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 11 * 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
J1335 - Injection, ertapenem sodium, 500 mg 500 MG 9.160 - - - - - -
J1364 - Injection, erythromycin lactobionate, per 500 mg 500 MG 20.159 - - - - - -
J1380 - Injection, estradiol valerate, up to 10 mg 10 MG 7.446 - - - - - -
J1410 - Injection, estrogen conjugated, per 25 mg 25 MG 391.761 - - - - - -
J1430 - Injection, ethanolamine oleate, 100 mg 100 MG 517.078 - - - - - -
J1434 - Injection, fosaprepitant (focinvez), 1 mg 1 MG 2.630 - - - - - -
J1437 - Injection, ferric derisomaltose, 10 mg 10 MG 22.829 - - - - - -
J1439 - Injection, ferric carboxymaltose, 1 mg 1 MG 1.115 - - - - - -
J1440 - Fecal microbiota, live - jslm, 1 ml 1 ML 64.625 - - - - - -
J1442 - Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram 1 MCG 0.997 - - - - - -
J1447 - Injection, tbo-filgrastim, 1 microgram 1 MCG 0.249 - - - - - -
J1448 - Injection, trilaciclib, 1mg 1 MG 5.422 - - - - - -
J1449 - Injection, eflapegrastim-xnst, 0.1 mg 0.1 MG 23.550 - - - - - -
J1450 - Injection fluconazole, 200 mg 200 MG 4.480 - - - - - -
J1453 - Injection, fosaprepitant, 1 mg 1 MG 0.105 - - - - - -
J1454 - Injection, fosnetupitant 235 mg and palonosetron 0.25 mg 0.25 MG 546.932 - - - - - -
J1455 - Injection, foscarnet sodium, per 1000 mg 1000 MG 6.710 - - - - - -
J1456 - Injection, fosaprepitant (teva), not therapeutically equivalent to j1453, 1 mg 1 MG 0.639 - - - - - -
J1458 - Injection, galsulfase, 1 mg 1 MG 513.860 - - - - - -
J1459 - Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg 500 MG 50.281 - - - - - -
J1460 - Injection, gamma globulin, intramuscular, 1 cc 1 CC 49.923 - - - - - -
J1551 - Injection, immune globulin (cutaquig), 100 mg 100 MG 14.823 - - - - - -
J1552 - Injection, immune globulin (alyglo), 500 mg 500 MG 123.841 - - - - - -
J1554 - Injection, immune globulin (asceniv), 500 mg 500 MG 490.457 - - - - - -
J1555 - Injection, immune globulin (cuvitru), 100 mg 100 MG 17.262 - - - - - -
* Effective January 1, 2026 through March 31, 2026

ASP (Average Sale Price) Drug Pricing History