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 31 * 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
J9299 - Injection, nivolumab, 1 mg 1 MG 33.573 - - - - - -
J9301 - Injection, obinutuzumab, 10 mg 10 MG 81.625 - - - - - -
J9303 - Injection, panitumumab, 10 mg 10 MG 173.673 - - - - - -
J9304 - Injection, pemetrexed (pemfexy), 10 mg 10 MG 39.934 - - - - - -
J9305 - Injection, pemetrexed, not otherwise specified, 10 mg 10 MG 3.594 - - - - - -
J9306 - Injection, pertuzumab, 1 mg 1 MG 17.012 - - - - - -
J9307 - Injection, pralatrexate, 1 mg 1 MG 392.719 - - - - - -
J9308 - Injection, ramucirumab, 5 mg 5 MG 75.583 - - - - - -
J9309 - Injection, polatuzumab vedotin-piiq, 1 mg 1 MG 136.772 - - - - - -
J9311 - Injection, rituximab 10 mg and hyaluronidase 10 mg 36.874 - - - - - -
J9312 - Injection, rituximab, 10 mg 10 MG 74.765 - - - - - -
J9314 - Injection, pemetrexed (teva), not therapeutically equivalent to j9305, 10 mg 10 MG 15.334 - - - - - -
J9316 - Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg 10 MG 60.960 - - - - - -
J9317 - Injection, sacituzumab govitecan-hziy, 2.5 mg 2.5 MG 36.982 - - - - - -
J9318 - Injection, romidepsin, non-lyophilized, 0.1 mg 0.1 MG 28.517 - - - - - -
J9319 - Injection, romidepsin, lyophilized, 0.1 mg 0.1 MG 30.906 - - - - - -
J9321 - Injection, epcoritamab-bysp, 0.16 mg 0.16 MG 56.805 - - - - - -
J9323 - Injection, pemetrexed ditromethamine, 10 mg 10 mg 0.125 - - - - - -
J9324 - Injection, pemetrexed (pemrydi rtu), 10 mg 10 MG 73.318 - - - - - -
J9325 - Injection, talimogene laherparepvec, per 1 million plaque forming units 1 million?PFU 73.939 - - - - - -
J9326 - Injection, telisotuzumab vedotin-tllv, 1 mg 1 MG 145.871 - - - - - -
J9328 - Injection, temozolomide, 1 mg 1 MG 10.398 - - - - - -
J9329 - Injection, tislelizumab-jsgr, 1mg 1 MG 58.371 - - - - - -
J9330 - Injection, temsirolimus, 1 mg 1 MG 20.316 - - - - - -
J9331 - Injection, sirolimus protein-bound particles, 1 mg 1 MG 87.110 - - - - - -
* Effective January 1, 2026 through March 31, 2026

ASP (Average Sale Price) Drug Pricing History