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Impact Tool · free, public math
Specialty societies have documented the problem — 97% of surveyed practices have had drugs reimburse below acquisition — but the published loss tables are static PDFs. This is the live version: 54 products across 11 biosimilar families, each against the current Medicare payment limit. Type your invoice price per product and see exactly which lines are underwater, and which same-molecule alternative isn’t.
infliximab · billed per 10 mg · GI · Rheumatology. The original underwater story — practice surveys (CSRO) documented acquisition above the ASP-based limit on infliximab products years before the current wave.
| Product | Code | Limit / 10 mg | Net collected* | Your acquisition / 10 mg | Margin / 10 mg |
|---|---|---|---|---|---|
| Remicade (reference) | J1745 | $31.479 | $30.975 | — | |
| Inflectra (infliximab-dyyb) | Q5103 | $27.710 | $27.267 | — | |
| Renflexis (infliximab-abda) | Q5104 | $26.615 | $26.189 | — | |
| Avsola (infliximab-axxq) | Q5121 | $30.830 | $30.337 | — |
*Net collected = the Q3 2026 payment limit × 98.4% (Medicare pays 80% less the 2% sequester; the 20% coinsurance is assumed fully collected). Medicare math only — commercial rates are contract-specific. Your acquisition figures never leave your browser.
Reimbursement below acquisition: Medicare's payment limit (106% of ASP, effectively ~104.3% after sequestration) has fallen below what the practice actually pays to acquire the product. A 2024 CSRO survey found 97% of responding practices had experienced underwater drugs, and an ACR-led coalition of 40+ specialty societies has asked CMS to address it.
The ASP lag. The payment limit is set from manufacturer sales data two quarters old. When competition pushes prices down fast — exactly what biosimilar entry does — the limit follows late, and a practice that bought at last quarter's price can be reimbursed at a limit that already reflects the next price cut. Falling-price markets put the lag against you; the steeper the decline, the deeper the hole.
Because the escape hatch is usually inside the family. Same-molecule products carry separate codes and separate payment limits that can differ by 2× or more — a practice underwater on one product may have a positive-margin alternative one row away, subject to payer coverage and interchangeability rules.
The CMS July 2026 ASP pricing file (public domain), effective July 1, 2026 — 54 products across 11 families, every code verified against the file. Acquisition prices are yours alone: typed in your browser, never stored, never sent.
Six levers, roughly in order: check the same-family alternatives above; take it to your wholesaler/GPO (published-limit declines are renegotiation leverage); tighten JW/JZ waste and coinsurance collection; review site-of-care and payer mix; escalate to the payer where contracts reference ASP; and only then consider dropping the line. The decision guide walks each one.
Found something underwater? The decision guide walks the six levers in order: Underwater — now what. Per-family pricing history: the drug trend pages. Which limits moved this quarter: the ASP-change leaderboard. Data practices: the Data Desk.
Drug economics as of Q3 2026 (Medicare ASP basis)
Your commercial contracts decide the other half — and which channel each payer actually rewards. The practice X-Ray runs your full book, from your own 835s, and prices every leak in dollars.