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 17 * 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
J2405 - Injection, ondansetron hydrochloride, per 1 mg 1 MG 0.093 - - - - - -
J2406 - Injection, oritavancin (kimyrsa), 10 mg 10 MG 43.059 - - - - - -
J2407 - Injection, oritavancin (orbactiv), 10 mg 10 MG 28.468 - - - - - -
J2425 - Injection, palifermin, 50 micrograms 50 MCG 36.628 - - - - - -
J2426 - Injection, paliperidone palmitate extended release (invega sustenna), 1 mg 1 MG 15.111 - - - - - -
J2427 - Injection, paliperidone palmitate extended release (invega hafyera, or invega trinza), 1 mg 1MG 12.991 - - - - - -
J2428 - Injection, paliperidone palmitate extended release (erzofri), 1 mg 1 MG 15.303 - - - - - -
J2430 - Injection, pamidronate disodium, per 30 mg 30 MG 11.290 - - - - - -
J2468 - Injection, palonosetron hydrochloride (posfrea), 25 micrograms 25 MCG 58.575 - - - - - -
J2469 - Injection, palonosetron hcl, 25 mcg 25 MCG 0.353 - - - - - -
J2501 - Injection, paricalcitol, 1 mcg 1 MCG 0.969 - - - - - -
J2502 - Injection, pasireotide long acting, 1 mg 1 MG 575.065 - - - - - -
J2506 - Injection, pegfilgrastim, excludes biosimilar, 0.5 mg 0.5 MG 122.837 - - - - - -
J2507 - Injection, pegloticase, 1 mg 1 MG 3768.809 - - - - - -
J2508 - Injection, pegunigalsidase alfa-iwxj, 1 mg 1 MG 225.948 - - - - - -
J2516 - Injection, pentamidine isethionate, 1 mg 1 MG 0.235 - - - - - -
J2540 - Injection, penicillin g potassium, up to 600,000 units 600000 UNITS 0.780 - - - - - -
J2543 - Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) 1.125 GM 1.091 - - - - - -
J2550 - Injection, promethazine hcl, up to 50 mg 50 MG 3.971 - - - - - -
J2560 - Injection, phenobarbital sodium, up to 120 mg 120 MG 29.077 - - - - - -
J2562 - Injection, plerixafor, 1 mg 1 MG 30.663 - - - - - -
J2596 - Injection, vasopressin (long grove), not therapeutically equivalent to j2598, 1 unit 1 UNIT 1.790 - - - - - -
J2597 - Injection, desmopressin acetate, per 1 mcg 1 MCG 3.414 - - - - - -
J2598 - Injection, vasopressin, 1 unit 1 UNIT 0.525 - - - - - -
J2599 - Injection, vasopressin (american regent), not therapeutically equivalent to j2598, 1 unit 1 UNIT 0.863 - - - - - -
* Effective January 1, 2026 through March 31, 2026

ASP (Average Sale Price) Drug Pricing History