Jurisdiction A DME MAC Fee Schedules

January 2007 Quarterly Oral Anticancer Drug Fees

Effective January 1, 2007 through March 31, 2007

NOTE: Inclusion of a fee amount does not necessarily indicate coverage

Drug Name	Strength	Per Tablet Fee
Busulfan	2 mg	$2.123
Capecitabine	150 mg	$3.959
Capecitabine	500 mg	$13.181
Cyclophosphamide	25 mg	$0.978
Cyclophosphamide	50 mg	$1.956
Etoposide	50 mg	$30.533
Melphalan	2 mg	$4.336
Methotrexate	2.5 mg	$0.218
Methotrexate	5 mg	$0.436
Methotrexate	7.5 mg	$0.654
Methotrexate	10 mg	$0.872
Methotrexate	15 mg	$1.308
Temozolomide	5 mg	$7.415
Temozolomide	20 mg	$29.660
Temozolomide	100 mg	$148.300
Temozolomide	250 mg	$370.750