Jurisdiction A DME MAC Fee Schedules
July 2008 Quarterly Oral Anticancer Drug Fees
Effective July1, 2008 through September 30, 2008
NOTE:
Inclusion of a fee amount does not necessarily indicate coverage
|
Drug
Name |
Strength |
Per
Tablet Fee |
|
Busulfan |
2 mg |
$2.569 |
|
Capecitabine |
150 mg |
$4.805 |
|
Capecitabine |
500 mg |
$15.962 |
|
Cyclophosphamide |
25 mg |
$0.807 |
|
Cyclophosphamide |
50 mg |
$1.614 |
|
Etoposide |
50 mg |
$29.332 |
|
Melphalan |
2 mg |
$4.505 |
|
Methotrexate |
2.5 mg |
$0.155 |
|
Methotrexate |
5 mg |
$0.310 |
|
Methotrexate |
7.5 mg |
$0.465 |
|
Methotrexate |
10 mg |
$0.620 |
|
Methotrexate |
15 mg |
$0.930 |
|
Temozolomide |
5 mg |
$8.140 |
|
Temozolomide |
20 mg |
$32.560 |
|
Temozolomide |
100 mg |
$162.800 |
|
Temozolomide |
250 mg |
$407.000 |