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 30 * 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
J9304 - Injection, pemetrexed (pemfexy), 10 mg 10 MG 7.994 - - - - - -
J9305 - Injection, pemetrexed, not otherwise specified, 10 mg 10 MG 4.038 - - - - - -
J9306 - Injection, pertuzumab, 1 mg 1 MG 17.016 - - - - - -
J9307 - Injection, pralatrexate, 1 mg 1 MG 392.719 - - - - - -
J9308 - Injection, ramucirumab, 5 mg 5 MG 75.472 - - - - - -
J9309 - Injection, polatuzumab vedotin-piiq, 1 mg 1 MG 137.227 - - - - - -
J9311 - Injection, rituximab 10 mg and hyaluronidase 10 mg 36.282 - - - - - -
J9312 - Injection, rituximab, 10 mg 10 MG 74.158 - - - - - -
J9314 - Injection, pemetrexed (teva), not therapeutically equivalent to j9305, 10 mg 10 MG 10.986 - - - - - -
J9316 - Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg 10 MG 60.225 - - - - - -
J9317 - Injection, sacituzumab govitecan-hziy, 2.5 mg 2.5 MG 36.797 - - - - - -
J9318 - Injection, romidepsin, non-lyophilized, 0.1 mg 0.1 MG 28.517 - - - - - -
J9319 - Injection, romidepsin, lyophilized, 0.1 mg 0.1 MG 30.796 - - - - - -
J9321 - Injection, epcoritamab-bysp, 0.16 mg 0.16 MG 56.916 - - - - - -
J9324 - Injection, pemetrexed (pemrydi rtu), 10 mg 10 MG 70.476 - - - - - -
J9325 - Injection, talimogene laherparepvec, per 1 million plaque forming units 1 million PFU 73.942 - - - - - -
J9326 - Injection, telisotuzumab vedotin-tllv, 1 mg 1 MG 145.994 - - - - - -
J9328 - Injection, temozolomide, 1 mg 1 MG 10.399 - - - - - -
J9329 - Injection, tislelizumab-jsgr, 1mg 1 MG 58.27 - - - - - -
J9330 - Injection, temsirolimus, 1 mg 1 MG 30.078 - - - - - -
J9331 - Injection, sirolimus protein-bound particles, 1 mg 1 MG 87.11 - - - - - -
J9332 - Injection, efgartigimod alfa-fcab, 2mg 2 MG 32.608 - - - - - -
J9333 - Injection, rozanolixizumab-noli, 1 mg 1 MG 23.396 - - - - - -
J9334 - Injection, efgartigimod alfa, 2 mg and hyaluronidase-qvfc 2 MG 34.325 - - - - - -
J9341 - Injection, thiotepa (tepylute), 1 mg 1 MG 38.55 - - - - - -
* Effective April 1, 2026 through June 30, 2026

ASP (Average Sale Price) Drug Pricing History