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 28 * 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
J9301 - Injection, obinutuzumab, 10 mg 10 MG 75.212 - - - - - -
J9303 - Injection, panitumumab, 10 mg 10 MG 164.923 - - - - - -
J9304 - Injection, pemetrexed (pemfexy), 10 mg 10 MG 46.35 - - - - - -
J9305 - Injection, pemetrexed, not otherwise specified, 10 mg 10 MG 3.771 - - - - - -
J9306 - Injection, pertuzumab, 1 mg 1 MG 16.229 - - - - - -
J9307 - Injection, pralatrexate, 1 mg 1 MG 373.768 - - - - - -
J9308 - Injection, ramucirumab, 5 mg 5 MG 73.368 - - - - - -
J9309 - Injection, polatuzumab vedotin-piiq, 1 mg 1 MG 132.725 - - - - - -
J9311 - Injection, rituximab 10 mg and hyaluronidase 10 mg 37.526 - - - - - -
J9312 - Injection, rituximab, 10 mg 10 MG 76.433 - - - - - -
J9314 - Injection, pemetrexed (teva), not therapeutically equivalent to j9305, 10 mg 10 MG 8.37 - - - - - -
J9316 - Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg 10 MG 62.993 - - - - - -
J9317 - Injection, sacituzumab govitecan-hziy, 2.5 mg 2.5 MG 35.8 - - - - - -
J9319 - Injection, romidepsin, lyophilized, 0.1 mg 0.1 MG 31.541 - - - - - -
J9321 - Injection, epcoritamab-bysp, 0.16 mg 0.16 MG 54.861 - - - - - -
J9323 - Injection, pemetrexed ditromethamine, 10 mg 10 mg 10.343 - - - - - -
J9324 - Injection, pemetrexed (pemrydi rtu), 10 mg 10 MG 81.057 - - - - - -
J9325 - Injection, talimogene laherparepvec, per 1 million plaque forming units 1 million PFU 70.376 - - - - - -
J9328 - Injection, temozolomide, 1 mg 1 MG 10.406 - - - - - -
J9330 - Injection, temsirolimus, 1 mg 1 MG 30.317 - - - - - -
J9331 - Injection, sirolimus protein-bound particles, 1 mg 1 MG 117.632 - - - - - -
J9332 - Injection, efgartigimod alfa-fcab, 2mg 2 MG 32.375 - - - - - -
J9333 - Injection, rozanolixizumab-noli, 1 mg 1 MG 22.842 - - - - - -
J9334 - Injection, efgartigimod alfa, 2 mg and hyaluronidase-qvfc 2 MG 33.371 - - - - - -
J9340 - Injection, thiotepa, 15 mg 15 MG 245.049 - - - - - -
* 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