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 22 * 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
J7205 - Injection, factor viii fc fusion protein (recombinant), per iu 1 IU 2.462 - - - - - - 1
J7207 - Injection, factor viii, (antihemophilic factor, recombinant), pegylated, 1 i.u. 1 IU 2.142 - - - - - - 1
J7208 - Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl, (jivi), 1 i.u. 1 IU 2.655 - - - - - - 1
J7209 - Injection, factor viii, (antihemophilic factor, recombinant), (nuwiq), 1 i.u. 1 IU 1.182 - - - - - - 1
J7210 - Injection, factor viii, (antihemophilic factor, recombinant), (afstyla), 1 i.u. 1 IU 1.572 - - - - - - 1
J7211 - Injection, factor viii, (antihemophilic factor, recombinant), (kovaltry), 1 i.u. 1 IU 1.564 - - - - - - 1
J7212 - Factor viia (antihemophilic factor, recombinant)-jncw (sevenfact), 1 microgram 1 MCG 2.198 - - - - - - 1
J7213 - Injection, coagulation factor ix (recombinant), ixinity, 1 i.u. 1 IU 1.973 - - - - - - 1
J7214 - Injection, factor viii/von willebrand factor complex, recombinant (altuviiio), per factor viii i.u. 1 IU 4.492 - - - - - - 1
J7308 - Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg) 354 MG 390.016 - - - - - -
J7311 - Injection, fluocinolone acetonide, intravitreal implant (retisert), 0.01 mg 0.01 MG 338.792 - - - - - -
J7312 - Injection, dexamethasone, intravitreal implant, 0.1 mg 0.1 MG 203.793 - - - - - -
J7313 - Injection, fluocinolone acetonide, intravitreal implant (iluvien), 0.01 mg 0.01 MG 509.81 - - - - - -
J7314 - Injection, fluocinolone acetonide, intravitreal implant (yutiq), 0.01 mg 0.01 MG 529.889 - - - - - -
J7318 - Hyaluronan or derivative, durolane, for intra-articular injection, 1 mg 1 MG 6.732 - - - - - -
J7320 - Hyaluronan or derivitive, genvisc 850, for intra-articular injection, 1 mg 1 MG 3.676 - - - - - -
J7321 - Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose per dose 74.434 - - - - - -
J7322 - Hyaluronan or derivative, hymovis or hymovis one, for intra-articular injection, 1 mg 1 MG 18.134 - - - - - -
J7323 - Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose per dose 105.58 - - - - - -
J7324 - Hyaluronan or derivative, orthovisc, for intra-articular injection, per dose PER DOSE 109.094 - - - - - -
J7325 - Hyaluronan or derivative, synvisc or synvisc-one, for intra-articular injection, 1 mg 1 MG 6.963 - - - - - -
J7326 - Hyaluronan or derivative, gel-one, for intra-articular injection, per dose per dose 526.786 - - - - - -
J7327 - Hyaluronan or derivative, monovisc, for intra-articular injection, per dose PER DOSE 655.337 - - - - - -
J7328 - Hyaluronan or derivative, gelsyn-3, for intra-articular injection, 0.1 mg 0.1 MG 0.68 - - - - - -
J7329 - Hyaluronan or derivative, trivisc, for intra-articular injection, 1 mg 1 MG 3.273 - - - - - -
* Effective April 1, 2026 through June 30, 2026

ASP (Average Sale Price) Drug Pricing History