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 9 * 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
J1302 - Injection, sutimlimab-jome, 10 mg 10 MG 18.86 - - - - - -
J1303 - Injection, ravulizumab-cwvz, 10 mg 10 MG 225.107 - - - - - -
J1304 - Injection, tofersen, 1 mg 1 MG 159.401 - - - - - -
J1305 - Injection, evinacumab-dgnb, 5mg 5 MG 193.758 - - - - - -
J1306 - Injection, inclisiran, 1 mg 1 MG 12.318 - - - - - -
J1308 - Injection, famotidine, 0.25 mg 0.25 MG 0.009 - - - - - -
J1322 - Injection, elosulfase alfa, 1 mg 1 MG 308.683 - - - - - -
J1323 - Injection, elranatamab-bcmm, 1 mg 1 MG 184.072 - - - - - -
J1325 - Injection, epoprostenol, 0.5 mg 0.5 MG 16.199 - - - - - -
J1326 - Injection, zolbetuximab-clzb, 2 mg 2 MG 33.709 - - - - - -
J1335 - Injection, ertapenem sodium, 500 mg 500 MG 9.86 - - - - - -
J1364 - Injection, erythromycin lactobionate, per 500 mg 500 MG 64.618 - - - - - -
J1380 - Injection, estradiol valerate, up to 10 mg 10 MG 7.248 - - - - - -
J1410 - Injection, estrogen conjugated, per 25 mg 25 MG 392.063 - - - - - -
J1430 - Injection, ethanolamine oleate, 100 mg 100 MG 508.963 - - - - - -
J1434 - Injection, fosaprepitant (focinvez), 1 mg 1 MG 2.839 - - - - - -
J1437 - Injection, ferric derisomaltose, 10 mg 10 MG 22.018 - - - - - -
J1439 - Injection, ferric carboxymaltose, 1 mg 1 MG 1.107 - - - - - -
J1440 - Fecal microbiota, live - jslm, 1 ml 1 ML 63.839 - - - - - -
J1442 - Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram 1 MCG 0.996 - - - - - -
J1447 - Injection, tbo-filgrastim, 1 microgram 1 MCG 0.28 - - - - - -
J1448 - Injection, trilaciclib, 1mg 1 MG 5.464 - - - - - -
J1449 - Injection, eflapegrastim-xnst, 0.1 mg 0.1 MG 20.874 - - - - - -
J1450 - Injection fluconazole, 200 mg 200 MG 2.263 - - - - - -
J1453 - Injection, fosaprepitant, 1 mg 1 MG 0.101 - - - - - -
* 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