ASP Drug Pricing - (2nd Quarter)
April 2026
Payment Allowance Limits for Medicare Part B Drugs

  • Note 1: Payment allowance limits subject to the ASP methodology are based on Oct 2025 (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 10 * Effective April 1, 2026 through June 30, 2026
HCPCS Code Code Dosage Payment
Limit		 Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
J1439 - Injection, ferric carboxymaltose, 1 mg 1 MG 1.103 - - - - - -
J1440 - Fecal microbiota, live - jslm, 1 ml 1 ML 64.322 - - - - - -
J1442 - Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram 1 MCG 1.016 - - - - - -
J1447 - Injection, tbo-filgrastim, 1 microgram 1 MCG 0.246 - - - - - -
J1448 - Injection, trilaciclib, 1mg 1 MG 5.488 - - - - - -
J1449 - Injection, eflapegrastim-xnst, 0.1 mg 0.1 MG 38.955 - - - - - -
J1450 - Injection fluconazole, 200 mg 200 MG 3.874 - - - - - -
J1453 - Injection, fosaprepitant, 1 mg 1 MG 0.106 - - - - - -
J1454 - Injection, fosnetupitant 235 mg and palonosetron 0.25 mg 0.25 MG 524.177 - - - - - -
J1455 - Injection, foscarnet sodium, per 1000 mg 1000 MG 8.356 - - - - - -
J1456 - Injection, fosaprepitant (teva), not therapeutically equivalent to j1453, 1 mg 1 MG 0.036 - - - - - -
J1458 - Injection, galsulfase, 1 mg 1 MG 513.595 - - - - - -
J1459 - Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg 500 MG 49.533 - - - - - -
J1460 - Injection, gamma globulin, intramuscular, 1 cc 1 CC 48.953 - - - - - -
J1551 - Injection, immune globulin (cutaquig), 100 mg 100 MG 13.927 - - - - - -
J1552 - Injection, immune globulin (alyglo), 500 mg 500 MG 123.125 - - - - - -
J1553 - Injection, immune globulin (yimmugo), 100 mg 100 MG 24.323 - - - - - -
J1554 - Injection, immune globulin (asceniv), 500 mg 500 MG 500.926 - - - - - -
J1555 - Injection, immune globulin (cuvitru), 100 mg 100 MG 17.58 - - - - - -
J1556 - Injection, immune globulin (bivigam), 500 mg 500 MG 79.441 - - - - - -
J1557 - Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg 500 MG 64.65 - - - - - -
J1558 - Injection, immune globulin (xembify), 100 mg 100 MG 15.367 - - - - - -
J1559 - Injection, immune globulin (hizentra), 100 mg 100 MG 14.515 - - - - - -
J1560 - Injection, gamma globulin, intramuscular, over 10 cc 10 CC 160.286 - - - - - -
J1561 - Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg 500 MG 49.726 - - - - - -
* Effective April 1, 2026 through June 30, 2026

ASP (Average Sale Price) Drug Pricing History