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 28 * 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
J9201 - Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg 200 MG 3.237 - - - - - -
J9203 - Injection, gemtuzumab ozogamicin, 0.1 mg 0.1 MG 240.165 - - - - - -
J9204 - Injection, mogamulizumab-kpkc, 1 mg 1 MG 253.467 - - - - - -
J9205 - Injection, irinotecan liposome, 1 mg 1 MG 66.374 - - - - - -
J9206 - Injection, irinotecan, 20 mg 20 MG 1.532 - - - - - -
J9207 - Injection, ixabepilone, 1 mg 1 MG 139.749 - - - - - -
J9208 - Injection, ifosfamide, 1 gram 1 GM 24.682 - - - - - -
J9209 - Injection, mesna, 200 mg 200 MG 1.334 - - - - - -
J9210 - Injection, emapalumab-lzsg, 1 mg 1 MG 384.135 - - - - - -
J9211 - Injection, idarubicin hydrochloride, 5 mg 5 MG 39.756 - - - - - -
J9217 - Leuprolide acetate (for depot suspension), 7.5 mg 7.5 MG 176.2 - - - - - -
J9223 - Injection, lurbinectedin, 0.1 mg 0.1 MG 212.099 - - - - - -
J9226 - Histrelin implant (supprelin la), 50 mg 50 MG 41173.427 - - - - - -
J9227 - Injection, isatuximab-irfc, 10 mg 10 MG 83.577 - - - - - -
J9228 - Injection, ipilimumab, 1 mg 1 MG 187.166 - - - - - -
J9229 - Injection, inotuzumab ozogamicin, 0.1 mg 0.1 MG 2816.767 - - - - - -
J9245 - Injection, melphalan hydrochloride, not otherwise specified, 50 mg 50 MG 120.668 - - - - - -
J9246 - Injection, melphalan (evomela), 1 mg 1 MG 19.429 - - - - - -
J9248 - Injection, melphalan (hepzato), 1 mg 1 MG 795 - - - - - -
J9256 - Injection, nipocalimab-aahu, 3 mg 3 MG 32.67 - - - - - -
J9260 - Injection, methotrexate sodium, 50 mg 50 MG 2.677 - - - - - -
J9261 - Injection, nelarabine, 50 mg 50 MG 52.707 - - - - - -
J9263 - Injection, oxaliplatin, 0.5 mg 0.5 MG 0.078 - - - - - -
J9264 - Injection, paclitaxel protein-bound particles, 1 mg 1 MG 6.02 - - - - - -
J9266 - Injection, pegaspargase, per single dose vial 1 EA 28424.059 - - - - - -
* Effective April 1, 2026 through June 30, 2026

ASP (Average Sale Price) Drug Pricing History