Entyvio (J3380): what insurers contract to pay

Vedolizumab · Gastroenterology

CareCost Research · Reviewed by Erin Rose

Entyvio (J3380) carries a median commercial contracted rate of 98.8 on the Medicare ASP=100 index — 3.8% below the 102.7 typical-acquisition benchmark and 5.3% below the 104.3 Medicare payment line. 59 insurers report contracted rates across 52 states (1,053 priced cells), covering $574M in modeled Part B spend. It ranks #14 of 25 on the CareCost Buy-and-Bill Risk List, with a risk score of 72.3 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 Wyoming	158.9	+54.7%	44	7
BlueCross BlueShield of South Carolina	144.7	+40.9%	55	6
HMSA (BCBS Hawaii)	144.3	+40.5%	80	3
Premera Blue Cross	120.3	+17.1%	102	9
Regence Idaho	113.2	+10.2%	45	6
BlueCross BlueShield of Nebraska	111.9	+9.0%	34	7
Regence Utah	110.5	+7.6%	50	5
Blue Shield of California	108.7	+5.8%	118	4
Blue Cross of Idaho	108.7	+5.8%	58	6
BlueCross BlueShield of Texas	108.4	+5.6%	46	22
BCBS North Dakota	107.3	+4.5%	139	3
BlueCross BlueShield of Arkansas	107.2	+4.4%	48	21
BlueCross BlueShield of Louisiana	105.4	+2.6%	54	7
Blue Cross NC	104.4	+1.7%	187	52
Aetna	103.8	+1.1%	668	51
Capital Blue Cross	102.6	−0.1%	92	35
BlueCross BlueShield of Kansas	102.2	−0.5%	60	5
Anthem Massachusetts	100.6	−2.0%	64	25
Anthem Indiana	98.8	−3.8%	136	25
Anthem New York	98.8	−3.8%	72	15
Centene	98.8	−3.8%	188	26
Cigna	98.8	−3.8%	649	51
Kaiser Permanente	98.8	−3.8%	312	8
BlueCross BlueShield of Rhode Island	98.8	−3.8%	291	3
Florida Blue	98.8	−3.8%	32	5
Anthem Maine	98.8	−3.8%	65	5
Regence Washington	98.8	−3.8%	75	5
Anthem New Hampshire	98.8	−3.8%	49	7
Anthem Georgia	98.8	−3.8%	64	16
Anthem Ohio	98.8	−3.8%	78	13
BlueCross BlueShield of Alabama	98.8	−3.8%	91	6
Regence Oregon	98.8	−3.8%	64	7
CareFirst BlueCross BlueShield	98.8	−3.8%	58	19
Anthem Missouri	98.8	−3.8%	44	8
Anthem Connecticut	98.8	−3.8%	66	5
Anthem Nevada	98.8	−3.8%	194	4
UnitedHealthcare	98.8	−3.8%	1,080	51
Anthem California	98.7	−3.9%	64	4
BlueCross BlueShield of Minnesota	98.6	−4.0%	68	7
BlueCross BlueShield of Tennessee	98.6	−4.0%	61	10
Wellmark BCBS (Iowa/South Dakota)	98.6	−4.0%	78	10
Anthem Virginia	97.9	−4.7%	72	20
Horizon BCBS of New Jersey	97.9	−4.7%	42	6
Harvard Pilgrim Health Care	97.0	−5.6%	229	10
Anthem Kentucky	97.0	−5.6%	85	9
Regence BlueCross BlueShield	97.0	−5.6%	58	14
BlueCross BlueShield of Massachusetts	97.0	−5.6%	55	6
Anthem Wisconsin	97.0	−5.6%	140	5
BlueCross BlueShield of Michigan	95.6	−6.9%	63	7
BlueCross BlueShield of Arizona	82.1	−20.1%	38	19

The price history

Medicare's payment limit for Entyvio moved -1.5% 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	$334M	18.7
2020	$434M	23.6
2021	$527M	27.8
2022	$674M	31.2
2023	$728M	33.6
2024	$770M	—
2025	$574M	—

Where it pays most and least

Highest-paying states	Index	Insurers
Alaska (AK)	148.3	7
Hawaii (HI)	114.5	7
Idaho (ID)	110.8	12
Utah (UT)	108.5	12
Oregon (OR)	108.5	14

Lowest-paying states	Index	Insurers
New Jersey (NJ)	98.8	14
Rhode Island (RI)	98.8	9
Tennessee (TN)	98.8	19
South Dakota (SD)	98.8	8
Texas (TX)	98.8	36

Getting paid for it

Prior authorization required	94% of policies
Site-of-care steering	39% of policies
Pharmacy (white-bag) channel multiple	1.520×
Drug class	integrin (alpha4beta7) 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 −$3,764 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 1,053 priced contract cells across 59 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: Kyprolis · Krystexxa · Enhertu · report home · methodology