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Drug Prices

Asp Payment Limit

asp_payment_limit
Read-onlyIdempotent

What Medicare Part B PAYS for a drug administered by a provider — the quarterly ASP payment limit, set by statute at 106% of the manufacturer-reported Average Sales Price. Look up by HCPCS J-code ("J9271") or drug name ("pembrolizumab", "Keytruda"). This is the clinic/infusion benchmark: oncology drugs, biologics, injectables and vaccines. Returns the limit per its dosage unit, the quarter it is in force, AND the earlier quarter of ASP data it was derived from — those differ by two quarters and the gap matters. For retail pharmacy acquisition cost use nadac_price instead. Keyless.

Input Schema

TableJSON Schema
NameRequiredDescriptionDefault
drugNoDrug name or fragment matched against the short description, e.g. "pembrolizumab", "rituximab". Give either this or `hcpcs`.
hcpcsNoHCPCS code, e.g. "J9271" (pembrolizumab), "J0178" (aflibercept), "90632".
limitNoMax codes to return when searching by name, 1–100 (default 20).
quarterNoOptional quarter as a date in it, or "YYYY-Qn" (e.g. "2026-Q1", "2026-01-01"). Defaults to the most recent quarter loaded.

Schema Changelog

Changes observed during successful MCP inspections.

  1. First observed

TDQS

A4.2/5.0
Behavior4/5

Does the description disclose side effects, auth requirements, rate limits, or destructive behavior?

Annotations already mark this as readOnly and idempotent, and the description adds meaningful behavioral context: the statutory 106% markup, the fact that the returned payment quarter and the source ASP data quarter differ by two quarters, and that the tool is keyless. This goes beyond the annotation safety profile to explain how the data behaves over time.

Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.

Conciseness5/5

Is the description appropriately sized, front-loaded, and free of redundancy?

Four sentences, each earning its place: what it is, how to look up, domain context, return details including the critical two-quarter lag, and pointer to the alternative. The core definition is front-loaded and there is no filler or duplication of the schema.

Shorter descriptions cost fewer tokens and are easier for agents to parse. Every sentence should earn its place.

Completeness4/5

Given the tool's complexity, does the description cover enough for an agent to succeed on first attempt?

With no output schema, the description correctly takes on the burden of explaining return contents (limit per dosage unit, in-force quarter, derived ASP quarter) and even flags why the two-quarter gap matters. It is complete for a read-only lookup tool, with only minor omissions like conflict handling when both hcpcs and drug are supplied, which the schema leaves open.

Complex tools with many parameters or behaviors need more documentation. Simple tools need less. This dimension scales expectations accordingly.

Parameters3/5

Does the description clarify parameter syntax, constraints, interactions, or defaults beyond what the schema provides?

Schema coverage is 100%, so the baseline is 3; the schema already documents drug, hcpcs, limit, and quarter including formats and defaults. The description reiterates the look-up options (J-code or drug name) but adds little new parameter-level meaning beyond the schema, mostly clarifying that the returned quarter and derivation quarter are distinct.

Input schemas describe structure but not intent. Descriptions should explain non-obvious parameter relationships and valid value ranges.

Purpose5/5

Does the description clearly state what the tool does and how it differs from similar tools?

The description states a specific verb and resource: it 'Returns' the quarterly ASP payment limit for a provider-administered drug, and identifies the exact computation (106% of Average Sales Price). It explicitly differentiates from sibling nadac_price by framing this as the 'clinic/infusion benchmark' and retail as the alternative, so an agent can distinguish it without inspecting other tools.

Agents choose between tools based on descriptions. A clear purpose with a specific verb and resource helps agents select the right tool.

Usage Guidelines4/5

Does the description explain when to use this tool, when not to, or what alternatives exist?

The description gives a clear when-to-use context ('clinic/infusion benchmark: oncology drugs, biologics, injectables and vaccines') and a direct when-not-to-use with an explicit alternative ('For retail pharmacy acquisition cost use nadac_price instead'). It does not enumerate every sibling relationship (e.g., nadac_history or drug_price_compare), but the key retail-vs-provider routing is explicit.

Agents often have multiple tools that could apply. Explicit usage guidance like "use X instead of Y when Z" prevents misuse.

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