Impact Tool · free, public math
Is Buy-and-Bill Profitable? The ASP+6-After-Sequestration Calculator
Pick any of the 1,474 drugs in the current CMS file, enter the acquisition cost on your invoice, and see the honest Medicare margin — allowable, the 2% sequester haircut, the coinsurance you still have to collect, and the per-claim result. No login. Nothing stored.
The math, explained
Is buy-and-bill profitable in 2026?
Drug by drug. The on-paper margin is ASP+6%, but the 2% sequester on Medicare's 80% share cuts the effective add-on to roughly 4.3% — and that's before denials, waste, carrying cost, and coinsurance you fail to collect. A drug is profitable when your acquisition cost sits far enough below ASP to clear all of that; this calculator shows the Medicare arithmetic for any J-code in the current CMS file.
How does the ASP+6 calculation actually work?
CMS sets a quarterly payment limit at 106% of the manufacturer-reported Average Sales Price (two quarters in arrears). Medicare pays 80% of the allowable, reduced 2% by sequestration; the patient or secondary owes the other 20%. Fully collected, that's about 98.4% of the allowable — an effective add-on of roughly 4.3% over ASP, not 6%.
Why does the calculator only show Medicare?
Because Medicare's price is public — the CMS payment limit file — and your commercial rates are not. Commercial reimbursement depends on your specific payer contracts, which often pay a different multiple of ASP entirely. That contracted side typically decides whether a drug is profitable across your whole book; quantifying it requires your contracts and remittances, which is what the practice X-Ray does.
Where do the payment limits come from?
Directly from the CMS July 2026 ASP pricing file (public domain), covering 1,474 HCPCS codes, effective July 1, 2026. The full change history is on our ASP-change leaderboard, and our sourcing and verification practices are documented at the Data Desk.
Which payment limits moved this quarter: the ASP-change leaderboard. Per-drug pricing history: drug trend pages. Data practices: the Data Desk.
Drug economics as of Q3 2026 (Medicare ASP basis)
Medicare is the public half. Your contracts are the other half.
The practice X-Ray runs your full book — commercial contracts, payer mix, 835s, waste, denials — and prices the whole margin picture in dollars, drug by drug.