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 20 * 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
J3240 - Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial 0.9 MG 2125.636 - - - - - -
J3241 - Injection, teprotumumab-trbw, 10 mg 10 MG 369.312 - - - - - -
J3243 - Injection, tigecycline, 1 mg 1 MG 0.562 - - - - - -
J3245 - Injection, tildrakizumab, 1 mg 1 MG 123.785 - - - - - -
J3246 - Injection, tirofiban hcl, 0.25 mg 0.25 MG 3.450 - - - - - -
J3247 - Injection, secukinumab, intravenous, 1 mg 1 MG 18.073 - - - - - -
J3250 - Injection, trimethobenzamide hcl, up to 200 mg 200 MG 57.597 - - - - - -
J3260 - Injection, tobramycin sulfate, up to 80 mg 80 MG 2.071 - - - - - -
J3262 - Injection, tocilizumab, 1 mg 1 MG 5.609 - - - - - -
J3263 - Injection, toripalimab-tpzi, 1 mg 1 MG 40.210 - - - - - -
J3285 - Injection, treprostinil, 1 mg 1 MG 54.480 - - - - - -
J3299 - Injection, triamcinolone acetonide (xipere), 1 mg 1 MG 47.850 - - - - - -
J3300 - Injection, triamcinolone acetonide, preservative free, 1 mg 1 MG 24.491 - - - - - -
J3301 - Injection, triamcinolone acetonide, not otherwise specified, 10 mg 10 MG 0.741 - - - - - -
J3304 - Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg 1 MG 18.579 - - - - - -
J3315 - Injection, triptorelin pamoate, 3.75 mg 3.75 MG 463.195 - - - - - -
J3316 - Injection, triptorelin, extended-release, 3.75 mg 3.75 MG 3764.986 - - - - - -
J3358 - Ustekinumab, for intravenous injection, 1 mg 1 MG 12.490 - - - - - -
J3360 - Injection, diazepam, up to 5 mg 5 MG 6.690 - - - - - -
J3373 - Injection, vancomycin hydrochloride, 10 mg 10 MG 0.031 - - - - - -
J3374 - Injection, vancomycin hydrochloride (mylan) not therapeutically equivalent to j3373, 10 mg 10 MG 0.103 - - - - - -
J3375 - Injection, vancomycin hydrochloride (xellia), not therapeutically equivalent to j3373, 10 mg 10 MG 0.134 - - - - - -
J3376 - Injection, vancomycin hcl (hikma), not therapeutically equivalent to j3373, 10 mg 10 MG 0.019 - - - - - -
J3379 - Injection, valproate sodium, 5 mg 5 MG 0.045 - - - - - -
J3380 - Injection, vedolizumab, intravenous, 1 mg 1 MG 21.371 - - - - - -
* Effective January 1, 2026 through March 31, 2026

ASP (Average Sale Price) Drug Pricing History