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 9 * 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
J1250 - Injection, dobutamine hydrochloride, per 250 mg 250 MG 7.691 - - - - - -
J1265 - Injection, dopamine hcl, 40 mg 40 MG 1.012 - - - - - -
J1270 - Injection, doxercalciferol, 1 mcg 1 MCG 0.325 - - - - - -
J1271 - Injection, doxycycline hyclate, 1 mg 1 MG 0.087 - - - - - -
J1290 - Injection, ecallantide, 1 mg 1 MG 595.944 - - - - - -
J1299 - Injection, eculizumab, 2 mg 2 MG 44.198 - - - - - -
J1301 - Injection, edaravone, 1 mg 1 MG 6.463 - - - - - -
J1302 - Injection, sutimlimab-jome, 10 mg 10 MG 19.642 - - - - - -
J1303 - Injection, ravulizumab-cwvz, 10 mg 10 MG 226.92 - - - - - -
J1304 - Injection, tofersen, 1 mg 1 MG 164.816 - - - - - -
J1305 - Injection, evinacumab-dgnb, 5mg 5 MG 197.633 - - - - - -
J1306 - Injection, inclisiran, 1 mg 1 MG 12.905 - - - - - -
J1307 - Injection, crovalimab-akkz, 10 mg 10 MG 551.512 - - - - - -
J1308 - Injection, famotidine, 0.25 mg 0.25 MG 0.008 - - - - - -
J1322 - Injection, elosulfase alfa, 1 mg 1 MG 319.517 - - - - - -
J1323 - Injection, elranatamab-bcmm, 1 mg 1 MG 192.482 - - - - - -
J1325 - Injection, epoprostenol, 0.5 mg 0.5 MG 16.918 - - - - - -
J1326 - Injection, zolbetuximab-clzb, 2 mg 2 MG 33.924 - - - - - -
J1335 - Injection, ertapenem sodium, 500 mg 500 MG 6.75 - - - - - -
J1364 - Injection, erythromycin lactobionate, per 500 mg 500 MG 172.479 - - - - - -
J1380 - Injection, estradiol valerate, up to 10 mg 10 MG 7.702 - - - - - -
J1410 - Injection, estrogen conjugated, per 25 mg 25 MG 401.503 - - - - - -
J1430 - Injection, ethanolamine oleate, 100 mg 100 MG 547.271 - - - - - -
J1434 - Injection, fosaprepitant (focinvez), 1 mg 1 MG 2.456 - - - - - -
J1437 - Injection, ferric derisomaltose, 10 mg 10 MG 21.077 - - - - - -
* Effective Jul 1, 2026 through Sep 30, 2026

ASP (Average Sale Price) Drug Pricing History