Jurisdiction A DME MAC Fee Schedules
April 2006 Quarterly Oral Anticancer Drug Fees
Effective April 1, 2006 through June 30, 2006 (Revised October 1, 2006)
NOTE: Inclusion of a fee amount does not necessarily indicate coverage
|
Drug Name |
Strength |
Per Tablet Fee |
|
Busulfan |
2 mg |
$1.973 |
|
Capecitabine |
150 mg |
$3.630 |
|
Capecitabine |
500 mg |
$12.083 |
|
Cyclophosphamide |
25 mg |
$0.971 |
|
Cyclophosphamide |
50 mg |
$1.942 |
|
Etoposide |
50 mg |
$33.039 |
|
Melphalan |
2 mg |
$4.336 |
|
Methotrexate |
2.5 mg |
$0.239 |
|
Methotrexate |
5 mg |
$0.478 |
|
Methotrexate |
7.5 mg |
$0.717 |
|
Methotrexate |
10 mg |
$0.956 |
|
Methotrexate |
15 mg |
$1.434 |
|
Temozolomide |
5 mg |
$7.228 |
|
Temozolomide |
20 mg |
$28.912 |
|
Temozolomide |
100 mg |
$144.560 |
|
Temozolomide |
250 mg |
$361.400 |