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 28 * 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
J9063 - Injection, mirvetuximab soravtansine-gynx, 1 mg 1 MG 71.166 - - - - - -
J9065 - Injection, cladribine, per 1 mg 1 MG 7.419 - - - - - -
J9071 - Injection, cyclophosphamide (auromedics), 5 mg 5 MG 0.606 - - - - - -
J9072 - Injection, cyclophosphamide (frindovyx), 5 mg 5 MG 8.991 - - - - - -
J9073 - Injection, cyclophosphamide (dr. reddy's), 5 mg 5 MG 0.696 - - - - - -
J9074 - Injection, cyclophosphamide (sandoz), 5 mg 5 MG 3.841 - - - - - -
J9075 - Injection, cyclophosphamide, not otherwise specified, 5 mg 5 MG 0.585 - - - - - -
J9076 - Injection, cyclophosphamide (baxter), 5 mg 5 MG 4.920 - - - - - -
J9100 - Injection, cytarabine, 100 mg 100 MG 0.835 - - - - - -
J9118 - Injection, calaspargase pegol-mknl, 10 units 10 UNIT 82.075 - - - - - -
J9119 - Injection, cemiplimab-rwlc, 1 mg 1 MG 28.691 - - - - - -
J9120 - Injection, dactinomycin, 0.5 mg 0.5 MG 307.985 - - - - - -
J9130 - Dacarbazine, 100 mg 100 MG 4.124 - - - - - -
J9144 - Injection, daratumumab, 10 mg and hyaluronidase-fihj 10 MG 55.058 - - - - - -
J9145 - Injection, daratumumab, 10 mg 10 MG 70.788 - - - - - -
J9150 - Injection, daunorubicin, 10 mg 10 MG 26.326 - - - - - -
J9153 - Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine 1 MG/2.27 MG 260.490 - - - - - -
J9155 - Injection, degarelix, 1 mg 1 MG 4.450 - - - - - -
J9171 - Injection, docetaxel, 1 mg 1 MG 0.651 - - - - - -
J9172 - Injection, docetaxel (docivyx), 1 mg 1 MG 49.757 - - - - - -
J9173 - Injection, durvalumab, 10 mg 10 MG 86.270 - - - - - -
J9176 - Injection, elotuzumab, 1 mg 1 MG 8.037 - - - - - -
J9177 - Injection, enfortumab vedotin-ejfv, 0.25 mg 0.25 MG 36.718 - - - - - -
J9178 - Injection, epirubicin hcl, 2 mg 2 MG 1.973 - - - - - -
J9179 - Injection, eribulin mesylate, 0.1 mg 0.1 MG 72.608 - - - - - -
* Effective January 1, 2026 through March 31, 2026

ASP (Average Sale Price) Drug Pricing History