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 29 * 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
J9316 - Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg 10 MG 63.387 - - - - - -
J9317 - Injection, sacituzumab govitecan-hziy, 2.5 mg 2.5 MG 36.258 - - - - - -
J9318 - Injection, romidepsin, non-lyophilized, 0.1 mg 0.1 MG 28.517 - - - - - -
J9319 - Injection, romidepsin, lyophilized, 0.1 mg 0.1 MG 31.075 - - - - - -
J9321 - Injection, epcoritamab-bysp, 0.16 mg 0.16 MG 55.658 - - - - - -
J9323 - Injection, pemetrexed ditromethamine, 10 mg 10 mg 10.343 - - - - - -
J9324 - Injection, pemetrexed (pemrydi rtu), 10 mg 10 MG 80.1 - - - - - -
J9325 - Injection, talimogene laherparepvec, per 1 million plaque forming units 1 million PFU 73.547 - - - - - -
J9328 - Injection, temozolomide, 1 mg 1 MG 10.394 - - - - - -
J9329 - Injection, tislelizumab-jsgr, 1mg 1 MG 57.416 - - - - - -
J9330 - Injection, temsirolimus, 1 mg 1 MG 32.286 - - - - - -
J9331 - Injection, sirolimus protein-bound particles, 1 mg 1 MG 84.529 - - - - - -
J9332 - Injection, efgartigimod alfa-fcab, 2mg 2 MG 32.396 - - - - - -
J9333 - Injection, rozanolixizumab-noli, 1 mg 1 MG 23.162 - - - - - -
J9334 - Injection, efgartigimod alfa, 2 mg and hyaluronidase-qvfc 2 MG 33.736 - - - - - -
J9342 - Injection, thiotepa, not otherwise specified, 1 mg 1 MG 12.236 - - - - - -
J9345 - Injection, retifanlimab-dlwr, 1 mg 1 MG 29.982 - - - - - -
J9347 - Injection, tremelimumab-actl, 1 mg 1 MG 141.165 - - - - - -
J9348 - Injection, naxitamab-gqgk, 1 mg 1 MG 685.906 - - - - - -
J9349 - Injection, tafasitamab-cxix, 2 mg 2 MG 14.075 - - - - - -
J9350 - Injection, mosunetuzumab-axgb, 1 mg 1 MG 652.746 - - - - - -
J9351 - Injection, topotecan, 0.1 mg 0.1 MG 1.342 - - - - - -
J9352 - Injection, trabectedin, 0.1 mg 0.1 MG 383.067 - - - - - -
J9353 - Injection, margetuximab-cmkb, 5 mg 5 MG 50.45 - - - - - -
J9354 - Injection, ado-trastuzumab emtansine, 1 mg 1 MG 41.854 - - - - - -
* 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