ASP Drug Pricing - (3rd Quarter)
July 2026
Payment Allowance Limits for Medicare Part B Drugs

  • Note 1: Payment allowance limits subject to the ASP methodology are based on Jan 2026 (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 12 * Effective Jul 1, 2026 through Sep 30, 2026
HCPCS Code Code Dosage Payment
Limit		 Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
J1645 - Injection, dalteparin sodium, per 2500 iu 2500 IU 48.413 - - - - - -
J1650 - Injection, enoxaparin sodium, 10 mg 10 MG 0.536 - - - - - -
J1652 - Injection, fondaparinux sodium, 0.5 mg 0.5 MG 0.925 - - - - - -
J1670 - Injection, tetanus immune globulin, human, up to 250 units 250 UNITS 595.017 - - - - - -
J1720 - Injection, hydrocortisone sodium succinate, up to 100 mg 100 MG 23.056 - - - - - -
J1740 - Injection, ibandronate sodium, 1 mg 1 MG 45.154 - - - - - -
J1741 - Injection, ibuprofen, 100 mg 100 MG 3.252 - - - - - -
J1743 - Injection, idursulfase, 1 mg 1 MG 570.043 - - - - - -
J1745 - Injection, infliximab, excludes biosimilar, 10 mg 10 MG 31.479 - - - - - -
J1746 - Injection, ibalizumab-uiyk, 10 mg 10 MG 79.512 - - - - - -
J1747 - Injection, spesolimab-sbzo, 1 mg 1 MG 65.728 - - - - - -
J1749 - Injection, iloprost, 0.1 mcg 0.1 MCG 5.651 - - - - - -
J1750 - Injection, iron dextran, 50 mg 50 MG 18.993 - - - - - -
J1756 - Injection, iron sucrose, 1 mg 1 MG 0.227 - - - - - -
J1786 - Injection, imiglucerase, 10 units 10 UNITS 43.326 - - - - - -
J1790 - Injection, droperidol, up to 5 mg up to 5 MG 8.124 - - - - - -
J1805 - Injection, esmolol hydrochloride, 10 mg 10 MG 0.23 - - - - - -
J1806 - Injection, esmolol hydrochloride (wg critical care), not therapeutically equivalent to j1805, 10 mg 10 MG 0.196 - - - - - -
J1808 - Injection, folic acid, 0.1 mg 0.1 MG 0.051 - - - - - -
J1809 - Injection, fosdenopterin, 0.1 mg 0.1 MG 17.736 - - - - - -
J1811 - Insulin (fiasp) for administration through dme (i.e., insulin pump) per 50 units 50 UNITS 1.727 - - - - - -
J1813 - Insulin (lyumjev) for administration through dme (i.e., insulin pump) per 50 units 50 UNITS 4.802 - - - - - -
J1817 - Insulin for administration through dme (i.e., insulin pump) per 50 units 50 UNITS 3.062 - - - - - -
J1823 - Injection, inebilizumab-cdon, 1 mg 1 MG 510.652 - - - - - -
J1836 - Injection, metronidazole, 10 mg 10 MG 0.033 - - - - - -
* Effective Jul 1, 2026 through Sep 30, 2026

ASP (Average Sale Price) Drug Pricing History