84 drugs carry reduced coinsurance
Most codes in the 4Q26 file (800 of 918) carry a 20% coinsurance. For the codes below, CMS lists a lower percentage and notes it as “inflation-adjusted coinsurance”. According to CMS, this happens when a Part B drug’s price rises faster than inflation. See the Medicare Inflation Rebate Program.
Sorted by coinsurance, lowest first. “Patient pays less” is the payment limit times the difference between 20% and the code’s coinsurance, for one billing unit, rounded to the cent. What a patient actually pays also depends on other coverage they have. Codes with 0% coinsurance are not listed: CMS does not note them as inflation-adjusted.
| Code | Drug | Billing unit | Payment limit | Coinsurance | Patient pays less |
|---|---|---|---|---|---|
| J7521 | Tacrolim granules oral susp | 0.1 MG | $1.328 | 0.997% | $0.25 |
| J1645 | Dalteparin sodium | 2500 IU | $45.668 | 4.812% | $6.94 |
| J3300 | Triamcinolone a inj prs-free | 1 MG | $17.199 | 5.754% | $2.45 |
| J9297 | Inj pemetrexed (sandoz) 10mg | 10 MG | $4.879 | 5.788% | $0.69 |
| J0701 | Inj. cefepime hcl (baxter) | 500 MG | $6.096 | 7.89% | $0.74 |
| J0703 | Inj, cefepime hcl (b braun) | 500 MG | $4.748 | 10.13% | $0.47 |
| J2184 | Inj, meropenem (b. braun) | 100 MG | $1.921 | 10.855% | $0.18 |
| J7504 | Lymphocyte immune globulin | 250 MG | $5,509.072 | 10.918% | $500.33 |
| J0283 | Inj, amiodarone (nexterone) | 30 MG | $2.763 | 11.501% | $0.23 |
| J1954 | Inj leu acet lutr dpt 7.5 mg | 7.5 MG | $683.86 | 13.851% | $42.05 |
| J2502 | Inj, pasireotide long acting | 1 MG | $613.14 | 14.593% | $33.15 |
| J3101 | Tenecteplase injection | 1 MG | $230.742 | 14.876% | $11.82 |
| J0561 | Penicillin g benzathine inj | 100,000 UNITS | $25.612 | 15.105% | $1.25 |
| J2425 | Palifermin injection | 50 MCG | $38.839 | 15.688% | $1.67 |
| J0558 | Peng benzathine/procaine inj | 100,000 UNITS | $19.523 | 15.704% | $0.84 |
| J0695 | Inj ceftolozane tazobactam | 75mg (50mg cft/25mg taz) | $10.015 | 16.874% | $0.31 |
| J9047 | Injection, carfilzomib, 1 mg | 1 MG | $60.391 | 17.068% | $1.77 |
| J0775 | Collagenase, clost hist inj | 0.01 MG | $81.072 | 17.086% | $2.36 |
| J9042 | Brentuximab vedotin inj | 1 MG | $279.207 | 17.251% | $7.68 |
| Q2042 | Tisagenlecleucel car-pos t | up to 600 million CAR-positive viable T cells | $626,315.834 | 17.294% | $16,948.11 |
| J0248 | Inj, remdesivir, 1 mg | 1 MG | $7.511 | 17.385% | $0.20 |
| J2860 | Injection, siltuximab | 10 MG | $178.427 | 17.398% | $4.64 |
| Q2041 | Axicabtagene ciloleucel car+ | UP TO 200 MILLION CAR T CELLS | $577,943.258 | 17.419% | $14,916.72 |
| J8655 | Oral netupitant, palonosetro | 0.5 MG | $455.762 | 17.677% | $10.59 |
| J9303 | Panitumumab injection | 10 MG | $183.275 | 17.864% | $3.91 |
| J0897 | Denosumab injection | 1 MG | $29.856 | 17.885% | $0.63 |
| J2802 | Inj, romiplostim 1 microgram | 1 MCG | $11.713 | 17.89% | $0.25 |
| Q2054 | Lisocabtagene mara car pos t | Up to 110 million CAR-positive viable T cells, per therapeutic dose | $589,846.771 | 17.989% | $11,861.82 |
| J9039 | Injection, blinatumomab | 1 MCG | $173.047 | 17.991% | $3.48 |
| J3145 | Testosterone undecanoate 1mg | 1 MG | $2.203 | 18.111% | $0.04 |
| J0584 | Injection, burosumab-twza 1m | 1 MG | $516.85 | 18.18% | $9.41 |
| J9266 | Pegaspargase injection | 1 EA | $29,845.265 | 18.38% | $483.49 |
| J1162 | Digoxin immune fab (ovine) | PER VIAL | $5,711.373 | 18.404% | $91.15 |
| J0597 | C-1 esterase, berinert | 10 UNITS | $79.329 | 18.454% | $1.23 |
| J2507 | Pegloticase injection | 1 MG | $4,000.629 | 18.46% | $61.61 |
| J9061 | Inj, amivantamab-vmjw | 2 MG | $23.622 | 18.492% | $0.36 |
| J1950 | Leuprolide acetate /3.75 mg | 3.75 MG | $1,799.052 | 18.505% | $26.90 |
| J3111 | Inj. romosozumab-aqqg 1 mg | 1 MG | $12.792 | 18.523% | $0.19 |
| J9325 | Inj talimogene laherparepvec | 1 million PFU | $77.657 | 18.53% | $1.14 |
| Q2056 | Ciltacabtagene car-pos t | up to 100 million autologous b-cell maturation antigen (bcma) directed car-positive t cells | $594,112.255 | 18.651% | $8,014.57 |
| J1640 | Hemin, 1 mg | 1 MG | $36.05 | 18.677% | $0.48 |
| J3032 | Inj. eptinezumab-jjmr 1 mg | 1 MG | $21.243 | 18.702% | $0.28 |
| J0638 | Canakinumab injection | 1 MG | $156.953 | 18.725% | $2.00 |
| J9153 | Inj daunorubicin, cytarabine | 1 MG/2.27 MG | $274.30 | 18.826% | $3.22 |
| Q2055 | Idecabtagene vicleucel car | UP TO 510 MILLION AUTOLOGOUS ANTI-BCMA CAR-POSITIVE VIABLE T CELLS | $575,850.465 | 18.839% | $6,685.62 |
| J7530 | Mycophenolat (myhibbin) 5 mg | 5 MG | $0.115 | 18.875% | $0.00 |
| J1449 | Inj eflapegrastim-xnst 0.1mg | 0.1 MG | $37.421 | 18.902% | $0.41 |
| Q2053 | Brexucabtagene car pos t | UP TO 200 MILLION AUTOLOGOUS ANTI-CD19 CAR POSITIVE VIABLE T CELLS | $532,352.741 | 18.911% | $5,797.32 |
| J3055 | Inj talquetamab-tgvs 0.25 mg | 0.25 MG | $77.473 | 18.921% | $0.84 |
| J9358 | Inj fam-trastu deru-nxki 1mg | 1 MG | $32.653 | 18.94% | $0.35 |
| J9021 | Inj, aspara, rylaze, 0.1 mg | 0.1 MG | $59.042 | 18.979% | $0.60 |
| J9273 | Inj tisotu vedotin-tftv, 1mg | 1 MG | $196.121 | 19.149% | $1.67 |
| J9227 | Inj. isatuximab-irfc 10 mg | 10 MG | $89.812 | 19.193% | $0.72 |
| J9268 | Pentostatin injection | 10 MG | $2,612.893 | 19.207% | $20.72 |
| J9380 | Inj teclistamab cqyv 0.5 mg | 0.5 MG | $35.818 | 19.228% | $0.28 |
| J0217 | Inj velmanase alfa-tycv 1 mg | 1 MG | $479.191 | 19.279% | $3.45 |
| J2315 | Naltrexone, depot form | 1 MG | $4.537 | 19.283% | $0.03 |
| J9301 | Obinutuzumab inj | 10 MG | $85.039 | 19.287% | $0.61 |
| J1559 | Hizentra injection | 100 MG | $14.786 | 19.344% | $0.10 |
| J9032 | Injection, belinostat, 10mg | 10 MG | $55.526 | 19.364% | $0.35 |
| J9353 | Inj. margetuximab-cmkb, 5 mg | 5 MG | $56.046 | 19.438% | $0.31 |
| J0122 | Inj., eravacycline, 1 mg | 1 MG | $1.333 | 19.445% | $0.01 |
| J7208 | Inj. jivi 1 iu | 1 IU | $2.744 | 19.449% | $0.02 |
| J1302 | Inj, sutimlimab-jome, 10 mg | 10 MG | $20.133 | 19.461% | $0.11 |
| J9348 | Inj. naxitamab-gqgk, 1 mg | 1 MG | $685.988 | 19.467% | $3.66 |
| J0121 | Inj., omadacycline, 1 mg | 1 MG | $4.293 | 19.501% | $0.02 |
| J9145 | Injection, daratumumab 10 mg | 10 MG | $75.228 | 19.508% | $0.37 |
| J7213 | Inj, ixinity, 1 i.u. | 1 IU | $2.035 | 19.552% | $0.01 |
| J3090 | Inj tedizolid phosphate | 1 MG | $2.062 | 19.56% | $0.01 |
| J1575 | Hyqvia 100mg immuneglobulin | 100 MG | $19.293 | 19.577% | $0.08 |
| J0349 | Inj, rezafungin, 1 mg | 1 MG | $11.182 | 19.601% | $0.04 |
| Q2058 | Obecbtge autol up to 400 mil | Per Therapeutic Dose | $293,725.702 | 19.668% | $975.17 |
| J0458 | Aztreonam/avibactam 10 mg | 10 MG | $1.756 | 19.702% | $0.01 |
| J1203 | Inj, cipaglucosidase, 5 mg | 5 MG | $96.491 | 19.727% | $0.26 |
| J9362 | Inj, trabectedin, 0.01 mg | 0.01 MG | $41.844 | 19.728% | $0.11 |
| J7197 | Antithrombin iii injection | 1 IU | $4.264 | 19.759% | $0.01 |
| J1458 | Galsulfase injection | 1 MG | $529.58 | 19.787% | $1.13 |
| J0870 | Injection, imetelstat, 1 mg | 1 MG | $59.355 | 19.788% | $0.13 |
| J9144 | Daratumumab, hyaluronidase | 10 MG | $57.973 | 19.825% | $0.10 |
| J9354 | Inj, ado-trastuzumab emt 1mg | 1 MG | $43.86 | 19.828% | $0.08 |
| J1322 | Elosulfase alfa, injection | 1 MG | $320.781 | 19.853% | $0.47 |
| J1304 | Inj tofersen intrathec 1 mg | 1 MG | $164.812 | 19.941% | $0.10 |
| J9306 | Injection, pertuzumab, 1 mg | 1 MG | $17.269 | 19.948% | $0.01 |
| J0699 | Inj, cefiderocol, 10 mg | 10 mg | $2.564 | 19.97% | $0.00 |