The Access Brief

What changed for provider-administered drugs. We only send this when something did.

Part B / Part D moves (self-administered list)

These drugs moved between Part B and Part D. That changes which benefit pays — and what the patient owes. Verify on the full SAD list, which cites each MAC's CMS article.

• Belimumab Benlysta (J0490) — Route-dependent effective Nov 15, 2025 · run J0490 numbers
• Inj ustekinumab-srlf, 1 mg (Q5098) — Route-dependent effective Aug 31, 2025 · run Q5098 numbers
• Inj ustekinumab-kfce, 1 mg (Q5100) — Route-dependent effective Aug 31, 2025 · run Q5100 numbers
• Inj ustekinumab-stba, 1 mg (Q5099) — Route-dependent effective Jul 1, 2025 · run Q5099 numbers
• Otulfi (Q9999) — Route-dependent effective Jun 30, 2025 · run Q9999 numbers
• Injection, adalimumab, 1 mg Humira® (J0139) — Excluded (all MACs) effective Mar 16, 2025 · run J0139 numbers
• Injection, adalimumab-fkjp, biosimilar, 1 mg (Q5140) — Excluded (all MACs) effective Mar 16, 2025 · run Q5140 numbers
• Injection, adalimumab-aaty, biosimilar, 1 mg (Q5141) — Excluded (all MACs) effective Mar 16, 2025 · run Q5141 numbers
• Injection, adalimumab-ryvk biosimilar, 1 mg (Q5142) — Excluded (all MACs) effective Mar 16, 2025 · run Q5142 numbers
• Injection, adalimumab-adbm, biosimilar, 1 mg (Q5143) — Excluded (all MACs) effective Mar 16, 2025 · run Q5143 numbers
• Injection, adalimumab-aacf (idacio), biosimilar, 1 mg (Q5144) — Excluded (all MACs) effective Mar 16, 2025 · run Q5144 numbers
• Injection, adalimumab-afzb (abrilada), biosimilar, 1 mg (Q5145) — Excluded (all MACs) effective Mar 16, 2025 · run Q5145 numbers
• Injection, ustekinumab-ttwe (pyzchiva), subcutaneous, 1 mg pyzchiva (Q9996) — Excluded (all MACs) effective Mar 16, 2025 · run Q9996 numbers
• Injection, ustekinumab-aekn (selarsdi), 1 mg ustekinumab-aekn (selarsdi) (Q9998) — Route-dependent effective Mar 16, 2025 · run Q9998 numbers
• Zymfentra (infliximab-dyyb) (J1748) — Route-dependent effective Sep 1, 2024 · run J1748 numbers
• Omvoh mirikizumab-mrkz (J2267) — Route-dependent effective Jul 1, 2024 · run J2267 numbers
• Wezlana (ustekinumab-auub) (Q5137) — Route-dependent effective Jul 1, 2024 · run Q5137 numbers
• INJECTION, SERMORELIN ACETATE, 1 MICROGRAM Geref Diagnostic (Q0515) — Excluded — varies by MAC effective Oct 25, 2023 · run Q0515 numbers
• Acthar® Gel (J0801) — Route-dependent effective Oct 1, 2023 · run J0801 numbers
• Purified Cortrophin Gel ® (J0802) — Route-dependent effective Oct 1, 2023 · run J0802 numbers
• Insulin via insulin pump (fiasp) (J1811) — Excluded (all MACs) effective Sep 3, 2023 · run J1811 numbers
• Inj. Insulin (fiasp) (J1812) — Route-dependent effective Sep 3, 2023 · run J1812 numbers
• Insulin via insulin pump (lyumjev) (J1813) — Excluded (all MACs) effective Sep 3, 2023 · run J1813 numbers
• Inj. insulin (lyumjev) U-100 and U-200 (J1814) — Route-dependent effective Sep 3, 2023 · run J1814 numbers
• furosemide (Furoscix) (J1941) — Excluded (all MACs) effective Sep 3, 2023 · run J1941 numbers

Need these as patient estimates? CareCost re-quotes a patient in about 90 seconds — free during beta.