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 35 * 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
`Q9991` - Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg	Less than or equal to 100 MG	1996.557	-	-	-	-	-	-
`Q9992` - Injection, buprenorphine extended-release (sublocade), greater than 100 mg	Greater than 100 MG	1996.557	-	-	-	-	-	-
`Q9997` - Injection, ustekinumab-ttwe (pyzchiva), intravenous, 1 mg	1 MG	4.531	-	-	-	-	-	-
`Q9998` - Injection, ustekinumab-aekn (selarsdi), biosimilar, 1 mg	1 MG	11.138	-	-	-	-	-	-
`Q9999` - Injection, ustekinumab-aauz (otulfi), biosimilar, 1 mg	1 MG	13.293	-	-	-	-	-	-
* Effective April 1, 2026 through June 30, 2026

ASP (Average Sale Price) Drug Pricing History