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 8 * 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
J0750 - Emtricitabine 200mg and tenofovir disoproxil fumarate 300mg, oral, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment of hiv) 200 mg/300 mg 1.342 - - - - - -
J0751 - Emtricitabine 200mg and tenofovir alafenamide 25mg, oral, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment of hiv) 200 mg/25 mg 71.327 - - - - - -
J0752 - Oral, lenacapavir, 300 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv) 300 MG 623.148 - - - - - -
J0770 - Injection, colistimethate sodium, up to 150 mg 150 MG 12.080 - - - - - -
J0775 - Injection, collagenase, clostridium histolyticum, 0.01 mg 0.01 MG 75.745 - - - - - -
J0780 - Injection, prochlorperazine, up to 10 mg 10 MG 2.521 - - - - - -
J0791 - Injection, crizanlizumab-tmca, 5 mg 5 MG 129.593 - - - - - -
J0801 - Injection, corticotropin (acthar gel), up to 40 units 40 UNITS 4172.530 - - - - - -
J0802 - Injection, corticotropin (ani), up to 40 units up to 40 Units 3551.739 - - - - - -
J0834 - Injection, cosyntropin, 0.25 mg 0.25 MG 20.652 - - - - - -
J0840 - Injection, crotalidae polyvalent immune fab (ovine), up to 1 gram UP TO 1 GM 1826.518 - - - - - -
J0841 - Injection, crotalidae immune f(ab')2 (equine), 120 mg 120 MG 4925.160 - - - - - -
J0850 - Injection, cytomegalovirus immune globulin intravenous (human), per vial PER VIAL 1808.329 - - - - - -
J0870 - Injection, imetelstat, 1 mg 1 MG 58.302 - - - - - -
J0872 - Injection, daptomycin (xellia), unrefrigerated, not therapeutically equivalent to j0878 or j0873, 1 mg 1 MG 0.057 - - - - - -
J0873 - Injection, daptomycin (xellia), not therapeutically equivalent to j0878 or j0872, 1 mg 1 MG 0.026 - - - - - -
J0874 - Injection, daptomycin (baxter), not therapeutically equivalent to j0878, 1 mg 1 MG 0.059 - - - - - -
J0875 - Injection, dalbavancin, 5 mg 5 MG 15.589 - - - - - -
J0877 - Injection, daptomycin (hospira), not therapeutically equivalent to j0878, 1 mg 1 MG 0.056 - - - - - -
J0878 - Injection, daptomycin, 1 mg 1 MG 0.028 - - - - - -
J0881 - Injection, darbepoetin alfa, 1 microgram (non-esrd use) 1 MCG 3.021 - - - - - -
J0882 - Injection, darbepoetin alfa, 1 microgram (for esrd on dialysis) 1 MCG 3.021 - - - - - -
J0883 - Injection, argatroban, 1 mg (for non-esrd use) 1 MG 0.609 - - - - - -
J0884 - Injection, argatroban, 1 mg (for esrd on dialysis) 1 MG 0.609 - - - - - -
J0885 - Injection, epoetin alfa, (for non-esrd use), 1000 units 1000 UNITS 7.743 - - - - - -
* Effective January 1, 2026 through March 31, 2026

ASP (Average Sale Price) Drug Pricing History