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 27 * 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
J9245 - Injection, melphalan hydrochloride, not otherwise specified, 50 mg 50 MG 157.102 - - - - - -
J9246 - Injection, melphalan (evomela), 1 mg 1 MG 18.498 - - - - - -
J9248 - Injection, melphalan (hepzato), 1 mg 1 MG 773.8 - - - - - -
J9260 - Injection, methotrexate sodium, 50 mg 50 MG 2.584 - - - - - -
J9261 - Injection, nelarabine, 50 mg 50 MG 63.184 - - - - - -
J9263 - Injection, oxaliplatin, 0.5 mg 0.5 MG 0.049 - - - - - -
J9264 - Injection, paclitaxel protein-bound particles, 1 mg 1 MG 13.064 - - - - - -
J9266 - Injection, pegaspargase, per single dose vial 1 EA 27070.534 - - - - - -
J9267 - Injection, paclitaxel, 1 mg 1 MG 0.126 - - - - - -
J9268 - Injection, pentostatin, 10 mg 10 MG 2673.431 - - - - - -
J9269 - Injection, tagraxofusp-erzs, 10 micrograms 10 MCG 338.532 - - - - - -
J9271 - Injection, pembrolizumab, 1 mg 1 MG 59.349 - - - - - -
J9272 - Injection, dostarlimab-gxly, 10 mg 10 MG 240.135 - - - - - -
J9273 - Injection, tisotumab vedotin-tftv, 1 mg 1 MG 188.651 - - - - - -
J9274 - Injection, tebentafusp-tebn, 1 microgram 1 MCG 214.756 - - - - - -
J9280 - Injection, mitomycin, 5 mg 5 MG 25.602 - - - - - -
J9281 - Mitomycin pyelocalyceal instillation, 1 mg 1 MG 312.995 - - - - - -
J9286 - Injection, glofitamab-gxbm, 2.5 mg 2.5 MG 2772.798 - - - - - -
J9293 - Injection, mitoxantrone hydrochloride, per 5 mg 5 MG 27.693 - - - - - -
J9294 - Injection, pemetrexed (hospira), not therapeutically equivalent to j9305, 10 mg 10 MG 3.86 - - - - - -
J9295 - Injection, necitumumab, 1 mg 1 MG 5.731 - - - - - -
J9296 - Injection, pemetrexed (accord), not therapeutically equivalent to j9305, 10 mg 10 mg 9.736 - - - - - -
J9297 - Injection, pemetrexed (sandoz), not therapeutically equivalent to j9305, 10 mg 10 MG 1.739 - - - - - -
J9298 - Injection, nivolumab and relatlimab-rmbw, 3 mg/1 mg 3 mg/1 mg 194.077 - - - - - -
J9299 - Injection, nivolumab, 1 mg 1 MG 32.352 - - - - - -
* 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