ASP Drug Pricing - (2nd Quarter)
April 2025
Payment Allowance Limits for Medicare Part B Drugs

  • Note 1: Payment allowance limits subject to the ASP methodology are based on Oct 2024 (4th 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 2 * Effective April 1, 2025 through June 30, 2025
HCPCS Code Code Dosage Payment
Limit		 Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
J0175 - Injection, donanemab-azbt, 2 mg 2 MG 4.181 - - - - - -
J0177 - Injection, aflibercept hd, 1 mg 1 MG 321.176 - - - - - -
J0178 - Injection, aflibercept, 1 mg 1 MG 795.861 - - - - - -
J0179 - Injection, brolucizumab-dbll, 1 mg 1 MG 339.988 - - - - - -
J0180 - Injection, agalsidase beta, 1 mg 1 MG 222.839 - - - - - -
J0185 - Injection, aprepitant, 1 mg 1 MG 1.71 - - - - - -
J0202 - Injection, alemtuzumab, 1 mg 1 MG 2441.493 - - - - - -
J0206 - Injection, allopurinol sodium, 1 mg 1 MG 4.45 - - - - - -
J0217 - Injection, velmanase alfa-tycv, 1 mg 1 MG 444.976 - - - - - -
J0218 - Injection, olipudase alfa-rpcp, 1 mg 1 MG 381.237 - - - - - -
J0219 - Injection, avalglucosidase alfa-ngpt, 4 mg 4 MG 77.817 - - - - - -
J0221 - Injection, alglucosidase alfa, (lumizyme), 10 mg 10 MG 201.566 - - - - - -
J0222 - Injection, patisiran, 0.1 mg 0.1 MG 99.039 - - - - - -
J0223 - Injection, givosiran, 0.5 mg 0.5 MG 116.471 - - - - - -
J0224 - Injection, lumasiran, 0.5 mg 0.5 MG 318.852 - - - - - -
J0225 - Injection, vutrisiran, 1 mg 1 MG 4956.31 - - - - - -
J0248 - Injection, remdesivir, 1 mg 1 MG 6.354 - - - - - -
J0256 - Injection, alpha 1 proteinase inhibitor (human), not otherwise specified, 10 mg 10 MG 5.16 - - - - - -
J0257 - Injection, alpha 1 proteinase inhibitor (human), (glassia), 10 mg 10 MG 5.448 - - - - - -
J0278 - Injection, amikacin sulfate, 100 mg 100 MG 0.601 - - - - - -
J0280 - Injection, aminophyllin, up to 250 mg 250 MG 11.049 - - - - - -
J0281 - Injection, aminocaproic acid, 1 gram 1 GM 1.303 - - - - - -
J0282 - Injection, amiodarone hydrochloride, 30 mg 30 MG 0.327 - - - - - -
J0283 - Injection, amiodarone hydrochloride (nexterone), 30 mg 30 MG 2.594 - - - - - -
J0285 - Injection, amphotericin b, 50 mg 50 MG 50.066 - - - - - -
* Effective April 1, 2025 through June 30, 2025

Drugs not otherwise classified - April 2025

 

Medicare Part B payment allowance limits for drugs not otherwise classified - Effective April 1, 2025 through June 30, 2025

Drug name Dosage Payment limit Notes
Diltiazem Hydrochloride 5 MG 0.416
Metoprolol Tartrate 1 MG 0.123
Vasopressin (Long Grove) 1 UNIT 3.272 Added April 2025

ASP (Average Sale Price) Drug Pricing History