Truxima (Q5115): what insurers contract to pay

Rituximab-abbs · Hematology-Oncology

CareCost Research · Reviewed by Erin Rose

Truxima (Q5115) carries a median commercial contracted rate of 89.8 on the Medicare ASP=100 index — 12.6% below the 102.7 typical-acquisition benchmark and 13.9% below the 104.3 Medicare payment line. 57 insurers report contracted rates across 52 states (1,005 priced cells), covering $98M in modeled Part B spend. It ranks #21 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 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
Premera Blue Cross	136.2	+32.6%	102	9
BlueCross BlueShield of Arkansas	136.2	+32.6%	48	21
HMSA (BCBS Hawaii)	127.4	+24.1%	84	4
UnitedHealthcare	123.1	+19.9%	1,080	51
BlueCross BlueShield of Alabama	122.3	+19.1%	91	6
BlueCross BlueShield of Michigan	120.6	+17.4%	63	7
BlueCross BlueShield of Nebraska	106.9	+4.1%	34	7
Blue Shield of California	102.2	−0.5%	118	4
Regence BlueCross BlueShield	99.6	−3.0%	56	14
BlueCross BlueShield of Kansas	98.4	−4.2%	60	5
BlueCross BlueShield of Texas	96.5	−6.0%	41	10
Regence Washington	96.0	−6.5%	75	5
Blue Cross of Idaho	95.9	−6.6%	58	6
Anthem Massachusetts	93.9	−8.6%	56	25
CareFirst BlueCross BlueShield	91.3	−11.1%	58	19
BlueCross BlueShield of South Carolina	90.5	−11.9%	56	6
Anthem Kentucky	90.5	−11.9%	85	9
BlueCross BlueShield of Massachusetts	90.5	−11.9%	45	4
Anthem Missouri	90.5	−11.9%	47	10
Anthem Wisconsin	90.5	−11.9%	145	4
Harvard Pilgrim Health Care	90.5	−11.9%	229	10
Aetna	89.7	−12.7%	514	51
Anthem Virginia	88.9	−13.4%	72	20
Capital Blue Cross	88.8	−13.5%	92	35
Horizon BCBS of New Jersey	87.9	−14.4%	44	6
Anthem Georgia	87.2	−15.1%	64	16
Anthem Maine	87.2	−15.1%	65	5
Anthem Connecticut	87.2	−15.1%	66	5
Anthem New Hampshire	87.2	−15.1%	49	7
Centene	87.2	−15.1%	163	27
Anthem Indiana	87.2	−15.1%	133	24
Regence Oregon	87.2	−15.1%	56	7
Anthem Nevada	87.2	−15.1%	194	4
Florida Blue	87.2	−15.1%	32	5
Cigna	87.2	−15.1%	721	51
Kaiser Permanente	87.2	−15.1%	312	8
Anthem New York	87.2	−15.1%	72	15
BlueCross BlueShield of Rhode Island	87.2	−15.1%	291	3
Anthem Ohio	87.2	−15.1%	80	12
Anthem California	86.1	−16.2%	64	4
Regence Utah	86.0	−16.3%	50	5
Regence Idaho	86.0	−16.3%	45	6
Wellmark BCBS (Iowa/South Dakota)	85.0	−17.2%	78	10
BlueCross BlueShield of Minnesota	85.0	−17.2%	68	7
BlueCross BlueShield of Tennessee	83.4	−18.8%	61	10
BlueCross BlueShield of Louisiana	82.1	−20.1%	54	7
BCBS North Dakota	81.5	−20.6%	139	3
Blue Cross NC	79.4	−22.7%	164	48
BlueCross BlueShield of Arizona	73.3	−28.6%	38	19

The price history

Medicare's payment limit for Truxima moved -45.5% 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	$0M	0.0
2020	$186M	2.5
2021	$234M	3.7
2022	$196M	3.7
2023	$175M	4.1
2024	$127M	—
2025	$98M	—

Where it pays most and least

Highest-paying states	Index	Insurers
Alaska (AK)	130.8	7
Wyoming (WY)	114.7	5
Nebraska (NE)	99.7	9
Kansas (KS)	99.5	11
Arkansas (AR)	98.1	9

Lowest-paying states	Index	Insurers
South Dakota (SD)	87.2	9
Louisiana (LA)	87.2	9
Vermont (VT)	87.2	8
Iowa (IA)	87.0	10
North Dakota (ND)	86.1	6

What this means in dollars

At the median contracted rate, this code models a −$12,526 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 1,005 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: Tecentriq · Adcetris · Enhertu · report home · methodology