+1057.2%
Pemfexy payment limit rises 1057.2%
Medicare’s limit for J9304 moves from $7.994 to $92.505 per 10 MG, the largest percent increase among the 879 codes compared with 3Q26.
Read the full record for J9304 →367codes went up from 3Q26
433codes went down
0.0%median change across the 879 codes compared
Medicare Part B usage
Largest Part B drugs by Medicare spending, 2025
The 10 HCPCS codes with the most Medicare Part B fee-for-service spending in 2025 (preliminary, from CMS’s quarterly spending file). Each code page has its spending by year, top states, and payment limit history.
- KeytrudaJ9271 · Inj pembrolizumab · 464,033 claims $6.36B
- Darzalex FasproJ9144 · Daratumumab, hyaluronidase · 319,072 claims $3.18B
- AmchoPlastQ4316 · Amchoplast, per sq cm · 49,629 claims $2.91B
- Prolia / XgevaJ0897 · Denosumab injection · 1,348,383 claims $2.62B
- VabysmoJ2777 · Inj, faricimab-svoa, 0.1mg · 994,661 claims $2.38B
- OpdivoJ9299 · Injection, nivolumab · 174,666 claims $2.00B
- Tri Membrane WrapQ4344 · Tri membrane wrap, per sq cm · 35,217 claims $1.82B
- EyleaJ0178 · Aflibercept injection · 857,976 claims $1.54B
- SimpliMaxQ4341 · Simplimax, per sq cm · 29,994 claims $1.54B
- Xcell Amnio MatrixQ4280 · Xcell amnio matrix per sq cm · 34,831 claims $1.44B
Inflation-adjusted coinsurance
84 drugs carry reduced coinsurance this quarter
Most codes in the 4Q26 file (800 of 918) carry a 20% coinsurance. For these, CMS lists a lower, inflation-adjusted percentage. According to CMS, this happens when a Part B drug’s price rises faster than inflation (Medicare Inflation Rebate Program). The lowest:
All 84 drugs →- Prograf GranulesJ7521 · Tacrolim granules oral susp · per 0.1 MG 0.997% patient pays $0.25 less per unit
- FragminJ1645 · Dalteparin sodium · per 2500 IU 4.812% patient pays $6.94 less per unit
- TriesenceJ3300 · Triamcinolone a inj prs-free · per 1 MG 5.754% patient pays $2.45 less per unit
- PemetrexedJ9297 · Inj pemetrexed (sandoz) 10mg · per 10 MG 5.788% patient pays $0.69 less per unit
- Cefepime HClJ0701 · Inj. cefepime hcl (baxter) · per 500 MG 7.89% patient pays $0.74 less per unit
- Cefepime HCl in DextroseJ0703 · Inj, cefepime hcl (b braun) · per 500 MG 10.13% patient pays $0.47 less per unit
- MeropenemJ2184 · Inj, meropenem (b. braun) · per 100 MG 10.855% patient pays $0.18 less per unit
- AtgamJ7504 · Lymphocyte immune globulin · per 250 MG 10.918% patient pays $500.33 less per unit
This quarter
4Q26 in one paragraph
The 4Q26 payment limit file (October–December 2026), posted by CMS on September 17, 2026, lists 918 HCPCS codes (1 without a payment limit). Compared with 3Q26, 367 codes went up, 433 went down and 79 did not change, and the median change was 0.0%. 38 codes are new this quarter and 10 were dropped.
The comparison covers the 879 codes that are in both quarters, have a payment limit in both, and kept the same billing unit. Left out: 1 with no payment limit in one of the quarters. The lead story and lists rank by percent change and skip codes under $1.00 last quarter.
Explore
- 3Q26 → 4Q26MoversThe 25 biggest increases and decreases, by percent or dollars
- 4Q26New & dropped38 new and 10 dropped codes
- MarketsBiosimilarsPrices, Medicare spending, market share and state maps for each biosimilar market
- 1,205 codesAll codesEvery code’s payment limit history
- CSVDownloadsThe full history as one file
- MethodAboutWhere the data comes from and what it means