kaiser Permanente	97.7	−4.9%	312	8
Florida Blue	97.7	−4.9%	32	5
Regence Washington	97.7	−4.9%	75	5
CareFirst BlueCross BlueShield	97.7	−4.9%	58	19
Cigna	97.7	−4.9%	636	52
Anthem California	96.7	−5.8%	64	4
Centene	96.2	−6.3%	424	28
Wellmark BCBS (Iowa/South Dakota)	95.7	−6.8%	78	10
BlueCross BlueShield of Tennessee	95.7	−6.8%	61	10
BlueCross BlueShield of Minnesota	95.7	−6.8%	68	7
BlueCross BlueShield of Michigan	94.5	−8.0%	63	7
Anthem Virginia	93.7	−8.8%	72	20
BlueCross BlueShield of Texas	93.4	−9.1%	44	10
Anthem Massachusetts	93.2	−9.3%	64	25
Regence BlueCross BlueShield	89.8	−12.6%	57	14
Anthem Wisconsin	89.8	−12.6%	140	5
Harvard Pilgrim Health Care	89.8	−12.6%	229	10
Anthem Missouri	89.8	−12.6%	44	10
Anthem Kentucky	89.8	−12.6%	66	10
Horizon BCBS of New Jersey	86.1	−16.2%	42	6
BlueCross BlueShield of Arizona	82.0	−20.2%	38	19

The price history

Medicare's payment limit for Xolair moved +11.5% 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	$400M	11.9
2020	$400M	11.6
2021	$402M	11.6
2022	$420M	11.4
2023	$420M	11.2
2024	$415M	—
2025	$316M	—

Where it pays most and least

Highest-paying states	Index	Insurers
Alaska (AK)	111.5	7
Arkansas (AR)	105.5	9
Nebraska (NE)	104.0	9
Oregon (OR)	102.7	13
Idaho (ID)	102.6	12

Lowest-paying states	Index	Insurers
Ohio (OH)	97.7	17
Wyoming (WY)	97.7	5
New Jersey (NJ)	97.1	13
Vermont (VT)	97.1	9

Getting paid for it

Prior authorization required	93% of policies
Site-of-care steering	30% of policies
Pharmacy (white-bag) channel multiple	1.040×
Drug class	anti-IgE

Selected for Medicare drug price negotiation. The negotiated Maximum Fair Price (MFP) takes effect 2028-01-01; from that date CMS publishes only 106% of MFP as the benchmark for this drug, replacing ASP+6%. The figures on this page are the commercial baseline before that change.

What this means in dollars

At the median contracted rate, this code models a −$4,903 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 1,041 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: Prolia · Nplate · Enhertu · report home · methodology