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 23 * 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
J7608 - Acetylcysteine, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per gram 1 GM 8.437 - - - - - -
J7611 - Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg 1 MG 0.176 - - - - - -
J7612 - Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 0.5 mg 0.5 MG 0.283 - - - - - -
J7613 - Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg 1 MG 0.077 - - - - - -
J7614 - Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 0.5 mg 0.5 MG 0.087 - - - - - -
J7620 - Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme 2.5 MG/0.5 MG 0.194 - - - - - -
J7626 - Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 0.5 mg 0.5 MG 1.193 - - - - - -
J7631 - Cromolyn sodium, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 10 milligrams 10 MG 0.293 - - - - - -
J7639 - Dornase alfa, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram 1 MG 53.588 - - - - - -
J7644 - Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram 1 MG 0.362 - - - - - -
J7674 - Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg 1 MG 1.631 - - - - - -
J7677 - Revefenacin inhalation solution, fda-approved final product, non-compounded, administered through dme, 1 microgram 1 MCG 0.195 - - - - - -
J7682 - Tobramycin, inhalation solution, fda-approved final product, non-compounded, unit dose form, administered through dme, per 300 milligrams 300 MG 14.803 - - - - - -
J7686 - Treprostinil, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, 1.74 mg 1.74 MG 760.395 - - - - - -
J8501 - Aprepitant, oral, 5 mg 5 MG 3.042 - - - - - -
J8522 - Capecitabine, oral, 50 mg 50 MG 0.065 - - - - - -
J8530 - Cyclophosphamide; oral, 25 mg 25 MG 1.139 - - - - - -
J8540 - Dexamethasone, oral, 0.25 mg 0.25 MG 0.059 - - - - - -
J8560 - Etoposide; oral, 50 mg 50 MG 76.456 - - - - - -
J8610 - Methotrexate; oral, 2.5 mg 2.5 MG 0.201 - - - - - -
J8655 - Netupitant 300 mg and palonosetron 0.5 mg, oral 0.5 MG 409.009 - - - - - -
J8670 - Rolapitant, oral, 1 mg 1 MG 1.789 - - - - - -
J8700 - Temozolomide, oral, 5 mg 5 MG 0.384 - - - - - -
J8705 - Topotecan, oral, 0.25 mg 0.25 mg 124.9 - - - - - -
J9000 - Injection, doxorubicin hydrochloride, 10 mg 10 MG 3.153 - - - - - -
* 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