ASP Drug Pricing - (2nd Quarter)
April 2026
Payment Allowance Limits for Medicare Part B Drugs

  • Note 1: Payment allowance limits subject to the ASP methodology are based on Oct 2025 (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, 2026 through June 30, 2026
HCPCS Code Code Dosage Payment
Limit		 Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
J0166 - Injection, epinephrine (bpi), not therapeutically equivalent to j0165, 0.1 mg 0.1 MG 0.836 - - - - - -
J0167 - Injection, epinephrine (hospira), not therapeutically equivalent to j0165, 0.1 mg 0.1 MG 1.082 - - - - - -
J0168 - Injection, epinephrine (international medication systems), not therapeutically equivalent to j0165, 0.1 mg 0.1 MG 2.876 - - - - - -
J0169 - Injection, epinephrine (adrenalin), not therapeutically equivalent to j0165, 0.1 mg 0.1 MG 0.869 - - - - - -
J0174 - Lecanemab-irmb, for intravenous injection, 1 mg 1 MG 1.336 - - - - - -
J0175 - Injection, donanemab-azbt, 2 mg 2 MG 4.14 - - - - - -
J0177 - Injection, aflibercept hd, 1 mg 1 MG 301.177 - - - - - -
J0178 - Injection, aflibercept, 1 mg 1 MG 731.885 - - - - - -
J0179 - Injection, brolucizumab-dbll, 1 mg 1 MG 353.069 - - - - - -
J0180 - Injection, agalsidase beta, 1 mg 1 MG 227.58 - - - - - -
J0185 - Injection, aprepitant, 1 mg 1 MG 1.692 - - - - - -
J0202 - Injection, alemtuzumab, 1 mg 1 MG 2440.415 - - - - - -
J0206 - Injection, allopurinol sodium, 1 mg 1 MG 3.809 - - - - - -
J0217 - Injection, velmanase alfa-tycv, 1 mg 1 MG 465.234 - - - - - -
J0218 - Injection, olipudase alfa-rpcp, 1 mg 1 MG 395.598 - - - - - -
J0219 - Injection, avalglucosidase alfa-ngpt, 4 mg 4 MG 81.204 - - - - - -
J0221 - Injection, alglucosidase alfa, (lumizyme), 10 mg 10 MG 207.512 - - - - - -
J0222 - Injection, patisiran, 0.1 mg 0.1 MG 100.896 - - - - - -
J0223 - Injection, givosiran, 0.5 mg 0.5 MG 120.983 - - - - - -
J0224 - Injection, lumasiran, 0.5 mg 0.5 MG 327.715 - - - - - -
J0225 - Injection, vutrisiran, 1 mg 1 MG 5019.273 - - - - - -
J0248 - Injection, remdesivir, 1 mg 1 MG 6.898 - - - - - -
J0256 - Injection, alpha 1 proteinase inhibitor (human), not otherwise specified, 10 mg 10 MG 5.141 - - - - - -
J0257 - Injection, alpha 1 proteinase inhibitor (human), (glassia), 10 mg 10 MG 5.66 - - - - - -
J0278 - Injection, amikacin sulfate, 100 mg 100 MG 0.61 - - - - - -
* Effective April 1, 2026 through June 30, 2026

ASP (Average Sale Price) Drug Pricing History