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 36 * 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
Q9998 - Injection, ustekinumab-aekn (selarsdi), biosimilar, 1 mg 1 MG 43.201 - - - - - -
Q9999 - Injection, ustekinumab-aauz (otulfi), biosimilar, 1 mg 1 MG 32.957 - - - - - -
* Effective January 1, 2026 through March 31, 2026

ASP (Average Sale Price) Drug Pricing History