ASP Drug Pricing - (1st Quarter)
January 2026
Payment Allowance Limits for Medicare Part B Drugs

  • Note 1: Payment allowance limits subject to the ASP methodology are based on Jul 2025 (3nd Quarter) ASP data.
  • Note 2: The absence or presence of a HCPCS code and the payment allowance limits in this table does not indicate whether Medicare covers a drug. These determinations shall be made by the local Medicare contractor processing the claim.
 
Page 4 * Effective January 1, 2026 through March 31, 2026
HCPCS Code Code Dosage Payment
Limit		 Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
J0222 - Injection, patisiran, 0.1 mg 0.1 MG 99.973 - - - - - -
J0223 - Injection, givosiran, 0.5 mg 0.5 MG 120.685 - - - - - -
J0224 - Injection, lumasiran, 0.5 mg 0.5 MG 328.024 - - - - - -
J0225 - Injection, vutrisiran, 1 mg 1 MG 5009.558 - - - - - -
J0248 - Injection, remdesivir, 1 mg 1 MG 6.898 - - - - - -
J0256 - Injection, alpha 1 proteinase inhibitor (human), not otherwise specified, 10 mg 10 MG 5.372 - - - - - -
J0257 - Injection, alpha 1 proteinase inhibitor (human), (glassia), 10 mg 10 MG 5.693 - - - - - -
J0278 - Injection, amikacin sulfate, 100 mg 100 MG 0.621 - - - - - -
J0280 - Injection, aminophyllin, up to 250 mg 250 MG 10.407 - - - - - -
J0281 - Injection, aminocaproic acid, 1 gram 1 GM 1.594 - - - - - -
J0282 - Injection, amiodarone hydrochloride, 30 mg 30 MG 0.409 - - - - - -
J0283 - Injection, amiodarone hydrochloride (nexterone), 30 mg 30 MG 2.529 - - - - - -
J0285 - Injection, amphotericin b, 50 mg 50 MG 43.291 - - - - - -
J0289 - Injection, amphotericin b liposome, 10 mg 10 MG 20.721 - - - - - -
J0290 - Injection, ampicillin sodium, 500 mg 500 MG 0.591 - - - - - -
J0291 - Injection, plazomicin, 5 mg 5 MG 3.510 - - - - - -
J0295 - Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm 1.5 GM 1.329 - - - - - -
J0348 - Injection, anidulafungin, 1 mg 1 MG 0.510 - - - - - -
J0349 - Injection, rezafungin, 1 mg 1 MG 10.815 - - - - - -
J0360 - Injection, hydralazine hcl, up to 20 mg 20 MG 4.388 - - - - - -
J0401 - Injection, aripiprazole (abilify maintena), 1 mg 1 MG 7.275 - - - - - -
J0402 - Injection, aripiprazole (abilify asimtufii), 1 mg 1 MG 6.020 - - - - - -
J0456 - Injection, azithromycin, 500 mg 500 MG 2.044 - - - - - -
J0457 - Injection, aztreonam, 100 mg 100 MG 2.233 - - - - - -
J0458 - Injection, aztreonam/avibactam, 7.5 mg/2.5 mg (10 mg) 10 MG 1.678 - - - - - -
* Effective January 1, 2026 through March 31, 2026

ASP (Average Sale Price) Drug Pricing History