ASP Drug Pricing - (1st Quarter)
January 2026
Payment Allowance Limits for Medicare Part B Drugs

  • Note 1: Payment allowance limits subject to the ASP methodology are based on Jul 2025 (3nd Quarter) ASP data.
  • Note 2: The absence or presence of a HCPCS code and the payment allowance limits in this table does not indicate whether Medicare covers a drug. These determinations shall be made by the local Medicare contractor processing the claim.
 
Page 10 * Effective January 1, 2026 through March 31, 2026
HCPCS Code Code Dosage Payment
Limit		 Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
J1201 - Injection, cetirizine hydrochloride, 0.5 mg 0.5 MG 17.092 - - - - - -
J1203 - Injection, cipaglucosidase alfa-atga, 5 mg 5 MG 91.203 - - - - - -
J1205 - Injection, chlorothiazide sodium, per 500 mg 500 MG 58.126 - - - - - -
J1212 - Injection, dmso, dimethyl sulfoxide, 50%, 50 ml 50 ML 749.232 - - - - - -
J1230 - Injection, methadone hcl, up to 10 mg 10 MG 17.700 - - - - - -
J1240 - Injection, dimenhydrinate, up to 50 mg 50 MG 0.916 - - - - - -
J1245 - Injection, dipyridamole, per 10 mg 10 MG 8.410 - - - - - -
J1250 - Injection, dobutamine hydrochloride, per 250 mg 250 MG 8.024 - - - - - -
J1265 - Injection, dopamine hcl, 40 mg 40 MG 0.802 - - - - - -
J1270 - Injection, doxercalciferol, 1 mcg 1 MCG 0.313 - - - - - -
J1271 - Injection, doxycycline hyclate, 1 mg 1 MG 0.102 - - - - - -
J1290 - Injection, ecallantide, 1 mg 1 MG 579.746 - - - - - -
J1299 - Injection, eculizumab, 2 mg 2 MG 45.028 - - - - - -
J1301 - Injection, edaravone, 1 mg 1 MG 17.470 - - - - - -
J1302 - Injection, sutimlimab-jome, 10 mg 10 MG 19.028 - - - - - -
J1303 - Injection, ravulizumab-cwvz, 10 mg 10 MG 224.804 - - - - - -
J1304 - Injection, tofersen, 1 mg 1 MG 160.009 - - - - - -
J1305 - Injection, evinacumab-dgnb, 5mg 5 MG 197.166 - - - - - -
J1306 - Injection, inclisiran, 1 mg 1 MG 12.690 - - - - - -
J1307 - Injection, crovalimab-akkz, 10 mg 10 MG 551.512 - - - - - -
J1308 - Injection, famotidine, 0.25 mg 0.25 MG 0.009 - - - - - -
J1322 - Injection, elosulfase alfa, 1 mg 1 MG 311.940 - - - - - -
J1323 - Injection, elranatamab-bcmm, 1 mg 1 MG 188.520 - - - - - -
J1325 - Injection, epoprostenol, 0.5 mg 0.5 MG 15.654 - - - - - -
J1326 - Injection, zolbetuximab-clzb, 2 mg 2 MG 33.666 - - - - - -
* Effective January 1, 2026 through March 31, 2026

ASP (Average Sale Price) Drug Pricing History