ASP Drug Pricing - (2nd Quarter)
April 2025
Payment Allowance Limits for Medicare Part B Drugs

  • Note 1: Payment allowance limits subject to the ASP methodology are based on Oct 2024 (4th Quarter) ASP data.
  • Note 2: The absence or presence of a HCPCS code and the payment allowance limits in this table does not indicate Medicare coverage of the drug. Similarly, the inclusion of a payment allowance limit within a specific column does not indicate Medicare coverage of the drug in that specific category. These determinations shall be made by the local Medicare contractor processing the claim.
 
Page 22 * Effective April 1, 2025 through June 30, 2025
HCPCS Code Code Dosage Payment
Limit		 Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
J7354 - Cantharidin for topical administration, 0.7%, single unit dose applicator (3.2 mg) Per 3.2 mg single-use applicator 682.257 - - - - - -
J7355 - Injection, travoprost, intracameral implant, 1 microgram 1 MCG 194.411 - - - - - -
J7402 - Mometasone furoate sinus implant, (sinuva), 10 micrograms 10 MCG 11.345 - - - - - -
J7500 - Azathioprine, oral, 50 mg 50 MG 1.014 - - - - - -
J7502 - Cyclosporine, oral, 100 mg 100 MG 2.023 - - - - - -
J7503 - Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg 0.25 MG 1.805 - - - - - -
J7504 - Lymphocyte immune globulin, antithymocyte globulin, equine, parenteral, 250 mg 250 MG 4376.29 - - - - - -
J7507 - Tacrolimus, immediate release, oral, 1 mg 1 MG 0.194 - - - - - -
J7508 - Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg 0.1 MG 0.569 - - - - - -
J7509 - Methylprednisolone oral, per 4 mg 4 MG 0.243 - - - - - -
J7510 - Prednisolone oral, per 5 mg 5 MG 0.483 - - - - - -
J7511 - Lymphocyte immune globulin, antithymocyte globulin, rabbit, parenteral, 25 mg 25 MG 939.346 - - - - - -
J7512 - Prednisone, immediate release or delayed release, oral, 1 mg 1 MG 0.004 - - - - - -
J7515 - Cyclosporine, oral, 25 mg 25 MG 0.742 - - - - - -
J7516 - Injection, cyclosporine, 250 mg 250 MG 71.401 - - - - - -
J7517 - Mycophenolate mofetil, oral, 250 mg 250 MG 0.154 - - - - - -
J7518 - Mycophenolic acid, oral, 180 mg 180 MG 0.379 - - - - - -
J7519 - Injection, mycophenolate mofetil, 10 mg 10 MG 0.305 - - - - - -
J7520 - Sirolimus, oral, 1 mg 1 MG 1.144 - - - - - -
J7521 - Tacrolimus, granules, oral suspension, 0.1 mg 0.1 MG 1.334 - - - - - -
J7525 - Tacrolimus, parenteral, 5 mg 5 MG 255.058 - - - - - -
J7527 - Everolimus, oral, 0.25 mg 0.25 MG 2.018 - - - - - -
J7601 - Ensifentrine, inhalation suspension, fda approved final product, non-compounded, administered through dme, unit dose form, 3 mg 3 MG 52.117 - - - - - -
J7605 - Arformoterol, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 15 micrograms 15 mcg 0.686 - - - - - -
J7606 - Formoterol fumarate, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 20 micrograms 20 MCG 1.699 - - - - - -
* Effective April 1, 2025 through June 30, 2025

Drugs not otherwise classified - April 2025

 

Medicare Part B payment allowance limits for drugs not otherwise classified - Effective April 1, 2025 through June 30, 2025

Drug name Dosage Payment limit Notes
Diltiazem Hydrochloride 5 MG 0.416
Metoprolol Tartrate 1 MG 0.123
Vasopressin (Long Grove) 1 UNIT 3.272 Added April 2025

ASP (Average Sale Price) Drug Pricing History