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 14 * 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
J1811 - Insulin (fiasp) for administration through dme (i.e., insulin pump) per 50 units 50 UNITS 7.903 - - - - - -
J1813 - Insulin (lyumjev) for administration through dme (i.e., insulin pump) per 50 units 50 UNITS 15.104 - - - - - -
J1817 - Insulin for administration through dme (i.e., insulin pump) per 50 units 50 UNITS 3.200 - - - - - -
J1823 - Injection, inebilizumab-cdon, 1 mg 1 MG 495.545 - - - - - -
J1836 - Injection, metronidazole, 10 mg 10 MG 0.028 - - - - - -
J1837 - Injection, posaconazole, 1 mg 1 MG 0.346 - - - - - -
J1885 - Injection, ketorolac tromethamine, per 15 mg 15 MG 0.333 - - - - - -
J1920 - Injection, labetalol hydrochloride, 5 mg 5 MG 0.348 - - - - - -
J1921 - Injection, labetalol hydrochloride (hikma), not therapeutically equivalent to j1920, 5 mg 5 MG 1.090 - - - - - -
J1930 - Injection, lanreotide, 1 mg 1 MG 35.388 - - - - - -
J1931 - Injection, laronidase, 0.1 mg 0.1 MG 39.953 - - - - - -
J1932 - Injection, lanreotide, (cipla), 1 mg 1 MG 38.217 - - - - - -
J1938 - Injection, furosemide, 1 mg 1 MG 0.019 - - - - - -
J1939 - Injection, bumetanide, 0.5 mg 0.5 MG 0.357 - - - - - -
J1943 - Injection, aripiprazole lauroxil, (aristada initio), 1 mg 1 MG 3.245 - - - - - -
J1944 - Injection, aripiprazole lauroxil, (aristada), 1 mg 1 MG 3.341 - - - - - -
J1950 - Injection, leuprolide acetate (for depot suspension), per 3.75 mg 3.75 MG 1763.869 - - - - - -
J1951 - Injection, leuprolide acetate for depot suspension (fensolvi), 0.25 mg 0.25 MG 139.877 - - - - - -
J1952 - Leuprolide injectable, camcevi, 1 mg 1 mg 57.034 - - - - - -
J1953 - Injection, levetiracetam, 10 mg 10 MG 0.039 - - - - - -
J1954 - Injection, leuprolide acetate for depot suspension (lutrate depot), 7.5 mg 7.5 MG 706.667 - - - - - -
J1955 - Injection, levocarnitine, per 1 gm 1 GM 23.268 - - - - - -
J1956 - Injection, levofloxacin, 250 mg 250 MG 2.161 - - - - - -
J1961 - Injection, lenacapavir (only for use as hiv treatment), 1 mg 1 MG 22.298 - - - - - -
J2002 - Injection, lidocaine hcl in 5% dextrose, 1 mg 1 MG 0.003 - - - - - -
* Effective January 1, 2026 through March 31, 2026

ASP (Average Sale Price) Drug Pricing History