Adcetris (J9042): what insurers contract to pay

Brentuximab Vedotin · Specialty pharmacy

CareCost Research · Reviewed by Erin Rose

Adcetris (J9042) carries a median commercial contracted rate of 96.2 on the Medicare ASP=100 index — 6.3% below the 102.7 typical-acquisition benchmark and 7.8% below the 104.3 Medicare payment line. 58 insurers report contracted rates across 52 states (1,010 priced cells), covering $142M in modeled Part B spend. It ranks #22 of 25 on the CareCost Buy-and-Bill Risk List, with a risk score of 68.2 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).

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
Regence Idaho	110.1	+7.2%	45	6
BlueCross BlueShield of Nebraska	108.8	+5.9%	34	7
Regence Utah	107.5	+4.7%	50	5
BlueCross BlueShield of South Carolina	107.5	+4.7%	55	6
Regence BlueCross BlueShield	105.9	+3.1%	56	14
Regence Washington	105.8	+3.0%	75	5
BlueCross BlueShield of Arkansas	104.3	+1.6%	48	21
BCBS North Dakota	104.3	+1.6%	139	3
Wellmark BCBS (Iowa/South Dakota)	101.4	−1.3%	78	10
Anthem Massachusetts	99.9	−2.7%	58	25
Capital Blue Cross	99.8	−2.8%	92	35
Aetna	99.5	−3.1%	622	51
BlueCross BlueShield of Kansas	99.4	−3.2%	60	5
Blue Cross NC	98.9	−3.7%	187	52
Blue Shield of California	98.0	−4.6%	61	4
Anthem California	98.0	−4.6%	64	4
Premera Blue Cross	97.8	−4.8%	103	9
BlueCross BlueShield of Minnesota	97.3	−5.3%	68	7
Anthem Virginia	96.2	−6.3%	72	20
UnitedHealthcare	96.2	−6.3%	1,068	52
Anthem Wisconsin	96.2	−6.3%	140	5
BlueCross BlueShield of Wyoming	96.2	−6.3%	44	7
Anthem Missouri	96.2	−6.3%	44	10
CareFirst BlueCross BlueShield	96.2	−6.3%	58	19
Anthem Kentucky	96.2	−6.3%	85	9
BlueCross BlueShield of Massachusetts	96.2	−6.3%	43	4
Harvard Pilgrim Health Care	96.2	−6.3%	229	10
Anthem Nevada	96.1	−6.4%	194	4
Cigna	96.1	−6.4%	636	52
Kaiser Permanente	96.1	−6.4%	312	8
BlueCross BlueShield of Rhode Island	96.1	−6.4%	291	3
Regence Oregon	96.1	−6.4%	58	7
Anthem New York	96.1	−6.4%	72	15
BlueCross BlueShield of Alabama	96.1	−6.4%	91	6
Anthem Maine	96.1	−6.4%	65	5
Anthem Ohio	96.1	−6.4%	78	13
Anthem Georgia	96.1	−6.4%	64	16
Anthem New Hampshire	96.1	−6.4%	49	7
Anthem Connecticut	96.1	−6.4%	66	5
Florida Blue	96.1	−6.4%	32	5
Anthem Indiana	96.1	−6.4%	136	25
BlueCross BlueShield of Michigan	93.1	−9.3%	63	7
Centene	92.6	−9.8%	47	12
Blue Cross of Idaho	92.6	−9.8%	58	6
BlueCross BlueShield of Louisiana	92.6	−9.8%	54	7
BlueCross BlueShield of Tennessee	92.6	−9.8%	61	10
HMSA (BCBS Hawaii)	88.8	−13.5%	69	4
BlueCross BlueShield of Texas	86.5	−15.8%	35	6
Horizon BCBS of New Jersey	85.6	−16.7%	42	6
BlueCross BlueShield of Arizona	80.8	−21.3%	38	19

The price history

Medicare's payment limit for Adcetris moved +36.7% 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	$155M	1.1
2020	$161M	1.1
2021	$164M	1.0
2022	$186M	0.9
2023	$193M	0.9
2024	$187M	—
2025	$142M	—

Where it pays most and least

Highest-paying states	Index	Insurers
Nebraska (NE)	108.8	8
Alaska (AK)	104.9	7
Idaho (ID)	104.2	12
South Dakota (SD)	101.4	8
Arkansas (AR)	100.7	9

Lowest-paying states	Index	Insurers
Maryland (MD)	96.2	13
Mississippi (MS)	96.1	11
Florida (FL)	96.1	34
New York (NY)	96.1	22
Alabama (AL)	96.1	12

What this means in dollars

At the median contracted rate, this code models a −$6,283 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 1,010 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: Truxima · Yervoy · Enhertu · report home · methodology