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 19 * 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
J3247 - Injection, secukinumab, intravenous, 1 mg 1 MG 18.042 - - - - - -
J3250 - Injection, trimethobenzamide hcl, up to 200 mg 200 MG 57.22 - - - - - -
J3260 - Injection, tobramycin sulfate, up to 80 mg 80 MG 2.019 - - - - - -
J3262 - Injection, tocilizumab, 1 mg 1 MG 5.53 - - - - - -
J3263 - Injection, toripalimab-tpzi, 1 mg 1 MG 39.993 - - - - - -
J3285 - Injection, treprostinil, 1 mg 1 MG 55.185 - - - - - -
J3299 - Injection, triamcinolone acetonide (xipere), 1 mg 1 MG 47.779 - - - - - -
J3300 - Injection, triamcinolone acetonide, preservative free, 1 mg 1 MG 18.78 - - - - - -
J3301 - Injection, triamcinolone acetonide, not otherwise specified, 10 mg 10 MG 0.895 - - - - - -
J3304 - Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg 1 MG 18.636 - - - - - -
J3315 - Injection, triptorelin pamoate, 3.75 mg 3.75 MG 469.376 - - - - - -
J3316 - Injection, triptorelin, extended-release, 3.75 mg 3.75 MG 3723.756 - - - - - -
J3358 - Ustekinumab, for intravenous injection, 1 mg 1 MG 11.624 - - - - - -
J3360 - Injection, diazepam, up to 5 mg 5 MG 8.508 - - - - - -
J3373 - Injection, vancomycin hydrochloride, 10 mg 10 MG 0.03 - - - - - -
J3374 - Injection, vancomycin hydrochloride (mylan) not therapeutically equivalent to j3373, 10 mg 10 MG 0.098 - - - - - -
J3375 - Injection, vancomycin hydrochloride (xellia), not therapeutically equivalent to j3373, 10 mg 10 MG 0.162 - - - - - -
J3376 - Injection, vancomycin hcl (hikma), not therapeutically equivalent to j3373, 10 mg 10 MG 0.014 - - - - - -
J3379 - Injection, valproate sodium, 5 mg 5 MG 0.04 - - - - - -
J3380 - Injection, vedolizumab, intravenous, 1 mg 1 MG 20.98 - - - - - -
J3385 - Injection, velaglucerase alfa, 100 units 100 UNITS 388.157 - - - - - -
J3396 - Injection, verteporfin, 0.1 mg 0.1 MG 11.574 - - - - - -
J3401 - Beremagene geperpavec-svdt for topical administration, containing nominal 5 x 10^9 pfu/ml vector genomes, per 0.1 ml 0.1 ML 1004.582 - - - - - -
J3402 - Injection, remestemcel-l-rknd, per therapeutic dose Per Therapeutic Dose 202713.584 - - - - - -
J3410 - Injection, hydroxyzine hcl, up to 25 mg 25 MG 15.165 - - - - - -
* Effective April 1, 2026 through June 30, 2026

ASP (Average Sale Price) Drug Pricing History