Jurisdiction A DME MAC Fee Schedules
2nd Quarter 2009 Oral Anti-Cancer Drug Fees
Effective April 1, 2009 through June 30, 2009
NOTE:
Inclusion of a fee amount does not necessarily indicate coverage
|
Drug Name |
Strength |
Per Tablet Fee |
|
Busulfan |
2 mg |
$3.057 |
|
Capecitabine |
150 mg |
$5.283 |
|
Capecitabine |
500 mg |
$17.510 |
|
Cyclophosphamide |
25 mg |
$0.889 |
|
Cyclophosphamide |
50 mg |
$1.778 |
|
Etoposide |
50 mg |
$29.691 |
|
Melphalan |
2 mg |
$4.505 |
|
Methotrexate |
2.5 mg |
$0.154 |
|
Methotrexate |
5 mg |
$0.308 |
|
Methotrexate |
7.5 mg |
$0.462 |
|
Methotrexate |
10 mg |
$0.616 |
|
Methotrexate |
15 mg |
$0.924 |
|
Temozolomide |
5 mg |
$8.307 |
|
Temozolomide |
20 mg |
$33.228 |
|
Temozolomide |
100 mg |
$166.140 |
|
Temozolomide |
250 mg |
$415.350 |