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 29 * 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
J9181 - Injection, etoposide, 10 mg 10 MG 1.044 - - - - - -
J9185 - Injection, fludarabine phosphate, 50 mg 50 MG 81.409 - - - - - -
J9190 - Injection, fluorouracil, 500 mg 500 MG 1.941 - - - - - -
J9196 - Injection, gemcitabine hydrochloride (accord), not therapeutically equivalent to j9201, 200 mg 200 MG 5.290 - - - - - -
J9200 - Injection, floxuridine, 500 mg 500 MG 4254.923 - - - - - -
J9201 - Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg 200 MG 3.590 - - - - - -
J9202 - Goserelin acetate implant, per 3.6 mg 3.6 MG 777.502 - - - - - -
J9203 - Injection, gemtuzumab ozogamicin, 0.1 mg 0.1 MG 240.165 - - - - - -
J9204 - Injection, mogamulizumab-kpkc, 1 mg 1 MG 253.467 - - - - - -
J9205 - Injection, irinotecan liposome, 1 mg 1 MG 65.956 - - - - - -
J9206 - Injection, irinotecan, 20 mg 20 MG 1.794 - - - - - -
J9207 - Injection, ixabepilone, 1 mg 1 MG 139.976 - - - - - -
J9208 - Injection, ifosfamide, 1 gram 1 GM 24.843 - - - - - -
J9209 - Injection, mesna, 200 mg 200 MG 1.700 - - - - - -
J9210 - Injection, emapalumab-lzsg, 1 mg 1 MG 384.132 - - - - - -
J9211 - Injection, idarubicin hydrochloride, 5 mg 5 MG 40.048 - - - - - -
J9217 - Leuprolide acetate (for depot suspension), 7.5 mg 7.5 MG 170.778 - - - - - -
J9223 - Injection, lurbinectedin, 0.1 mg 0.1 MG 210.784 - - - - - -
J9226 - Histrelin implant (supprelin la), 50 mg 50 MG 43185.339 - - - - - -
J9227 - Injection, isatuximab-irfc, 10 mg 10 MG 84.295 - - - - - -
J9228 - Injection, ipilimumab, 1 mg 1 MG 186.914 - - - - - -
J9229 - Injection, inotuzumab ozogamicin, 0.1 mg 0.1 MG 2816.767 - - - - - -
J9245 - Injection, melphalan hydrochloride, not otherwise specified, 50 mg 50 MG 86.942 - - - - - -
J9246 - Injection, melphalan (evomela), 1 mg 1 MG 18.634 - - - - - -
J9248 - Injection, melphalan (hepzato), 1 mg 1 MG 795.000 - - - - - -
* Effective January 1, 2026 through March 31, 2026

ASP (Average Sale Price) Drug Pricing History