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 21 * 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
J7175 - Injection, factor x, (human), 1 i.u. 1 IU 9.953 - - - - - - 1
J7177 - Injection, human fibrinogen concentrate (fibryga), 1 mg 1 MG 1.237 - - - - - - 1
J7178 - Injection, human fibrinogen concentrate, not otherwise specified, 1 mg 1 MG 1.524 - - - - - - 1
J7179 - Injection, von willebrand factor (recombinant), (vonvendi), 1 i.u. vwf:rco 1 IU 1.83 - - - - - - 1
J7180 - Injection, factor xiii (antihemophilic factor, human), 1 i.u. 1 IU 10.778 - - - - - - 1
J7181 - Injection, factor xiii a-subunit, (recombinant), per iu 1 IU 18.331 - - - - - - 1
J7182 - Injection, factor viii, (antihemophilic factor, recombinant), (novoeight), per iu 1 IU 1.41 - - - - - - 1
J7183 - Injection, von willebrand factor complex (human), wilate, 1 i.u. vwf:rco 1 I.U. VWF:RCO 1.32 - - - - - - 1
J7185 - Injection, factor viii (antihemophilic factor, recombinant) (xyntha), per i.u. 1 IU 1.491 - - - - - - 1
J7186 - Injection, antihemophilic factor viii/von willebrand factor complex (human), per factor viii i.u. PER FACTOR VIII IU 1.252 - - - - - - 1
J7187 - Injection, von willebrand factor complex (humate-p), per iu vwf:rco 1 IU 1.494 - - - - - - 1
J7188 - Injection, factor viii (antihemophilic factor, recombinant), (obizur), per i.u. 1 IU 3.236 - - - - - - 1
J7189 - Factor viia (antihemophilic factor, recombinant), (novoseven rt), 1 microgram 1 MCG 2.64 - - - - - - 1
J7190 - Factor viii (antihemophilic factor, human) per i.u. 1 IU 1.393 - - - - - - 1
J7192 - Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified 1 IU 1.568 - - - - - - 1
J7193 - Factor ix (antihemophilic factor, purified, non-recombinant) per i.u. 1 IU 1.369 - - - - - - 1
J7194 - Factor ix, complex, per i.u. 1 IU 1.704 - - - - - - 1
J7195 - Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified 1 IU 1.836 - - - - - - 1
J7197 - Antithrombin iii (human), per i.u. 1 IU 4.1 - - - - - -
J7198 - Anti-inhibitor, per i.u. 1 IU 2.418 - - - - - - 1
J7200 - Injection, factor ix, (antihemophilic factor, recombinant), rixubis, per iu 1 IU 1.742 - - - - - - 1
J7201 - Injection, factor ix, fc fusion protein, (recombinant), alprolix, 1 i.u. 1 IU 3.58 - - - - - - 1
J7202 - Injection, factor ix, albumin fusion protein, (recombinant), idelvion, 1 i.u. 1 IU 5.319 - - - - - - 1
J7203 - Injection factor ix, (antihemophilic factor, recombinant), glycopegylated, (rebinyn), 1 iu 1 IU 4.496 - - - - - - 1
J7204 - Injection, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu 1 IU 2.225 - - - - - - 1
* Effective April 1, 2026 through June 30, 2026

ASP (Average Sale Price) Drug Pricing History