Jurisdiction A DME MAC Fee Schedules
April 2008 Quarterly Oral AntiCancer Drug Fees
Effective April 1, 2008 through June 30, 2008
NOTE: Inclusion of a fee amount does
not necessarily indicate coverage
|
Drug Name |
Strength |
Per Tablet Fee |
|
Busulfan |
2 mg |
$2.502 |
|
Capecitabine |
150 mg |
$4.610 |
|
Capecitabine |
500 mg |
$15.289 |
|
Cyclophosphamide |
25 mg |
$0.822 |
|
Cyclophosphamide |
50 mg |
$1.644 |
|
Etoposide |
50 mg |
$29.545 |
|
Melphalan |
2 mg |
$4.336 |
|
Methotrexate |
2.5 mg |
$0.162 |
|
Methotrexate |
5 mg |
$0.324 |
|
Methotrexate |
7.5 mg |
$0.486 |
|
Methotrexate |
10 mg |
$0.648 |
|
Methotrexate |
15 mg |
$0.972 |
|
Temozolomide |
5 mg |
$7.665 |
|
Temozolomide |
20 mg |
$30.660 |
|
Temozolomide |
100 mg |
$153.30 |
|
Temozolomide |
250 mg |
$383.250 |