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 25 * 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
J7511 - Lymphocyte immune globulin, antithymocyte globulin, rabbit, parenteral, 25 mg 25 MG 1009.752 - - - - - -
J7512 - Prednisone, immediate release or delayed release, oral, 1 mg 1 MG 0.005 - - - - - -
J7514 - Mycophenolate mofetil (myhibbin), oral suspension, 100 mg 100 MG 2.243 - - - - - -
J7515 - Cyclosporine, oral, 25 mg 25 MG 0.526 - - - - - -
J7516 - Injection, cyclosporine, 250 mg 250 MG 73.681 - - - - - -
J7517 - Mycophenolate mofetil, oral, 250 mg 250 MG 0.146 - - - - - -
J7518 - Mycophenolic acid, oral, 180 mg 180 MG 0.318 - - - - - -
J7519 - Injection, mycophenolate mofetil, 10 mg 10 MG 0.366 - - - - - -
J7520 - Sirolimus, oral, 1 mg 1 MG 0.969 - - - - - -
J7521 - Tacrolimus, granules, oral suspension, 0.1 mg 0.1 MG 1.318 - - - - - -
J7525 - Tacrolimus, parenteral, 5 mg 5 MG 262.449 - - - - - -
J7527 - Everolimus, oral, 0.25 mg 0.25 MG 1.176 - - - - - -
J7528 - Mycophenolate mofetil, for suspension, oral, 100 mg 100 MG 0.240 - - - - - -
J7601 - Ensifentrine, inhalation suspension, fda approved final product, non-compounded, administered through dme, unit dose form, 3 mg 3 MG 52.117 - - - - - -
J7605 - Arformoterol, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 15 micrograms 15 mcg 0.715 - - - - - -
J7606 - Formoterol fumarate, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 20 micrograms 20 MCG 2.196 - - - - - -
J7608 - Acetylcysteine, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per gram 1 GM 8.455 - - - - - -
J7611 - Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg 1 MG 0.262 - - - - - -
J7612 - Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 0.5 mg 0.5 MG 0.384 - - - - - -
J7613 - Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg 1 MG 0.073 - - - - - -
J7614 - Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 0.5 mg 0.5 MG 0.083 - - - - - -
J7620 - Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme 2.5 MG/0.5 MG 0.197 - - - - - -
J7626 - Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 0.5 mg 0.5 MG 1.049 - - - - - -
J7631 - Cromolyn sodium, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 10 milligrams 10 MG 0.911 - - - - - -
J7639 - Dornase alfa, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram 1 MG 55.158 - - - - - -
* Effective January 1, 2026 through March 31, 2026

ASP (Average Sale Price) Drug Pricing History