Cosentyx (J3247): what insurers contract to pay

Secukinumab · Rheumatology

CareCost Research · Reviewed by Erin Rose

Cosentyx (J3247) carries a median commercial contracted rate of 99.1 on the Medicare ASP=100 index — 3.5% below the 102.7 typical-acquisition benchmark and 5.0% below the 104.3 Medicare payment line. 50 insurers report contracted rates across 52 states (928 priced cells), covering $127M in modeled Part B spend.

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 42 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	118.2	+15.1%	55	6
BlueCross BlueShield of Nebraska	112.2	+9.3%	34	7
BCBS North Dakota	107.6	+4.8%	139	3
BlueCross BlueShield of Arkansas	107.6	+4.8%	48	21
BlueCross BlueShield of Kansas	107.2	+4.4%	60	5
Kaiser Permanente	106.3	+3.5%	308	8
Blue Cross NC	104.8	+2.0%	164	48
Premera Blue Cross	103.4	+0.7%	102	9
Capital Blue Cross	102.9	+0.2%	92	35
Anthem Massachusetts	102.7	+0.0%	64	25
Aetna	101.1	−1.6%	730	51
Blue Shield of California	101.0	−1.7%	112	4
Florida Blue	99.1	−3.5%	32	5
BlueCross BlueShield of Rhode Island	99.1	−3.5%	291	3
Anthem New York	99.1	−3.5%	72	15
Anthem Nevada	99.1	−3.5%	194	4
Anthem Georgia	99.1	−3.5%	66	16
Anthem New Hampshire	99.1	−3.5%	42	7
Anthem Indiana	99.1	−3.5%	136	25
CareFirst BlueCross BlueShield	99.1	−3.5%	58	19
Anthem Ohio	99.1	−3.5%	78	13
BlueCross BlueShield of Alabama	99.1	−3.5%	91	6
Cigna	99.1	−3.5%	1,243	51
Anthem Connecticut	99.1	−3.5%	66	5
UnitedHealthcare	99.1	−3.5%	1,080	51
Anthem Virginia	99.0	−3.6%	72	20
Anthem Missouri	99.0	−3.6%	42	9
Anthem Kentucky	98.9	−3.7%	85	9
Anthem Wisconsin	98.9	−3.7%	139	5
Harvard Pilgrim Health Care	98.9	−3.7%	229	10
Blue Cross of Idaho	98.5	−4.1%	58	6
Anthem California	98.5	−4.1%	64	4
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%	57	7
BlueCross BlueShield of Texas	97.5	−5.1%	42	9
Horizon BCBS of New Jersey	97.2	−5.4%	42	6
Anthem Maine	96.7	−5.8%	65	5
BlueCross BlueShield of Louisiana	95.0	−7.5%	54	7
HMSA (BCBS Hawaii)	94.7	−7.8%	69	4
BlueCross BlueShield of Michigan	85.8	−16.5%	68	10
BlueCross BlueShield of Arizona	83.3	−18.9%	38	19

The price history

Medicare's payment limit for Cosentyx moved +2.7% between Q3 2024 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)
2024	$54M	—
2025	$127M	—

Where it pays most and least

Highest-paying states	Index	Insurers
Alaska (AK)	113.6	6
Nebraska (NE)	109.7	8
Arkansas (AR)	107.5	8
Kansas (KS)	107.3	9
Oklahoma (OK)	104.8	8

Lowest-paying states	Index	Insurers
Pennsylvania (PA)	99.1	16
New York (NY)	99.1	22
Massachusetts (MA)	99.1	18
Texas (TX)	99.1	29
Louisiana (LA)	99.0	8

Getting paid for it

Prior authorization required	88% of policies
Site-of-care steering	28% of policies
Pharmacy (white-bag) channel multiple	0.920×
Drug class	IL-17A inhibitor

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 −$3,505 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 928 priced contract cells across 50 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: Cimzia · Enhertu · report home · methodology