ASP Drug Pricing - (4th Quarter)
October 2025
Payment Allowance Limits for Medicare Part B Drugs

  • Note 1: Payment allowance limits subject to the ASP methodology are based on Apr 2025 (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 12 * Effective October 1, 2025 - December 31, 2025
HCPCS Code Code Dosage Payment
Limit		 Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
J1749 - Injection, iloprost, 0.1 mcg 0.1 MCG 5.713 - - - - - -
J1750 - Injection, iron dextran, 50 mg 50 MG 18.106 - - - - - -
J1756 - Injection, iron sucrose, 1 mg 1 MG 0.229 - - - - - -
J1786 - Injection, imiglucerase, 10 units 10 UNITS 43.191 - - - - - -
J1790 - Injection, droperidol, up to 5 mg up to 5 MG 7.632 - - - - - -
J1805 - Injection, esmolol hydrochloride, 10 mg 10 MG 0.218 - - - - - -
J1806 - Injection, esmolol hydrochloride (wg critical care), not therapeutically equivalent to j1805, 10 mg 10 MG 0.437 - - - - - -
J1808 - Injection, folic acid, 0.1 mg 0.1 MG 0.062 - - - - - -
J1809 - Injection, fosdenopterin, 0.1 mg 0.1 MG 16.971 - - - - - -
J1811 - Insulin (fiasp) for administration through dme (i.e., insulin pump) per 50 units 50 UNITS 8.255 - - - - - -
J1813 - Insulin (lyumjev) for administration through dme (i.e., insulin pump) per 50 units 50 UNITS 15.123 - - - - - -
J1817 - Insulin for administration through dme (i.e., insulin pump) per 50 units 50 UNITS 3.187 - - - - - -
J1823 - Injection, inebilizumab-cdon, 1 mg 1 MG 495.545 - - - - - -
J1836 - Injection, metronidazole, 10 mg 10 MG 0.027 - - - - - -
J1885 - Injection, ketorolac tromethamine, per 15 mg 15 MG 0.303 - - - - - -
J1920 - Injection, labetalol hydrochloride, 5 mg 5 MG 0.342 - - - - - -
J1921 - Injection, labetalol hydrochloride (hikma), not therapeutically equivalent to j1920, 5 mg 5 MG 1.382 - - - - - -
J1930 - Injection, lanreotide, 1 mg 1 MG 34.046 - - - - - -
J1931 - Injection, laronidase, 0.1 mg 0.1 MG 39.869 - - - - - -
J1932 - Injection, lanreotide, (cipla), 1 mg 1 MG 29.844 - - - - - -
J1938 - Injection, furosemide, 1 mg 1 MG 0.018 - - - - - -
J1939 - Injection, bumetanide, 0.5 mg 0.5 MG 0.367 - - - - - -
J1943 - Injection, aripiprazole lauroxil, (aristada initio), 1 mg 1 MG 3.245 - - - - - -
J1944 - Injection, aripiprazole lauroxil, (aristada), 1 mg 1 MG 3.345 - - - - - -
J1950 - Injection, leuprolide acetate (for depot suspension), per 3.75 mg 3.75 MG 1730.324 - - - - - -
* Effective October 1, 2025 - December 31, 2025

Drugs not otherwise classified - October 2025

 

Medicare Part B payment allowance limits for drugs not otherwise classified - Effective October 1, 2025 - December 31, 2025

Drug name Dosage Payment limit Notes
Vasopressin (Long Grove) 1 UNIT 2.462

ASP (Average Sale Price) Drug Pricing History