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 34 * 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
Q5100 - Injection, ustekinumab-kfce (yesintek), biosimilar, 1 mg 1 MG 24.684 - - - - - -
Q5101 - Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram 1 MCG 0.349 - - - - - -
Q5103 - Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg 10 MG 24.220 - - - - - -
Q5104 - Injection, infliximab-abda, biosimilar, (renflexis), 10 mg 10 MG 27.754 - - - - - -
Q5105 - Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units 100 UNITS 0.757 - - - - - -
Q5106 - Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units 1000 UNITS 7.567 - - - - - -
Q5107 - Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg 10 MG 23.840 - - - - - -
Q5108 - Injection, pegfilgrastim-jmdb (fulphila), biosimilar, 0.5 mg 0.5 MG 98.871 - - - - - -
Q5110 - Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram 1 MCG 0.275 - - - - - -
Q5111 - Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg 0.5 MG 161.989 - - - - - -
Q5112 - Injection, trastuzumab-dttb, biosimilar, (ontruzant), 10 mg 10 MG 27.272 - - - - - -
Q5113 - Injection, trastuzumab-pkrb, biosimilar, (herzuma), 10 mg 10 MG 55.431 - - - - - -
Q5114 - Injection, trastuzumab-dkst, biosimilar, (ogivri), 10 mg 10 MG 37.709 - - - - - -
Q5115 - Injection, rituximab-abbs, biosimilar, (truxima), 10 mg 10 MG 30.145 - - - - - -
Q5116 - Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg 10 MG 8.205 - - - - - -
Q5117 - Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg 10 MG 51.439 - - - - - -
Q5118 - Injection, bevacizumab-bvzr, biosimilar, (zirabev), 10 mg 10 MG 25.799 - - - - - -
Q5119 - Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg 10 MG 13.270 - - - - - -
Q5120 - Injection, pegfilgrastim-bmez (ziextenzo), biosimilar, 0.5 mg 0.5 MG 119.294 - - - - - -
Q5121 - Injection, infliximab-axxq, biosimilar, (avsola), 10 mg 10 MG 23.811 - - - - - -
Q5122 - Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg 0.5 MG 133.054 - - - - - -
Q5123 - Injection, rituximab-arrx, biosimilar, (riabni), 10 mg 10 MG 20.896 - - - - - -
Q5124 - Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg 0.1 MG 60.215 - - - - - -
Q5125 - Injection, filgrastim-ayow, biosimilar, (releuko), 1 microgram 1 MCG 0.338 - - - - - -
Q5126 - Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg 10 MG 33.012 - - - - - -
* Effective January 1, 2026 through March 31, 2026

ASP (Average Sale Price) Drug Pricing History