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 31 * 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
J9342 - Injection, thiotepa, not otherwise specified, 1 mg 1 MG 5.738 - - - - - -
J9345 - Injection, retifanlimab-dlwr, 1 mg 1 MG 30.403 - - - - - -
J9347 - Injection, tremelimumab-actl, 1 mg 1 MG 143.228 - - - - - -
J9348 - Injection, naxitamab-gqgk, 1 mg 1 MG 686.092 - - - - - -
J9349 - Injection, tafasitamab-cxix, 2 mg 2 MG 14.166 - - - - - -
J9350 - Injection, mosunetuzumab-axgb, 1 mg 1 MG 654.542 - - - - - -
J9351 - Injection, topotecan, 0.1 mg 0.1 MG 2.111 - - - - - -
J9352 - Injection, trabectedin, 0.1 mg 0.1 MG 391.07 - - - - - -
J9353 - Injection, margetuximab-cmkb, 5 mg 5 MG 53.272 - - - - - -
J9354 - Injection, ado-trastuzumab emtansine, 1 mg 1 MG 42.198 - - - - - -
J9355 - Injection, trastuzumab, excludes biosimilar, 10 mg 10 MG 73.425 - - - - - -
J9356 - Injection, trastuzumab, 10 mg and hyaluronidase-oysk 10 MG 59.909 - - - - - -
J9357 - Injection, valrubicin, intravesical, 200 mg 200 MG 1270.524 - - - - - -
J9358 - Injection, fam-trastuzumab deruxtecan-nxki, 1 mg 1 MG 31.262 - - - - - -
J9359 - Injection, loncastuximab tesirine-lpyl, 0.075 mg 0.075 MG 221.493 - - - - - -
J9360 - Injection, vinblastine sulfate, 1 mg 1 MG 5.152 - - - - - -
J9370 - Vincristine sulfate, 1 mg 1 MG 8.113 - - - - - -
J9380 - Injection, teclistamab-cqyv, 0.5 mg 0.5 MG 34.501 - - - - - -
J9381 - Injection, teplizumab-mzwv, 5 mcg 5 MCG 38.394 - - - - - -
J9382 - Injection, zenocutuzumab-zbco, 1 mg 1 MG 33.567 - - - - - -
J9390 - Injection, vinorelbine tartrate, 10 mg 10 MG 4.974 - - - - - -
J9394 - Injection, fulvestrant (fresenius kabi) not therapeutically equivalent to j9395, 25 mg 25 MG 27.112 - - - - - -
J9395 - Injection, fulvestrant, 25 mg 25 MG 4.938 - - - - - -
J9400 - Injection, ziv-aflibercept, 1 mg 1 MG 8.608 - - - - - -
J9601 - Injection, linvoseltamab-gcpt, 1 mg 1 MG 99.502 - - - - - -
* Effective April 1, 2026 through June 30, 2026

ASP (Average Sale Price) Drug Pricing History