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 11 * 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
J1566 - Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg 500 MG 80.395 - - - - - -
J1568 - Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg 500 MG 47.035 - - - - - -
J1569 - Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg 500 MG 49.081 - - - - - -
J1570 - Injection, ganciclovir sodium, 500 mg 500 MG 34.047 - - - - - -
J1571 - Injection, hepatitis b immune globulin (hepagam b), intramuscular, 0.5 ml 0.5 ML 70.234 - - - - - -
J1573 - Injection, hepatitis b immune globulin (hepagam b), intravenous, 0.5 ml 0.5 ML 70.234 - - - - - -
J1575 - Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin 100 MG 18.804 - - - - - -
J1576 - Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg 500 MG 73.83 - - - - - -
J1580 - Injection, garamycin, gentamicin, up to 80 mg 80 MG 1.928 - - - - - -
J1596 - Injection, glycopyrrolate, 0.1 mg 0.1 MG 0.365 - - - - - -
J1597 - Injection, glycopyrrolate (glyrx-pf), 0.1 mg 0.1 MG 1.351 - - - - - -
J1598 - Injection, glycopyrrolate (fresenius kabi), not therapeutically equivalent to j1596, 0.1 mg 0.1 MG 1.342 - - - - - -
J1602 - Injection, golimumab, 1 mg, for intravenous use 1 MG 11.287 - - - - - -
J1610 - Injection, glucagon hydrochloride, per 1 mg 1 MG 146.332 - - - - - -
J1611 - Injection, glucagon hydrochloride (fresenius kabi), not therapeutically equivalent to j1610, per 1 mg 1 MG 135 - - - - - -
J1612 - Injection, glucagon (gvoke), 0.01 mg 0.01 MG 2.365 - - - - - -
J1626 - Injection, granisetron hydrochloride, 100 mcg 100 MCG 0.162 - - - - - -
J1627 - Injection, granisetron, extended-release, 0.1 mg 0.1 MG 3.876 - - - - - -
J1628 - Injection, guselkumab, 1 mg 1 MG 67.813 - - - - - -
J1630 - Injection, haloperidol, up to 5 mg 5 MG 0.789 - - - - - -
J1631 - Injection, haloperidol decanoate, per 50 mg 50 MG 6.07 - - - - - -
J1640 - Injection, hemin, 1 mg 1 MG 35.309 - - - - - -
J1642 - Injection, heparin sodium, (heparin lock flush), per 10 units 10 UNITS 0.018 - - - - - -
J1643 - Injection, heparin sodium (pfizer), not therapeutically equivalent to j1644, per 1000 units 1000 UNITS 1.146 - - - - - -
J1644 - Injection, heparin sodium, per 1000 units 1000 UNITS 0.221 - - - - - -
* Effective April 1, 2026 through June 30, 2026

ASP (Average Sale Price) Drug Pricing History