Jurisdiction A DME MAC Fee Schedules

July 2007 Quarterly Oral Anti-Cancer Drug Fees

Effective July 1, 2007 through September 30, 2007

NOTE: Inclusion of a fee amount does not necessarily indicate coverage

Drug Name	Strength	Per Tablet Fee
Busulfan	2 mg	$2.276
Capecitabine	150 mg	$4.215
Capecitabine	500 mg	$14.009
Cyclophosphamide	25 mg	$0.984
Cyclophosphamide	50 mg	$1.968
Etoposide	50 mg	$29.633
Melphalan	2 mg	$4.336
Methotrexate	2.5 mg	$0.251
Methotrexate	5 mg	$0.502
Methotrexate	7.5 mg	$0.753
Methotrexate	10 mg	$1.004
Methotrexate	15 mg	$1.506
Temozolomide	5 mg	$7.405
Temozolomide	20 mg	$29.62
Temozolomide	100 mg	$148.100
Temozolomide	250 mg	$370.25