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 18 * 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
J2805 - Injection, sincalide, 5 micrograms 5 MCG 110.462 - - - - - -
J2820 - Injection, sargramostim (gm-csf), 50 mcg 50 MCG 62.474 - - - - - -
J2860 - Injection, siltuximab, 10 mg 10 MG 174.066 - - - - - -
J2865 - Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg 5MG-1MG 0.036 - - - - - -
J2916 - Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg 12.5 MG 2.197 - - - - - -
J2919 - Injection, methylprednisolone sodium succinate, 5 mg 5 MG 0.224 - - - - - -
J2997 - Injection, alteplase recombinant, 1 mg 1 MG 98.587 - - - - - -
J3000 - Injection, streptomycin, up to 1 gm 1 GM 26.883 - - - - - -
J3010 - Injection, fentanyl citrate, 0.1 mg 0.1 MG 1.385 - - - - - -
J3032 - Injection, eptinezumab-jjmr, 1 mg 1 MG 21.101 - - - - - -
J3055 - Injection, talquetamab-tgvs, 0.25 mg 0.25 MG 76.721 - - - - - -
J3060 - Injection, taliglucerase alfa, 10 units 10 UNITS 42.675 - - - - - -
J3090 - Injection, tedizolid phosphate, 1 mg 1 MG 2.081 - - - - - -
J3095 - Injection, telavancin, 10 mg 10 MG 7.484 - - - - - -
J3101 - Injection, tenecteplase, 1 mg 1 MG 217.421 - - - - - -
J3105 - Injection, terbutaline sulfate, up to 1 mg 1 MG 2.82 - - - - - -
J3111 - Injection, romosozumab-aqqg, 1 mg 1 MG 12.732 - - - - - -
J3121 - Injection, testosterone enanthate, 1 mg 1 MG 0.053 - - - - - -
J3145 - Injection, testosterone undecanoate, 1 mg 1 MG 2.149 - - - - - -
J3230 - Injection, chlorpromazine hcl, up to 50 mg 50 MG 18.143 - - - - - -
J3240 - Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial 0.9 MG 2158.661 - - - - - -
J3241 - Injection, teprotumumab-trbw, 10 mg 10 MG 379.9 - - - - - -
J3243 - Injection, tigecycline, 1 mg 1 MG 0.517 - - - - - -
J3245 - Injection, tildrakizumab, 1 mg 1 MG 124.273 - - - - - -
J3246 - Injection, tirofiban hcl, 0.25 mg 0.25 MG 2.917 - - - - - -
* Effective Jul 1, 2026 through Sep 30, 2026

ASP (Average Sale Price) Drug Pricing History