ASP Drug Pricing - (3rd Quarter)
July 2025
Payment Allowance Limits for Medicare Part B Drugs

  • Note 1: Payment allowance limits subject to the ASP methodology are based on Jan 2025 (1st 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 26 * Effective Jul 1, 2025 through Sep 30, 2025
HCPCS Code Code Dosage Payment
Limit		 Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
J9119 - Injection, cemiplimab-rwlc, 1 mg 1 MG 28.697 - - - - - -
J9120 - Injection, dactinomycin, 0.5 mg 0.5 MG 302.923 - - - - - -
J9130 - Dacarbazine, 100 mg 100 MG 3.817 - - - - - -
J9144 - Injection, daratumumab, 10 mg and hyaluronidase-fihj 10 MG 54.667 - - - - - -
J9145 - Injection, daratumumab, 10 mg 10 MG 69.835 - - - - - -
J9150 - Injection, daunorubicin, 10 mg 10 MG 19.762 - - - - - -
J9153 - Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine 1 MG/2.27 MG 255.092 - - - - - -
J9155 - Injection, degarelix, 1 mg 1 MG 4.357 - - - - - -
J9171 - Injection, docetaxel, 1 mg 1 MG 0.379 - - - - - -
J9172 - Injection, docetaxel (docivyx), 1 mg 1 MG 49.077 - - - - - -
J9173 - Injection, durvalumab, 10 mg 10 MG 85.25 - - - - - -
J9176 - Injection, elotuzumab, 1 mg 1 MG 7.877 - - - - - -
J9177 - Injection, enfortumab vedotin-ejfv, 0.25 mg 0.25 MG 36.663 - - - - - -
J9178 - Injection, epirubicin hcl, 2 mg 2 MG 1.586 - - - - - -
J9179 - Injection, eribulin mesylate, 0.1 mg 0.1 MG 104.584 - - - - - -
J9181 - Injection, etoposide, 10 mg 10 MG 1.303 - - - - - -
J9185 - Injection, fludarabine phosphate, 50 mg 50 MG 71.649 - - - - - -
J9190 - Injection, fluorouracil, 500 mg 500 MG 1.715 - - - - - -
J9196 - Injection, gemcitabine hydrochloride (accord), not therapeutically equivalent to j9201, 200 mg 200 MG 5.29 - - - - - -
J9200 - Injection, floxuridine, 500 mg 500 MG 4125.55 - - - - - -
J9201 - Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg 200 MG 2.958 - - - - - -
J9202 - Goserelin acetate implant, per 3.6 mg 3.6 MG 734.151 - - - - - -
J9203 - Injection, gemtuzumab ozogamicin, 0.1 mg 0.1 MG 236.616 - - - - - -
J9204 - Injection, mogamulizumab-kpkc, 1 mg 1 MG 248.497 - - - - - -
J9205 - Injection, irinotecan liposome, 1 mg 1 MG 65.255 - - - - - -
* Effective Jul 1, 2025 through Sep 30, 2025

Drugs not otherwise classified - July 2025

 

Medicare Part B payment allowance limits for drugs not otherwise classified - Effective Jul 1, 2025 through Sep 30, 2025

Drug name Dosage Payment limit Notes
Vasopressin (Long Grove) 1 UNIT 2.796

ASP (Average Sale Price) Drug Pricing History