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 12 * 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
J1645 - Injection, dalteparin sodium, per 2500 iu 2500 IU 15.863 - - - - - -
J1650 - Injection, enoxaparin sodium, 10 mg 10 MG 0.542 - - - - - -
J1652 - Injection, fondaparinux sodium, 0.5 mg 0.5 MG 0.797 - - - - - -
J1670 - Injection, tetanus immune globulin, human, up to 250 units 250 UNITS 558.118 - - - - - -
J1720 - Injection, hydrocortisone sodium succinate, up to 100 mg 100 MG 22.141 - - - - - -
J1740 - Injection, ibandronate sodium, 1 mg 1 MG 9.057 - - - - - -
J1741 - Injection, ibuprofen, 100 mg 100 MG 3.177 - - - - - -
J1743 - Injection, idursulfase, 1 mg 1 MG 558.221 - - - - - -
J1745 - Injection, infliximab, excludes biosimilar, 10 mg 10 MG 31.041 - - - - - -
J1746 - Injection, ibalizumab-uiyk, 10 mg 10 MG 77.675 - - - - - -
J1747 - Injection, spesolimab-sbzo, 1 mg 1 MG 65.728 - - - - - -
J1749 - Injection, iloprost, 0.1 mcg 0.1 MCG 5.709 - - - - - -
J1750 - Injection, iron dextran, 50 mg 50 MG 18.105 - - - - - -
J1756 - Injection, iron sucrose, 1 mg 1 MG 0.223 - - - - - -
J1786 - Injection, imiglucerase, 10 units 10 UNITS 42.825 - - - - - -
J1790 - Injection, droperidol, up to 5 mg up to 5 MG 7.214 - - - - - -
J1805 - Injection, esmolol hydrochloride, 10 mg 10 MG 0.236 - - - - - -
J1806 - Injection, esmolol hydrochloride (wg critical care), not therapeutically equivalent to j1805, 10 mg 10 MG 0.196 - - - - - -
J1808 - Injection, folic acid, 0.1 mg 0.1 MG 0.054 - - - - - -
J1809 - Injection, fosdenopterin, 0.1 mg 0.1 MG 17.588 - - - - - -
J1811 - Insulin (fiasp) for administration through dme (i.e., insulin pump) per 50 units 50 UNITS 8.763 - - - - - -
J1813 - Insulin (lyumjev) for administration through dme (i.e., insulin pump) per 50 units 50 UNITS 15.104 - - - - - -
J1817 - Insulin for administration through dme (i.e., insulin pump) per 50 units 50 UNITS 3.128 - - - - - -
J1823 - Injection, inebilizumab-cdon, 1 mg 1 MG 495.545 - - - - - -
J1836 - Injection, metronidazole, 10 mg 10 MG 0.027 - - - - - -
* Effective April 1, 2026 through June 30, 2026

ASP (Average Sale Price) Drug Pricing History