A quarterly benchmark of what commercial insurers contract to pay for infused (J-code) drugs, built from insurers' own machine-readable files: 829,646 quality-checked rates across 61 insurers, reconciled to each filing's own published benchmark at 100.0% exact. Issue 01, v2.0. Reviewed by Erin Rose. Issue 02 publishes November 2026.
Drugs carrying 85.0% of Medicare Part B drug spend have a median commercial contracted rate below CMS's typical non-340B acquisition benchmark (102.7 on a scale where ASP = 100). Skin substitutes excluded; including them the figure is higher.
The median commercial contracted rate for an infused drug is 101.5 (ASP = 100) — below typical acquisition at 102.7 and below Medicare at 104.3 after sequestration.
Every national carrier except Kaiser contracts at or below actual Medicare for infused drugs. Cigna and UnitedHealthcare sit at roughly ASP itself.
For the same drug in the same state, the 90th-percentile insurer contracts 1.16× the 10th-percentile insurer's rate across 9,183 drug-state markets.
Of 37 insurer filings analyzed at practice level, 30 price infusion drugs on a card — a few standard rates with 90%+ of practices on the standard one. Only one payer, UnitedHealthcare, pays scale a premium (~9%).
Enhertu tops the CareCost Buy-and-Bill Risk List at an index of 95.2: a modeled margin exposure of $7,291 per $100,000 of drug cost.
Within any single carrier operating in 20+ states, no state's median contracted rate differs from that carrier's national median by more than 1.3% — fee schedules are effectively national.
Cite as: CareCost Estimate Infusion Reimbursement Index, Issue 01 (Q2 2026), v2.0. CC-BY 4.0.
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