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 29 * 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
J9261 - Injection, nelarabine, 50 mg 50 MG 65.407 - - - - - -
J9263 - Injection, oxaliplatin, 0.5 mg 0.5 MG 0.055 - - - - - -
J9264 - Injection, paclitaxel protein-bound particles, 1 mg 1 MG 6.586 - - - - - -
J9266 - Injection, pegaspargase, per single dose vial 1 EA 29663.965 - - - - - -
J9267 - Injection, paclitaxel, 1 mg 1 MG 0.112 - - - - - -
J9268 - Injection, pentostatin, 10 mg 10 MG 2697.987 - - - - - -
J9269 - Injection, tagraxofusp-erzs, 10 micrograms 10 MCG 357.522 - - - - - -
J9271 - Injection, pembrolizumab, 1 mg 1 MG 60.645 - - - - - -
J9272 - Injection, dostarlimab-gxly, 10 mg 10 MG 251.298 - - - - - -
J9273 - Injection, tisotumab vedotin-tftv, 1 mg 1 MG 196.121 - - - - - -
J9274 - Injection, tebentafusp-tebn, 1 microgram 1 MCG 228.006 - - - - - -
J9276 - Injection, zanidatamab-hrii, 2 mg 2 MG 25.663 - - - - - -
J9277 - Injection, pembrolizumab, 1 mg and berahyaluronidase alfa-pmph 1 MG 31.94 - - - - - -
J9278 - Injection, carboplatin (avyxa), 1 mg 1 MG 5.203 - - - - - -
J9280 - Injection, mitomycin, 5 mg 5 MG 34.107 - - - - - -
J9281 - Mitomycin pyelocalyceal instillation, 1 mg 1 MG 329.937 - - - - - -
J9282 - Mitomycin, intravesical instillation, 1 mg 1 MG 274.342 - - - - - -
J9286 - Injection, glofitamab-gxbm, 2.5 mg 2.5 MG 2864.678 - - - - - -
J9289 - Injection, nivolumab, 2 mg and hyaluronidase-nvhy 2 MG 28.14 - - - - - -
J9292 - Injection, pemetrexed dipotassium, 10 mg 10 MG 73.67 - - - - - -
J9293 - Injection, mitoxantrone hydrochloride, per 5 mg 5 MG 29.702 - - - - - -
J9294 - Injection, pemetrexed (hospira), not therapeutically equivalent to j9305, 10 mg 10 MG 2.943 - - - - - -
J9297 - Injection, pemetrexed (sandoz), not therapeutically equivalent to j9305, 10 mg 10 MG 4.879 - - - - - -
J9298 - Injection, nivolumab and relatlimab-rmbw, 3 mg/1 mg 3 mg/1 mg 205.511 - - - - - -
J9299 - Injection, nivolumab, 1 mg 1 MG 34.222 - - - - - -
* Effective Jul 1, 2026 through Sep 30, 2026

ASP (Average Sale Price) Drug Pricing History