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 29 * 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
J9299 - Injection, nivolumab, 1 mg 1 MG 32.964 - - - - - -
J9301 - Injection, obinutuzumab, 10 mg 10 MG 78.996 - - - - - -
J9303 - Injection, panitumumab, 10 mg 10 MG 173.03 - - - - - -
J9304 - Injection, pemetrexed (pemfexy), 10 mg 10 MG 46.321 - - - - - -
J9305 - Injection, pemetrexed, not otherwise specified, 10 mg 10 MG 4.355 - - - - - -
J9306 - Injection, pertuzumab, 1 mg 1 MG 17.017 - - - - - -
J9307 - Injection, pralatrexate, 1 mg 1 MG 392.629 - - - - - -
J9308 - Injection, ramucirumab, 5 mg 5 MG 74.359 - - - - - -
J9309 - Injection, polatuzumab vedotin-piiq, 1 mg 1 MG 136.666 - - - - - -
J9311 - Injection, rituximab 10 mg and hyaluronidase 10 mg 36.693 - - - - - -
J9312 - Injection, rituximab, 10 mg 10 MG 75.22 - - - - - -
J9314 - Injection, pemetrexed (teva), not therapeutically equivalent to j9305, 10 mg 10 MG 15.543 - - - - - -
J9316 - Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg 10 MG 62.098 - - - - - -
J9317 - Injection, sacituzumab govitecan-hziy, 2.5 mg 2.5 MG 36.276 - - - - - -
J9318 - Injection, romidepsin, non-lyophilized, 0.1 mg 0.1 MG 28.517 - - - - - -
J9319 - Injection, romidepsin, lyophilized, 0.1 mg 0.1 MG 30.777 - - - - - -
J9321 - Injection, epcoritamab-bysp, 0.16 mg 0.16 MG 55.841 - - - - - -
J9323 - Injection, pemetrexed ditromethamine, 10 mg 10 mg 0.125 - - - - - -
J9324 - Injection, pemetrexed (pemrydi rtu), 10 mg 10 MG 75.808 - - - - - -
J9325 - Injection, talimogene laherparepvec, per 1 million plaque forming units 1 million PFU 73.935 - - - - - -
J9328 - Injection, temozolomide, 1 mg 1 MG 10.389 - - - - - -
J9329 - Injection, tislelizumab-jsgr, 1mg 1 MG 57.445 - - - - - -
J9330 - Injection, temsirolimus, 1 mg 1 MG 26.712 - - - - - -
J9331 - Injection, sirolimus protein-bound particles, 1 mg 1 MG 84.572 - - - - - -
J9332 - Injection, efgartigimod alfa-fcab, 2mg 2 MG 32.147 - - - - - -
* 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