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 16 * 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
J2290 - Injection, nafcillin sodium, 20 mg 20 MG 0.062 - - - - - -
J2291 - Injection, nafcillin sodium (baxter), 20 mg 20 MG 0.150 - - - - - -
J2300 - Injection, nalbuphine hydrochloride, per 10 mg 10 MG 3.447 - - - - - -
J2305 - Injection, nitroglycerin, 5 mg 5 MG 1.523 - - - - - -
J2312 - Injection, naloxone hydrochloride, not otherwise specified, 0.01 mg 0.01 MG 0.065 - - - - - -
J2313 - Injection, naloxone hydrochloride (zimhi), 0.01 mg 0.01 MG 0.015 - - - - - -
J2315 - Injection, naltrexone, depot form, 1 mg 1 MG 4.244 - - - - - -
J2323 - Injection, natalizumab, 1 mg 1 MG 24.512 - - - - - -
J2327 - Injection, risankizumab-rzaa, intravenous, 1 mg 1 MG 14.932 - - - - - -
J2329 - Injection, ublituximab-xiiy, 1mg 1 MG 70.184 - - - - - -
J2350 - Injection, ocrelizumab, 1 mg 1 MG 59.324 - - - - - -
J2351 - Injection, ocrelizumab, 1 mg and hyaluronidase-ocsq 1 MG 47.045 - - - - - -
J2353 - Injection, octreotide, depot form for intramuscular injection, 1 mg 1 MG 199.170 - - - - - -
J2354 - Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg 25 MCG 0.658 - - - - - -
J2356 - Injection, tezepelumab-ekko, 1 mg 1 MG 17.822 - - - - - -
J2357 - Injection, omalizumab, 5 mg 5 MG 45.499 - - - - - -
J2358 - Injection, olanzapine, long-acting, 1 mg 1 MG 3.158 - - - - - -
J2359 - Injection, olanzapine, 0.5 mg 0.5 MG 0.806 - - - - - -
J2360 - Injection, orphenadrine citrate, up to 60 mg 60 MG 6.390 - - - - - -
J2371 - Injection, phenylephrine hydrochloride, 20 micrograms 20 MCG 0.002 - - - - - -
J2372 - Injection, phenylephrine hydrochloride (biorphen), 20 micrograms 20 MCG 0.163 - - - - - -
J2373 - Injection, phenylephrine hydrochloride (immphentiv), 20 micrograms 20 MCG 0.136 - - - - - -
J2401 - Injection, chloroprocaine hydrochloride, per 1 mg 1 MG 0.038 - - - - - -
J2403 - Chloroprocaine hcl ophthalmic, 3% gel, 1 mg 1 MG 0.580 - - - - - -
J2404 - Injection, nicardipine, 0.1 mg 0.1 MG 0.066 - - - - - -
* Effective January 1, 2026 through March 31, 2026

ASP (Average Sale Price) Drug Pricing History