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 4 * 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
J0491 - Injection, anifrolumab-fnia, 1 mg 1 MG 18.307 - - - - - -
J0500 - Injection, dicyclomine hcl, up to 20 mg 20 MG 9.365 - - - - - -
J0515 - Injection, benztropine mesylate, per 1 mg 1 MG 13.518 - - - - - -
J0517 - Injection, benralizumab, 1 mg 1 MG 163.357 - - - - - -
J0558 - Injection, penicillin g benzathine and penicillin g procaine, 100,000 units 100,000 UNITS 19.523 - - - - - -
J0561 - Injection, penicillin g benzathine, 100,000 units 100,000 UNITS 31.465 - - - - - -
J0565 - Injection, bezlotoxumab, 10 mg 10 MG 39.825 - - - - - -
J0577 - Injection, buprenorphine extended-release (brixadi), less than or equal to 7 days of therapy Less than or equal to 7 days of therapy 417.21 - - - - - -
J0578 - Injection, buprenorphine extended release (brixadi), greater than 7 days and up to 28 days of therapy Greater than 7 days and up to 28 days of therapy 1668.841 - - - - - -
J0582 - Injection, bivalirudin (endo), not therapeutically equivalent to j0583, 1 mg 1 MG 0.131 - - - - - -
J0583 - Injection, bivalirudin, 1 mg 1 MG 0.124 - - - - - -
J0584 - Injection, burosumab-twza 1 mg 1 MG 498.716 - - - - - -
J0585 - Injection, onabotulinumtoxina, 1 unit 1 UNIT 6.512 - - - - - -
J0586 - Injection, abobotulinumtoxina, 5 units 5 Unit 8.903 - - - - - -
J0587 - Injection, rimabotulinumtoxinb, 100 units 100 UNITS 13.283 - - - - - -
J0588 - Injection, incobotulinumtoxin a, 1 unit 1 UNIT 5.289 - - - - - -
J0589 - Injection, daxibotulinumtoxina-lanm, 1 unit 1 UNIT 3.093 - - - - - -
J0592 - Injection, buprenorphine hydrochloride, 0.1 mg 0.1 MG 4.166 - - - - - -
J0593 - Injection, lanadelumab-flyo, 1 mg (code may be used for medicare when drug administered under direct supervision of a physician, not for use when drug is self-administered) 1 mg 86.846 - - - - - -
J0594 - injection, busulfan, 1 mg 1 MG 0.677 - - - - - -
J0595 - Injection, butorphanol tartrate, 1 mg 1 MG 6.146 - - - - - -
J0596 - Injection, c1 esterase inhibitor (recombinant), ruconest, 10 units 10 UNITS 36.675 - - - - - -
J0597 - Injection, c-1 esterase inhibitor (human), berinert, 10 units 10 UNITS 76.051 - - - - - -
J0598 - Injection, c-1 esterase inhibitor (human), cinryze, 10 units 10 UNITS 65.501 - - - - - -
J0600 - Injection, edetate calcium disodium, up to 1000 mg 1000 MG 6102.866 - - - - - -
* Effective April 1, 2026 through June 30, 2026

ASP (Average Sale Price) Drug Pricing History