CareCost Estimate
The Infusion Reimbursement Index · Research Notes · Q2 2026

Medicare Negotiation: The Before-Picture

CareCost Research · Reviewed by Erin Rose

Six Part B drugs were the first ever selected for Medicare drug price negotiation. Starting 2028-01-01, Medicare's benchmark for each stops being ASP + 6% and becomes 106% of a negotiated Maximum Fair Price (MFP) — a number CMS sets, not a market rate. This table is the commercial baseline for all six, captured while ASP + 6% is still the rule everywhere, commercial and Medicare alike.

The six negotiated drugs, commercial rates today

Selected 2026-01-27. Median index is the middle insurer's contracted rate as a multiple of ASP × 100. p10/p90 mark the 10th–90th percentile spread across insurers on the same scale.

DrugInsurersMedian indexp10p90$/unitPart B spend
Orencia (abatacept)
J0129
58 97.6 96.2 121.2 $44.77 $718M
Entyvio (vedolizumab)
J3380
59 98.8 97.0 122.4 $21.37 $574M
Xolair (omalizumab)
J2357
58 97.7 89.8 110.5 $45.50 $316M
Botox (onabotulinumtoxinA)
J0585
59 100.1 96.2 120.0 $6.51 $395M
Cimzia (certolizumab pegol)
J0717
57 113.5 110.0 220.0 $3.91 $274M
Cosentyx (secukinumab)
J3247
50 99.1 97.8 112.2 $18.07 $127M

Why this baseline matters

The first Part B drugs ever selected for Medicare price negotiation. From 2028 their benchmark becomes the negotiated Maximum Fair Price, not ASP+6% — CMS will publish only 106% of MFP for them. This table is the commercial baseline before that happens.

This is the only public commercial baseline for these six drugs captured before MFP takes effect. Once 106% of MFP replaces ASP+6% as the Medicare benchmark on 2028-01-01, comparing commercial contracts to "Medicare" will mean comparing them to a negotiated government price instead of a statutory markup on a market price — a different kind of number. This table is the record of what commercial insurers were actually paying, relative to ASP, in the last vintage before that change.

Contracted rates from insurers’ machine-readable files, not amounts paid on a claim. Figures are drawn from report_data.json published alongside the Infusion Reimbursement Index and are not independently re-derived on this page.