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10 Prescription Drugs That Medicare Spends the Most On

Blood thinners, diabetes treatments dominate the latest list of costliest Part D medications

spinner image two bottles of the prescription drug eliquis sit on a counter
Kristoffer Tripplaar/Alamy

While Medicare Part D’s prescription drug program paid for more than 3,500 different medications in 2021, the 10 top-selling Rx drugs accounted for nearly one-quarter of the $216 billion in total Part D spending that year, according to a new analysis by the nonpartisan KFF.

“Our analysis shows that Medicare Part D spending is highly concentrated among a small share of covered brand-name drugs, and that increases in gross spending on the 10 top-selling drugs have contributed to a substantial increase in overall Medicare drug spending in recent years,” the report from KFF (formerly the Kaiser Family Foundation) says. The top 100 Part D drugs paid for by Medicare accounted for 61 percent of all Part D spending in 2021, the latest year for which data is available.

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The KFF analysis points out how much spending on these most expensive medications has increased. For example, total Part D spending on the blood thinner Eliquis increased two and a half times from $5 billion in 2018 to $12.6 billion in 2021. Spending for the diabetes drug Trulicity more than tripled from $1.4 billion in 2018 to $4.7 billion in 2021. The number of Medicare enrollees taking these drugs did not increase as much as Medicare spending on the medication did, KFF data shows.

Of the $216 billion Medicare spent on prescription drugs in 2021, $48 billion went toward the top 10 selling medications. Half of those brand-name drugs treat diabetes, two are blood thinners, two treat cancer and one treats rheumatoid arthritis. Here’s the full list: 

10 costliest Medicare Part D prescription drugs

  • Eliquis, a blood thinner, $12.6 billion
  • Revlimid, treats cancer, $5.9 billion
  • Xarelto, a blood thinner, $5.2 billion
  • Trulicity, treats diabetes, $4.7 billion
  • Januvia, treats diabetes, $4.1 billion
  • Jardiance, treats diabetes, $3.7 billion
  • Imbruvica, treats cancer, $3.2 billion 
  • Humira (CF) Pen, treats rheumatoid arthritis, $2.9 billion
  • Lantus Solostar, treats diabetes, $2.8 billion
  • Ozempic, treats diabetes, $2.6 billion

The KFF report comes as the Centers for Medicare & Medicaid Services (CMS) is in the process of deciding which will be the first 10 prescription drugs subject to price negotiations with manufacturers. A 2022 law that included a number of prescription drug reforms heavily supported by AARP will, for the first time, allow Medicare to negotiate the price of medications with drugmakers.

The negotiated prices of the first 10 drugs, which have not yet been publicly identified, will take effect in 2026. Each subsequent year, more medications will be subject to negotiation.

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The law includes a $35 copay cap on Medicare-covered insulin, and in 2025 out-of-pocket spending on Part D medications will be capped at $2,000. Drugmakers that raise their prices higher than the rate of inflation are subject to penalties, and vaccines approved for adults by the Centers for Disease Control and Prevention (CDC) are free to Part D enrollees.

In September, CMS is scheduled to release the names of the first 10 drugs that will be subject to negotiation. The agency will take several factors into account in deciding which medications will be the first whose prices are to be negotiated. The 10 drugs will be selected from the 50 medications with the highest Part D expenditures that also are brand-name drugs without generic equivalents and that have been on the market for at least seven years (or 11 years if they are labeled as biologics).

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