Jurisdiction A DME MAC Fee Schedules
October 2008 Quarterly Oral Anti-Cancer Drug Fees
Effective October 1, 2008 through December 31, 2008
NOTE: Inclusion of a fee amount does not
necessarily indicate coverage
|
Drug Name |
Strength |
Per Tablet Fee |
|
Busulfan |
2 mg |
$2.798 |
|
Capecitabine |
150 mg |
$4.915 |
|
Capecitabine |
500 mg |
$16.341 |
|
Cyclophosphamide |
25 mg |
$0.912 |
|
Cyclophosphamide |
50 mg |
$1.824 |
|
Etoposide |
50 mg |
$29.346 |
|
Melphalan |
2 mg |
$4.505 |
|
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 |
$8.243 |
|
Temozolomide |
20 mg |
$32.972 |
|
Temozolomide |
100 mg |
$164.860 |
|
Temozolomide |
250 mg |
$412.150 |