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 9 * 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
J1250 - Injection, dobutamine hydrochloride, per 250 mg 250 MG 7.882 - - - - - -
J1265 - Injection, dopamine hcl, 40 mg 40 MG 0.801 - - - - - -
J1270 - Injection, doxercalciferol, 1 mcg 1 MCG 0.307 - - - - - -
J1271 - Injection, doxycycline hyclate, 1 mg 1 MG 0.088 - - - - - -
J1290 - Injection, ecallantide, 1 mg 1 MG 578.747 - - - - - -
J1299 - Injection, eculizumab, 2 mg 2 MG 44.699 - - - - - -
J1301 - Injection, edaravone, 1 mg 1 MG 15.178 - - - - - -
J1302 - Injection, sutimlimab-jome, 10 mg 10 MG 19.642 - - - - - -
J1303 - Injection, ravulizumab-cwvz, 10 mg 10 MG 223.675 - - - - - -
J1304 - Injection, tofersen, 1 mg 1 MG 160.01 - - - - - -
J1305 - Injection, evinacumab-dgnb, 5mg 5 MG 197.633 - - - - - -
J1306 - Injection, inclisiran, 1 mg 1 MG 12.61 - - - - - -
J1307 - Injection, crovalimab-akkz, 10 mg 10 MG 551.512 - - - - - -
J1308 - Injection, famotidine, 0.25 mg 0.25 MG 0.009 - - - - - -
J1322 - Injection, elosulfase alfa, 1 mg 1 MG 311.946 - - - - - -
J1323 - Injection, elranatamab-bcmm, 1 mg 1 MG 186.791 - - - - - -
J1325 - Injection, epoprostenol, 0.5 mg 0.5 MG 14.876 - - - - - -
J1326 - Injection, zolbetuximab-clzb, 2 mg 2 MG 33.649 - - - - - -
J1335 - Injection, ertapenem sodium, 500 mg 500 MG 7.217 - - - - - -
J1364 - Injection, erythromycin lactobionate, per 500 mg 500 MG 91.226 - - - - - -
J1380 - Injection, estradiol valerate, up to 10 mg 10 MG 7.189 - - - - - -
J1410 - Injection, estrogen conjugated, per 25 mg 25 MG 391.718 - - - - - -
J1430 - Injection, ethanolamine oleate, 100 mg 100 MG 518.627 - - - - - -
J1434 - Injection, fosaprepitant (focinvez), 1 mg 1 MG 2.547 - - - - - -
J1437 - Injection, ferric derisomaltose, 10 mg 10 MG 21.93 - - - - - -
* Effective April 1, 2026 through June 30, 2026

ASP (Average Sale Price) Drug Pricing History