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 25 * 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
J8522 - Capecitabine, oral, 50 mg 50 MG 0.03 - - - - - -
J8530 - Cyclophosphamide; oral, 25 mg 25 MG 1.649 - - - - - -
J8540 - Dexamethasone, oral, 0.25 mg 0.25 MG 0.027 - - - - - -
J8560 - Etoposide; oral, 50 mg 50 MG 86.84 - - - - - -
J8610 - Methotrexate; oral, 2.5 mg 2.5 MG 0.14 - - - - - -
J8611 - Methotrexate (jylamvo), oral, 2.5 mg 2.5 MG 18.71 - - - - - -
J8612 - Methotrexate (xatmep), oral, 2.5 mg 2.5 MG 22.296 - - - - - -
J8655 - Netupitant 300 mg and palonosetron 0.5 mg, oral 0.5 MG 397.793 - - - - - -
J8700 - Temozolomide, oral, 5 mg 5 MG 0.395 - - - - - -
J8705 - Topotecan, oral, 0.25 mg 0.25 mg 125.224 - - - - - -
J9000 - Injection, doxorubicin hydrochloride, 10 mg 10 MG 2.729 - - - - - -
J9011 - Injection, datopotamab deruxtecan-dlnk, 1 mg 1 MG 51.516 - - - - - -
J9017 - Injection, arsenic trioxide, 1 mg 1 MG 6.445 - - - - - -
J9021 - Injection, asparaginase, recombinant, (rylaze), 0.1 mg 0.1 MG 56.286 - - - - - -
J9022 - Injection, atezolizumab, 10 mg 10 MG 93.997 - - - - - -
J9023 - Injection, avelumab, 10 mg 10 MG 105.545 - - - - - -
J9024 - Injection, atezolizumab, 5 mg and hyaluronidase-tqjs 5 MG 31.947 - - - - - -
J9025 - Injection, azacitidine, 1 mg 1 MG 0.41 - - - - - -
J9026 - Injection, tarlatamab-dlle, 1 mg 1 MG 1567.718 - - - - - -
J9027 - Injection, clofarabine, 1 mg 1 MG 10.937 - - - - - -
J9028 - Injection, nogapendekin alfa inbakicept-pmln, for intravesical use, 1 microgram 1 MCG 94.598 - - - - - -
J9029 - Intravesical instillation, nadofaragene firadenovec-vncg, per therapeutic dose PER THERAPEUTIC DOSE 64282.299 - - - - - -
J9030 - Bcg live intravesical instillation, 1 mg 1 MG 3.391 - - - - - -
J9032 - Injection, belinostat, 10 mg 10 MG 53.111 - - - - - -
J9033 - Injection, bendamustine hydrochloride, 1 mg 1 MG 2.159 - - - - - -
* Effective April 1, 2026 through June 30, 2026

ASP (Average Sale Price) Drug Pricing History