ASP Drug Pricing - (4th Quarter)
October 2024
Payment Allowance Limits for Medicare Part B Drugs

  • Note 1: Payment allowance limits subject to the ASP methodology are based on Apr 2024 (2nd 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 22 * Effective October 1, 2024 - December 31, 2024
HCPCS Code Code Dosage Payment
Limit		 Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
J8610 - Methotrexate; oral, 2.5 mg 2.5 MG 0.224 - - - - - -
J8655 - Netupitant 300 mg and palonosetron 0.5 mg, oral 0.5 MG 400.242 - - - - - -
J8670 - Rolapitant, oral, 1 mg 1 MG 1.583 - - - - - -
J8700 - Temozolomide, oral, 5 mg 5 MG 0.265 - - - - - -
J8705 - Topotecan, oral, 0.25 mg 0.25 mg 124.86 - - - - - -
J9000 - Injection, doxorubicin hydrochloride, 10 mg 10 MG 3.302 - - - - - -
J9017 - Injection, arsenic trioxide, 1 mg 1 MG 7.199 - - - - - -
J9021 - Injection, asparaginase, recombinant, (rylaze), 0.1 mg 0.1 MG 52.788 - - - - - -
J9022 - Injection, atezolizumab, 10 mg 10 MG 86.242 - - - - - -
J9023 - Injection, avelumab, 10 mg 10 MG 95.176 - - - - - -
J9025 - Injection, azacitidine, 1 mg 1 MG 0.32 - - - - - -
J9027 - Injection, clofarabine, 1 mg 1 MG 14.377 - - - - - -
J9029 - Intravesical instillation, nadofaragene firadenovec-vncg, per therapeutic dose PER THERAPEUTIC DOSE 63354.773 - - - - - -
J9030 - Bcg live intravesical instillation, 1 mg 1 MG 2.991 - - - - - -
J9032 - Injection, belinostat, 10 mg 10 MG 50.088 - - - - - -
J9033 - Injection, bendamustine hydrochloride, 1 mg 1 MG 5.431 - - - - - -
J9034 - Injection, bendamustine hcl (bendeka), 1 mg 1 MG 12.946 - - - - - -
J9035 - Injection, bevacizumab, 10 mg 10 MG 72.704 - - - - - -
J9039 - Injection, blinatumomab, 1 microgram 1 MCG 152.178 - - - - - -
J9040 - Injection, bleomycin sulfate, 15 units 15 UNITS 24.684 - - - - - -
J9041 - Injection, bortezomib, 0.1 mg 0.1 MG 1.572 - - - - - -
J9042 - Injection, brentuximab vedotin, 1 mg 1 MG 239.856 - - - - - -
J9043 - Injection, cabazitaxel, 1 mg 1 MG 216.455 - - - - - -
J9045 - Injection, carboplatin, 50 mg 50 MG 3.4 - - - - - -
J9047 - Injection, carfilzomib, 1 mg 1 MG 49.577 - - - - - -
* Effective October 1, 2024 - December 31, 2024

Drugs not otherwise classified - October 2024

 

Medicare Part B payment allowance limits for drugs not otherwise classified - Effective October 1, 2024 - December 31, 2024

Drug name Dosage Payment limit Notes
Aminocaproic acid 250 MG 0.319
Benzylpenicillin Benzathine (Extencilline) 100,000 UNITS 16.783
Diltiazem Hydrochloride 5 MG 0.378
Doxycycline Hyclate 100 MG 12.923
Famotidine 10 MG 0.324
Flumazenil 0.1 MG 1.183
Folic Acid 5 MG 3.17
Furosemide (Phlow Corporation) 20 MG 1.579
Glucarpidase 10 UNITS 399.73
Metoprolol Tartrate 1 MG 0.129
Rifampin 600 MG 91.656
Sodium Chloride, Hypertonic (3% - 5% infusion) 250 CC 1.393
Sulfamethoxazole-Trimethoprim 400-80 MG 0.629

ASP (Average Sale Price) Drug Pricing History