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 29 * 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
J9267 - Injection, paclitaxel, 1 mg 1 MG 0.147 - - - - - -
J9268 - Injection, pentostatin, 10 mg 10 MG 2626.328 - - - - - -
J9269 - Injection, tagraxofusp-erzs, 10 micrograms 10 MCG 357.279 - - - - - -
J9271 - Injection, pembrolizumab, 1 mg 1 MG 61.251 - - - - - -
J9272 - Injection, dostarlimab-gxly, 10 mg 10 MG 247.083 - - - - - -
J9273 - Injection, tisotumab vedotin-tftv, 1 mg 1 MG 196.121 - - - - - -
J9274 - Injection, tebentafusp-tebn, 1 microgram 1 MCG 222.494 - - - - - -
J9276 - Injection, zanidatamab-hrii, 2 mg 2 MG 24.996 - - - - - -
J9277 - Injection, pembrolizumab, 1 mg and berahyaluronidase alfa-pmph 1 MG 32.129 - - - - - -
J9278 - Injection, carboplatin (avyxa), 1 mg 1 MG 5.242 - - - - - -
J9280 - Injection, mitomycin, 5 mg 5 MG 28.459 - - - - - -
J9281 - Mitomycin pyelocalyceal instillation, 1 mg 1 MG 323.171 - - - - - -
J9282 - Mitomycin, intravesical instillation, 1 mg 1 MG 278.332 - - - - - -
J9286 - Injection, glofitamab-gxbm, 2.5 mg 2.5 MG 2840.677 - - - - - -
J9289 - Injection, nivolumab, 2 mg and hyaluronidase-nvhy 2 MG 27.729 - - - - - -
J9292 - Injection, pemetrexed dipotassium, 10 mg 10 MG 82.019 - - - - - -
J9293 - Injection, mitoxantrone hydrochloride, per 5 mg 5 MG 38.614 - - - - - -
J9294 - Injection, pemetrexed (hospira), not therapeutically equivalent to j9305, 10 mg 10 MG 5.198 - - - - - -
J9295 - Injection, necitumumab, 1 mg 1 MG 5.731 - - - - - -
J9296 - Injection, pemetrexed (accord), not therapeutically equivalent to j9305, 10 mg 10 mg 9.656 - - - - - -
J9297 - Injection, pemetrexed (sandoz), not therapeutically equivalent to j9305, 10 mg 10 MG 1.459 - - - - - -
J9298 - Injection, nivolumab and relatlimab-rmbw, 3 mg/1 mg 3 mg/1 mg 201.755 - - - - - -
J9299 - Injection, nivolumab, 1 mg 1 MG 33.624 - - - - - -
J9301 - Injection, obinutuzumab, 10 mg 10 MG 81.806 - - - - - -
J9303 - Injection, panitumumab, 10 mg 10 MG 174.386 - - - - - -
* Effective April 1, 2026 through June 30, 2026

ASP (Average Sale Price) Drug Pricing History