Kyprolis (J9047): what insurers contract to pay

Carfilzomib · Hematology-Oncology

CareCost Research · Reviewed by Erin Rose

Kyprolis (J9047) carries a median commercial contracted rate of 94.5 on the Medicare ASP=100 index — 8.0% below the 102.7 typical-acquisition benchmark and 9.4% below the 104.3 Medicare payment line. 57 insurers report contracted rates across 52 states (1,009 priced cells), covering $291M in modeled Part B spend. It ranks #13 of 25 on the CareCost Buy-and-Bill Risk List, with a risk score of 73.3 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 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 South Carolina	119.3	+16.2%	55	6
BlueCross BlueShield of Nebraska	113.1	+10.1%	34	7
BlueCross BlueShield of Wyoming	106.7	+3.9%	44	7
Regence Idaho	105.6	+2.8%	45	6
Regence Utah	103.1	+0.4%	50	5
Regence BlueCross BlueShield	102.6	−0.1%	56	14
Blue Shield of California	101.5	−1.2%	118	4
Regence Washington	101.5	−1.2%	75	5
BlueCross BlueShield of Texas	101.2	−1.5%	39	8
Wellmark BCBS (Iowa/South Dakota)	101.0	−1.7%	78	10
BCBS North Dakota	100.1	−2.5%	139	3
BlueCross BlueShield of Arkansas	100.1	−2.5%	48	21
Blue Cross of Idaho	99.7	−2.9%	58	6
BlueCross BlueShield of Louisiana	98.8	−3.8%	54	7
BlueCross BlueShield of Minnesota	96.9	−5.6%	68	7
Centene	96.8	−5.7%	150	10
Aetna	96.8	−5.7%	582	51
Anthem Massachusetts	96.8	−5.7%	64	25
Premera Blue Cross	96.5	−6.0%	102	9
Anthem California	95.8	−6.7%	64	4
Capital Blue Cross	95.7	−6.8%	92	35
Blue Cross NC	95.7	−6.8%	187	52
HMSA (BCBS Hawaii)	95.6	−6.9%	80	3
BlueCross BlueShield of Kansas	95.4	−7.1%	60	5
Anthem Wisconsin	93.3	−9.2%	100	7
Harvard Pilgrim Health Care	93.3	−9.2%	229	10
Anthem Kentucky	93.3	−9.2%	85	9
UnitedHealthcare	93.3	−9.2%	1,068	52
Anthem Missouri	93.3	−9.2%	40	9
Anthem Virginia	92.8	−9.6%	72	20
BlueCross BlueShield of Tennessee	92.3	−10.1%	61	10
Cigna	92.2	−10.2%	608	52
CareFirst BlueCross BlueShield	92.2	−10.2%	58	19
Anthem New York	92.2	−10.2%	69	15
Regence Oregon	92.2	−10.2%	58	7
Anthem Nevada	92.2	−10.2%	194	4
BlueCross BlueShield of Alabama	92.2	−10.2%	91	6
Kaiser Permanente	92.2	−10.2%	312	8
Florida Blue	92.2	−10.2%	32	5
BlueCross BlueShield of Rhode Island	92.2	−10.2%	291	3
Anthem Georgia	92.2	−10.2%	64	16
Anthem New Hampshire	92.2	−10.2%	42	7
Anthem Ohio	92.2	−10.2%	78	13
Anthem Indiana	92.2	−10.2%	136	25
Anthem Maine	92.2	−10.2%	65	5
Anthem Connecticut	92.2	−10.2%	66	5
BlueCross BlueShield of Michigan	89.3	−13.0%	63	7
Horizon BCBS of New Jersey	86.0	−16.3%	42	6
BlueCross BlueShield of Arizona	77.5	−24.5%	38	19

The price history

Medicare's payment limit for Kyprolis moved +36.8% 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	$276M	8.3
2020	$293M	8.5
2021	$308M	8.5
2022	$367M	8.8
2023	$401M	8.9
2024	$397M	—
2025	$291M	—

Where it pays most and least

Highest-paying states	Index	Insurers
Alaska (AK)	110.0	7
Nebraska (NE)	105.4	9
Idaho (ID)	104.4	12
Utah (UT)	102.6	12
South Dakota (SD)	100.9	8

Lowest-paying states	Index	Insurers
Tennessee (TN)	92.5	18
Mississippi (MS)	92.3	11
Massachusetts (MA)	92.2	18
Maryland (MD)	92.2	13

What this means in dollars

At the median contracted rate, this code models a −$7,944 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 1,009 priced contract cells across 57 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: Opdivo · Entyvio · Enhertu · report home · methodology