Jurisdiction A DME MAC Fee Schedules
January 2008 Quarterly Oral Anticancer Drug Fees
Effective January 1, 2008 through March 31, 2008
NOTE:
Inclusion of a fee amount does not necessarily indicate coverage
|
Drug Name |
Strength |
Per Tablet Fee |
|
Busulfan |
2 mg |
$2.398 |
|
Capecitabine |
150 mg |
$4.590 |
|
Capecitabine |
500 mg |
$15.207 |
|
Cyclophosphamide |
25 mg |
$0.857 |
|
Cyclophosphamide |
50 mg |
$1.714 |
|
Etoposide |
50 mg |
$28.633 |
|
Melphalan |
2 mg |
$4.336 |
|
Methotrexate |
2.5 mg |
$0.209 |
|
Methotrexate |
5 mg |
$0.418 |
|
Methotrexate |
7.5 mg |
$0.627 |
|
Methotrexate |
10 mg |
$0.836 |
|
Methotrexate |
15 mg |
$1.254 |
|
Temozolomide |
5 mg |
$7.685 |
|
Temozolomide |
20 mg |
$30.740 |
|
Temozolomide |
100 mg |
$153.70 |
|
Temozolomide |
250 mg |
$384.25 |