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 23 * 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
J7508 - Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg 0.1 MG 0.586 - - - - - -
J7509 - Methylprednisolone oral, per 4 mg 4 MG 0.108 - - - - - -
J7510 - Prednisolone oral, per 5 mg 5 MG 0.231 - - - - - -
J7511 - Lymphocyte immune globulin, antithymocyte globulin, rabbit, parenteral, 25 mg 25 MG 999.367 - - - - - -
J7512 - Prednisone, immediate release or delayed release, oral, 1 mg 1 MG 0.005 - - - - - -
J7515 - Cyclosporine, oral, 25 mg 25 MG 0.802 - - - - - -
J7516 - Injection, cyclosporine, 250 mg 250 MG 72.581 - - - - - -
J7517 - Mycophenolate mofetil, oral, 250 mg 250 MG 0.157 - - - - - -
J7518 - Mycophenolic acid, oral, 180 mg 180 MG 0.337 - - - - - -
J7519 - Injection, mycophenolate mofetil, 10 mg 10 MG 0.361 - - - - - -
J7520 - Sirolimus, oral, 1 mg 1 MG 0.87 - - - - - -
J7521 - Tacrolimus, granules, oral suspension, 0.1 mg 0.1 MG 1.31 - - - - - -
J7525 - Tacrolimus, parenteral, 5 mg 5 MG 263.148 - - - - - -
J7527 - Everolimus, oral, 0.25 mg 0.25 MG 1.37 - - - - - -
J7601 - Ensifentrine, inhalation suspension, fda approved final product, non-compounded, administered through dme, unit dose form, 3 mg 3 MG 52.117 - - - - - -
J7605 - Arformoterol, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 15 micrograms 15 mcg 0.709 - - - - - -
J7606 - Formoterol fumarate, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 20 micrograms 20 MCG 2.728 - - - - - -
J7608 - Acetylcysteine, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per gram 1 GM 8.655 - - - - - -
J7611 - Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg 1 MG 0.169 - - - - - -
J7612 - Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 0.5 mg 0.5 MG 0.274 - - - - - -
J7613 - Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg 1 MG 0.077 - - - - - -
J7614 - Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 0.5 mg 0.5 MG 0.091 - - - - - -
J7620 - Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme 2.5 MG/0.5 MG 0.195 - - - - - -
J7626 - Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 0.5 mg 0.5 MG 1.351 - - - - - -
J7631 - Cromolyn sodium, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 10 milligrams 10 MG 0.437 - - - - - -
* 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