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 29 * 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
J9345 - Injection, retifanlimab-dlwr, 1 mg 1 MG 29.736 - - - - - -
J9347 - Injection, tremelimumab-actl, 1 mg 1 MG 138.244 - - - - - -
J9348 - Injection, naxitamab-gqgk, 1 mg 1 MG 641.829 - - - - - -
J9349 - Injection, tafasitamab-cxix, 2 mg 2 MG 13.925 - - - - - -
J9350 - Injection, mosunetuzumab-axgb, 1 mg 1 MG 640.956 - - - - - -
J9351 - Injection, topotecan, 0.1 mg 0.1 MG 1.273 - - - - - -
J9352 - Injection, trabectedin, 0.1 mg 0.1 MG 363.832 - - - - - -
J9353 - Injection, margetuximab-cmkb, 5 mg 5 MG 48.53 - - - - - -
J9354 - Injection, ado-trastuzumab emtansine, 1 mg 1 MG 41.105 - - - - - -
J9355 - Injection, trastuzumab, excludes biosimilar, 10 mg 10 MG 75.692 - - - - - -
J9356 - Injection, trastuzumab, 10 mg and hyaluronidase-oysk 10 MG 62.916 - - - - - -
J9357 - Injection, valrubicin, intravesical, 200 mg 200 MG 1444.55 - - - - - -
J9358 - Injection, fam-trastuzumab deruxtecan-nxki, 1 mg 1 MG 28.901 - - - - - -
J9359 - Injection, loncastuximab tesirine-lpyl, 0.075 mg 0.075 MG 211.995 - - - - - -
J9360 - Injection, vinblastine sulfate, 1 mg 1 MG 5.136 - - - - - -
J9370 - Vincristine sulfate, 1 mg 1 MG 8.196 - - - - - -
J9380 - Injection, teclistamab-cqyv, 0.5 mg 0.5 MG 32.419 - - - - - -
J9381 - Injection, teplizumab-mzwv, 5 mcg 5 MCG 37.307 - - - - - -
J9390 - Injection, vinorelbine tartrate, 10 mg 10 MG 6.586 - - - - - -
J9394 - Injection, fulvestrant (fresenius kabi) not therapeutically equivalent to j9395, 25 mg 25 MG 3.322 - - - - - -
J9395 - Injection, fulvestrant, 25 mg 25 MG 6.895 - - - - - -
J9400 - Injection, ziv-aflibercept, 1 mg 1 MG 8.298 - - - - - -
P9041 - Infusion, albumin (human), 5%, 50 ml 50 ML 10.615 - - - - 95% 10.615
P9045 - Infusion, albumin (human), 5%, 250 ml 250 ML 53.077 - - - - 95% 53.077
P9046 - Infusion, albumin (human), 25%, 20 ml 20 ML 21.231 - - - - 95% 21.231
* 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