Jurisdiction A DME MAC Fee Schedules
April 2007 Quarterly Oral Anti-Cancer Drug Fees
Effective April 1, 2007 through June 31, 2007
NOTE:
Inclusion of a fee amount does not necessarily indicate coverage
|
Drug Name |
Strength |
Per Tablet Fee |
|
Busulfan |
2 mg |
$2.126 |
|
Capecitabine |
150 mg |
$3.974 |
|
Capecitabine |
500 mg |
$13.242 |
|
Cyclophosphamide |
25 mg |
$0.975 |
|
Cyclophosphamide |
50 mg |
$1.950 |
|
Etoposide |
50 mg |
$29.604 |
|
Melphalan |
2 mg |
$4.336 |
|
Methotrexate |
2.5 mg |
$0.260 |
|
Methotrexate |
5 mg |
$0.520 |
|
Methotrexate |
7.5 mg |
$0.780 |
|
Methotrexate |
10 mg |
$1.040 |
|
Methotrexate |
15 mg |
$1.560 |
|
Temozolomide |
5 mg |
$7.409 |
|
Temozolomide |
20 mg |
$29.636 |
|
Temozolomide |
100 mg |
$148.180 |
|
Temozolomide |
250 mg |
$370.450 |