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 30 * 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
J9256 - Injection, nipocalimab-aahu, 3 mg 3 MG 32.743 - - - - - -
J9260 - Injection, methotrexate sodium, 50 mg 50 MG 2.579 - - - - - -
J9261 - Injection, nelarabine, 50 mg 50 MG 65.160 - - - - - -
J9263 - Injection, oxaliplatin, 0.5 mg 0.5 MG 0.047 - - - - - -
J9264 - Injection, paclitaxel protein-bound particles, 1 mg 1 MG 8.184 - - - - - -
J9266 - Injection, pegaspargase, per single dose vial 1 EA 28424.059 - - - - - -
J9267 - Injection, paclitaxel, 1 mg 1 MG 0.099 - - - - - -
J9268 - Injection, pentostatin, 10 mg 10 MG 2537.096 - - - - - -
J9269 - Injection, tagraxofusp-erzs, 10 micrograms 10 MCG 357.024 - - - - - -
J9271 - Injection, pembrolizumab, 1 mg 1 MG 59.726 - - - - - -
J9272 - Injection, dostarlimab-gxly, 10 mg 10 MG 247.437 - - - - - -
J9273 - Injection, tisotumab vedotin-tftv, 1 mg 1 MG 196.068 - - - - - -
J9274 - Injection, tebentafusp-tebn, 1 microgram 1 MCG 222.210 - - - - - -
J9276 - Injection, zanidatamab-hrii, 2 mg 2 MG 24.998 - - - - - -
J9280 - Injection, mitomycin, 5 mg 5 MG 26.104 - - - - - -
J9281 - Mitomycin pyelocalyceal instillation, 1 mg 1 MG 323.905 - - - - - -
J9286 - Injection, glofitamab-gxbm, 2.5 mg 2.5 MG 2843.588 - - - - - -
J9289 - Injection, nivolumab, 2 mg and hyaluronidase-nvhy 2 MG 27.801 - - - - - -
J9292 - Injection, pemetrexed dipotassium, 10 mg 10 MG 81.232 - - - - - -
J9293 - Injection, mitoxantrone hydrochloride, per 5 mg 5 MG 30.877 - - - - - -
J9294 - Injection, pemetrexed (hospira), not therapeutically equivalent to j9305, 10 mg 10 MG 4.190 - - - - - -
J9295 - Injection, necitumumab, 1 mg 1 MG 5.731 - - - - - -
J9296 - Injection, pemetrexed (accord), not therapeutically equivalent to j9305, 10 mg 10 mg 9.736 - - - - - -
J9297 - Injection, pemetrexed (sandoz), not therapeutically equivalent to j9305, 10 mg 10 MG 1.488 - - - - - -
J9298 - Injection, nivolumab and relatlimab-rmbw, 3 mg/1 mg 3 mg/1 mg 201.654 - - - - - -
* Effective January 1, 2026 through March 31, 2026

ASP (Average Sale Price) Drug Pricing History