Imfinzi (J9173): what insurers contract to pay

Durvalumab · Hematology-Oncology

CareCost Research · Reviewed by Erin Rose

Imfinzi (J9173) carries a median commercial contracted rate of 98.1 on the Medicare ASP=100 index — 4.5% below the 102.7 typical-acquisition benchmark and 5.9% below the 104.3 Medicare payment line. 57 insurers report contracted rates across 52 states (1,028 priced cells), covering $823M in modeled Part B spend. It ranks #7 of 25 on the CareCost Buy-and-Bill Risk List, with a risk score of 76.9 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 Nebraska	120.3	+17.1%	34	7
BlueCross BlueShield of South Carolina	114.1	+11.1%	55	6
Regence Idaho	112.3	+9.3%	45	6
Regence Utah	109.7	+6.8%	50	5
Regence Washington	107.9	+5.1%	75	5
Regence BlueCross BlueShield	107.8	+5.0%	56	14
BCBS North Dakota	106.4	+3.6%	139	3
BlueCross BlueShield of Arkansas	106.4	+3.6%	48	21
Wellmark BCBS (Iowa/South Dakota)	105.9	+3.1%	78	10
Blue Cross NC	103.6	+0.9%	187	52
Aetna	103.0	+0.3%	572	51
Premera Blue Cross	102.4	−0.3%	103	9
BlueCross BlueShield of Wyoming	102.1	−0.6%	44	7
Capital Blue Cross	101.8	−0.9%	92	35
BlueCross BlueShield of Minnesota	101.6	−1.1%	68	7
Anthem Massachusetts	101.6	−1.1%	64	25
BlueCross BlueShield of Kansas	101.4	−1.3%	60	5
Anthem California	101.1	−1.6%	64	4
Blue Shield of California	99.9	−2.7%	118	4
Blue Cross of Idaho	99.6	−3.0%	58	6
Anthem Indiana	98.1	−4.5%	136	25
BlueCross BlueShield of Rhode Island	98.1	−4.5%	291	3
UnitedHealthcare	98.1	−4.5%	1,080	51
Centene	98.1	−4.5%	200	26
Florida Blue	98.1	−4.5%	32	5
Anthem Georgia	98.1	−4.5%	64	16
Anthem New Hampshire	98.1	−4.5%	49	7
Anthem New York	98.1	−4.5%	72	15
Regence Oregon	98.1	−4.5%	58	7
Anthem Nevada	98.1	−4.5%	194	4
CareFirst BlueCross BlueShield	98.1	−4.5%	58	19
Anthem Ohio	98.1	−4.5%	78	13
BlueCross BlueShield of Alabama	98.1	−4.5%	91	6
Anthem Maine	98.1	−4.5%	65	5
Cigna	98.1	−4.5%	721	51
Kaiser Permanente	98.1	−4.5%	312	8
Anthem Connecticut	98.1	−4.5%	66	5
Harvard Pilgrim Health Care	98.0	−4.6%	229	10
Anthem Missouri	98.0	−4.6%	47	11
Anthem Kentucky	98.0	−4.6%	85	9
Anthem Wisconsin	98.0	−4.6%	144	6
Anthem Virginia	98.0	−4.6%	72	20
BlueCross BlueShield of Tennessee	96.8	−5.7%	61	10
HMSA (BCBS Hawaii)	96.1	−6.4%	84	4
Horizon BCBS of New Jersey	95.4	−7.1%	42	6
BlueCross BlueShield of Texas	95.1	−7.4%	39	8
BlueCross BlueShield of Michigan	94.9	−7.6%	63	7
BlueCross BlueShield of Louisiana	94.3	−8.2%	54	7
BlueCross BlueShield of Arizona	82.4	−19.8%	38	19

The price history

Medicare's payment limit for Imfinzi moved +12.1% 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	$450M	6.2
2020	$506M	6.8
2021	$454M	6.5
2022	$563M	7.4
2023	$739M	9.5
2024	$843M	—
2025	$823M	—

Where it pays most and least

Highest-paying states	Index	Insurers
Alaska (AK)	111.3	7
Idaho (ID)	106.7	12
Nebraska (NE)	106.4	9
Arkansas (AR)	105.9	9
South Dakota (SD)	105.9	8

Lowest-paying states	Index	Insurers
Kentucky (KY)	98.1	13
New Jersey (NJ)	98.1	13
Maine (ME)	98.1	10
Florida (FL)	98.1	34

What this means in dollars

At the median contracted rate, this code models a −$4,489 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 1,028 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: Evenity · Ocrevus · Enhertu · report home · methodology