Polivy (J9309): what insurers contract to pay

Polatuzumab Vedotin-piiq · Specialty pharmacy

CareCost Research · Reviewed by Erin Rose

Polivy (J9309) carries a median commercial contracted rate of 95.6 on the Medicare ASP=100 index — 6.9% below the 102.7 typical-acquisition benchmark and 8.3% below the 104.3 Medicare payment line. 57 insurers report contracted rates across 52 states (994 priced cells), covering $188M in modeled Part B spend. It ranks #16 of 25 on the CareCost Buy-and-Bill Risk List, with a risk score of 69.6 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), 93.3 (NADAC-measured acquisition, see below).

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 Nebraska	116.8	+13.7%	34	7
BlueCross BlueShield of South Carolina	111.9	+9.0%	55	6
Regence Idaho	109.1	+6.2%	45	6
Regence Utah	106.5	+3.7%	50	5
Regence BlueCross BlueShield	105.1	+2.3%	56	14
Regence Washington	104.8	+2.0%	75	5
Wellmark BCBS (Iowa/South Dakota)	104.1	+1.4%	78	10
BCBS North Dakota	103.3	+0.6%	139	3
BlueCross BlueShield of Arkansas	103.3	+0.6%	48	21
Blue Cross of Idaho	102.2	−0.5%	58	6
Blue Cross NC	100.6	−2.0%	168	48
Premera Blue Cross	100.2	−2.4%	103	9
BlueCross BlueShield of Wyoming	100.1	−2.5%	44	7
BlueCross BlueShield of Minnesota	99.9	−2.7%	69	6
Aetna	99.6	−3.0%	624	51
Anthem Massachusetts	99.2	−3.4%	64	25
Anthem California	98.8	−3.8%	64	4
Capital Blue Cross	98.8	−3.8%	92	35
BlueCross BlueShield of Kansas	98.4	−4.2%	60	5
Blue Shield of California	97.0	−5.6%	124	4
Harvard Pilgrim Health Care	95.6	−6.9%	229	10
Anthem Missouri	95.6	−6.9%	40	10
BlueCross BlueShield of Massachusetts	95.6	−6.9%	43	4
Anthem Kentucky	95.6	−6.9%	92	8
UnitedHealthcare	95.6	−6.9%	1,080	51
Anthem Wisconsin	95.6	−6.9%	139	5
Anthem Virginia	95.4	−7.1%	72	20
BlueCross BlueShield of Rhode Island	95.2	−7.3%	291	3
Anthem Ohio	95.2	−7.3%	78	13
Anthem New Hampshire	95.2	−7.3%	115	5
Cigna	95.2	−7.3%	721	51
Kaiser Permanente	95.2	−7.3%	312	8
Anthem New York	95.2	−7.3%	72	15
Anthem Georgia	95.2	−7.3%	72	15
Centene	95.2	−7.3%	212	12
BlueCross BlueShield of Tennessee	95.2	−7.3%	61	10
Anthem Connecticut	95.2	−7.3%	66	5
CareFirst BlueCross BlueShield	95.2	−7.3%	58	19
Florida Blue	95.2	−7.3%	32	5
Anthem Indiana	95.2	−7.3%	136	25
Anthem Nevada	95.2	−7.3%	194	4
Regence Oregon	95.2	−7.3%	58	7
BlueCross BlueShield of Alabama	95.2	−7.3%	91	6
Anthem Maine	95.2	−7.3%	61	5
BlueCross BlueShield of Texas	94.4	−8.1%	134	3
BlueCross BlueShield of Louisiana	93.5	−9.0%	54	7
BlueCross BlueShield of Michigan	92.2	−10.2%	63	7
HMSA (BCBS Hawaii)	91.1	−11.3%	84	4
Horizon BCBS of New Jersey	89.6	−12.8%	42	6
BlueCross BlueShield of Arizona	80.0	−22.1%	38	19

The price history

Medicare's payment limit for Polivy moved +20.8% 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)
2020	$48M	0.4
2021	$42M	0.4
2022	$66M	0.6
2023	$119M	1.0
2024	$202M	—
2025	$188M	—

The margin picture

NADAC-measured acquisition cost for Polivy runs $120.83/unit as of n/a — an acquisition index of 93.3 (ASP = 100).

At the median contracted index of 95.6, that implies a modeled gross margin of +2.3 points per ASP-unit — roughly +$3.12/unit at the latest ASP of $135.48.

Modeled from NADAC acquisition, high confidence — your invoice price governs.

Where it pays most and least

Highest-paying states	Index	Insurers
Alaska (AK)	108.1	7
South Dakota (SD)	104.1	8
Iowa (IA)	104.1	8
Nebraska (NE)	103.8	8
Idaho (ID)	103.5	12

Lowest-paying states	Index	Insurers
Florida (FL)	95.3	34
Louisiana (LA)	95.2	8
Mississippi (MS)	95.2	12
Alabama (AL)	95.2	13

What this means in dollars

At the median contracted rate, this code models a −$6,955 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 994 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.

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