cms-provider-data-catalog · CMS
cms-provider-data-catalog · CMS
cms-provider-data-catalog · CMS
cms-provider-data-catalog · CMS
cms-provider-data-catalog · CMS
Medicare Part D — the program that pays for the drugs older Americans pick up at the pharmacy counter — spent $275.9 billion on prescription drugs in 2023. CMS publishes the full ledger one drug at a time in its Medicare Part D Spending by Drug file: 3,598 drugs, each with its total spend, its claims, its beneficiary count, and how its per-dose price moved over one year and five. Read the ledger from the top and one fact dominates: a very small number of drugs carry most of the bill.
A hundred drugs, almost two-thirds of the bill
The 100 costliest drugs are just 2.8% of the 3,598 on the file, yet they account for $176.2 billion — 63.8% of all Part D drug spending. The curve is steep well before that: ten drugs alone are more than a quarter of the bill, and the fifty costliest cross the halfway mark.
| Costliest n drugs | Share of all Part D drug spending |
|---|---|
| Top 10 | 25.8% |
| Top 25 | 38.9% |
| Top 50 | 50.7% |
| Top 100 | 63.8% |
| Top 250 | 80.5% |
| All 3,598 | 100.0% |
Source: CMS Medicare Part D Spending by Drug, cumulative share of $275.9B by drug rank, data year 2023.
The long tail is real but thin: it takes 250 drugs to reach 80.5% of spending, and the remaining 3,348 drugs — 93% of the list — split the last fifth of the dollars between them. Concentration this sharp is the defining feature of the file, and it is what makes a drug's rank by spend a far better guide to Medicare's exposure than the raw number of drugs it covers.
A concentrated bill is not the same as a wasteful one. The figures here count where Medicare's drug dollars go — not whether any drug was worth its price, prescribed correctly, or priced fairly.
The top of the list
Eliquis, a blood thinner, cost Medicare Part D $18.27 billion in 2023 — 6.6% of the entire drug bill on a single product. The ten costliest drugs are a recognizable set of brand-name treatments for the conditions of an aging population.
| Drug | Generic | 2023 Part D spend | Share | Beneficiaries |
|---|---|---|---|---|
| Eliquis | Apixaban | $18.27B | 6.6% | 3,927,848 |
| Ozempic | Semaglutide | $9.19B | 3.3% | 1,464,468 |
| Jardiance | Empagliflozin | $8.84B | 3.2% | 1,882,768 |
| Trulicity | Dulaglutide | $7.36B | 2.7% | 938,731 |
| Xarelto | Rivaroxaban | $6.31B | 2.3% | 1,324,165 |
| Trelegy Ellipta | Fluticasone/Umeclidinium/Vilanterol | $4.46B | 1.6% | 1,050,583 |
| Humira(CF) Pen | Adalimumab | $4.42B | 1.6% | 61,474 |
| Farxiga | Dapagliflozin | $4.34B | 1.6% | 993,909 |
| Januvia | Sitagliptin | $4.09B | 1.5% | 843,391 |
| Revlimid | Lenalidomide | $3.86B | 1.4% | 36,967 |
Source: CMS Medicare Part D Spending by Drug, the ten costliest drugs, data year 2023.
Seven of the ten are brand-name drugs for diabetes, clotting risk, and COPD, each reaching between roughly 840,000 and 3.9 million beneficiaries — common conditions, common drugs, very large totals. The reason brand names dominate is structural: brand-name drugs hold 90.6% of all Part D dollars, while the 601 generic drugs on the file — a sixth of the list — carry only 9.4% of the spending. Cheap generics move the volume; expensive brands move the money.
Two roads to a big bill
Eliquis and Revlimid both rank in the top ten, but they get there in opposite ways. Eliquis reaches 3.9 million beneficiaries at $4,652 each; Revlimid, a cancer drug, reaches 36,967 at $104,412 each. Volume is one road to a large total. Price per patient is the other — and at the far end of that road sit the rare-disease therapies.
| Drug | Generic | 2023 Part D spend | Beneficiaries | Spend per beneficiary |
|---|---|---|---|---|
| Strensiq | Asfotase alfa | $258.9M | 207 | $1,250,918 |
| Soliris | Eculizumab | $223.5M | 462 | $483,709 |
| Takhzyro | Lanadelumab | $194.4M | 468 | $415,315 |
| Firdapse | Amifampridine | $146.3M | 356 | $411,048 |
| Acthar | Corticotropin | $377.8M | 942 | $401,104 |
Source: CMS Medicare Part D Spending by Drug, highest spend per beneficiary among drugs with ≥ $100M total spend, data year 2023.
Strensiq, a treatment for a rare metabolic bone disease, reached 207 beneficiaries in 2023 at an average of $1.25 million each — yet its total spend, $258.9 million, does not crack the top fifty drugs. These drugs barely register in the concentration curve above because that curve is built on total dollars, and a few hundred patients cannot out-total a few million. They matter for a different reason: they show that Medicare's drug bill is not one distribution but two overlaid — a high-volume economy of common brands and a low-volume economy of very high-priced therapies.
Prices are mostly still rising
The Spending by Drug file is one of the few public sources that tracks a drug's price per dose over time, not just its total spend. Of the 3,390 drugs with a year-over-year price recorded, 61.5% cost more per dose in 2023 than in 2022; over five years, 65.0% of priced drugs had a rising average price per dosage unit. Price growth is the rule on this file, not the exception.
| Price horizon | Drugs with a price | Share that rose |
|---|---|---|
| One year (2022 → 2023) | 3,390 | 61.5% |
| Five years (2019 → 2023, CAGR) | 3,423 | 65.0% |
Source: CMS Medicare Part D Spending by Drug, direction of change in average spend per dosage unit, data year 2023.
The steepest one-year climbs among material drugs — those with at least $50 million in spending, so the list is not noise from tiny products — were Zejula (+43.1%), Entyvio (+36.5%), Lumakras (+34.9%), and Erleada (+32.1%, on more than a billion dollars of spend). Prices do fall, too: Pradaxa dropped 54.0% per dose as a competing anticoagulant cleared, and a handful of drugs losing exclusivity fell by a third or more. But for roughly three drugs in five, the per-dose price moved up — which means concentration and price growth compound: the drugs that already carry most of the bill are, more often than not, getting more expensive per dose.
What one row actually is
Each row in cms_part_d_spending_by_drug is one drug — a brand name, its generic ingredient, and a manufacturer — with that drug's total Part D spend, claim count, beneficiary count, dosage units, and the one- and five-year change in its average price per dosage unit. The file ships an "Overall" row for every drug (the all-manufacturer total) plus extra rows that break that total out by manufacturer; summing every row double-counts, so this study reads the 3,598 Overall rows only, dropping 10,711 manufacturer-breakout rows. There is no prescriber, no NPI, and no beneficiary anywhere in the file — every figure is a count or ratio at the drug level, and no individual is named, ranked, or scored.
Methodology
All figures are direct aggregations over the cms_part_d_spending_by_drug table, populated from the CMS Medicare Part D Spending by Drug public-use file published through data.cms.gov (Summary Statistics on Use and Payments / Medicare-Medicaid Spending by Drug). The table holds 14,309 rows for data year 2023, source released 2025-05-19; public, read-only; license US-Government-Works. CMS republishes the file annually, so figures advance with each release.
The unit of analysis is the drug, defined as the per-drug "Overall" row (manufacturer_name = 'Overall') — 3,598 of them. The other 10,711 rows are manufacturer-level breakouts that restate each drug's Overall total and are excluded from every aggregate so that no spending is counted twice. Total spending is sum(total_spending) over those Overall rows ($275.9B). Concentration is computed by ranking drugs on total_spending and reading the cumulative share at each rank cutoff. The brand-versus-generic split uses the partition lower(brand_name) = lower(generic_name), the convention CMS follows when a drug is published under its own ingredient name. Price-direction figures use change_avg_spend_per_dosage_unit (one year) and cagr_avg_spend_per_dosage_unit (five years), each over its own non-null base — 208 drugs lack a one-year change and 175 lack a five-year CAGR, and those drugs are excluded from the price-direction percentages only. Because these are counts and ratios over a published file, every figure is exact as of the release rather than estimated. Methodology version: cms-part-d-spending/v1. The source-provenance contract is documented in the provenance methodology.
Limitations
- A spending count, not a value judgment. Every figure records where Part D drug dollars went. None of them speaks to whether a drug was worth its price, appropriately prescribed, clinically necessary, or fairly priced. A concentrated or rising bill is not, by itself, evidence of waste, fraud, or abuse, and this study draws no such inference.
- Drug-level only — no provider, no patient. The file carries no NPI, prescriber, or beneficiary identifier. Nothing here renders on any provider profile, and no individual is named, ranked, or scored.
- Spending is gross, not net of rebates. Part D total spending in this file is the gross amount before manufacturer rebates and other price concessions, which CMS does not publish at the drug level. Net program cost for rebated brand-name drugs — most of the top of the list — is lower than the gross figures shown, by an amount this file cannot measure.
- A single year, not a trend model. Figures reflect the 2023 file, source released 2025-05-19. The one- and five-year price changes are the values CMS recorded on that file; this study reports them but does not model spending or prices forward.
- Price change is per dose, not per drug's total cost. The rising-price figures describe
avg_spend_per_dosage_unit. A drug's total spend can move differently from its per-dose price when claim volume or dosing changes, so "61.5% of drugs rose" refers to unit price, not to total spending growth. - Brand-versus-generic follows the file's naming. The 90.6% brand share uses the
brand_name = generic_nameconvention; a small number of authorized generics or unusually named products may sit on the opposite side of that line from a clinical classification.
Sources
- CMS — Medicare Part D Spending by Drug — the annual public-use file behind every figure in this study.
- CMS — Medicare-Medicaid Spending by Drug — the data category that publishes the annual Part D and Part B spending-by-drug files, with methodology and prior years.
The companion dataset page for Medicare Part D Spending by Drug lists the full schema and refresh cadence, and the source page documents its provenance and limitations. This is the drug-level mirror of the most expensive Part D drugs ranked against the most prescribed and of how Part D's GLP-1 spending exploded; for who writes the prescriptions see Part D prescribing by specialty and by state, and for how the prescribing itself concentrates, the prescriber-concentration study.
Frequently asked questions
- Which drug costs Medicare Part D the most?
- Eliquis (apixaban), a blood thinner. Medicare Part D spent $18.27 billion on it in 2023 — 6.6% of the program's entire $275.9 billion drug bill, on a single drug, reaching 3.93 million beneficiaries. Ozempic ($9.19B) and Jardiance ($8.84B) are next.
- How concentrated is Medicare Part D drug spending?
- Heavily. The 100 costliest drugs are only 2.8% of the 3,598 drugs on CMS's 2023 spending file, but they account for $176.2 billion — 63.8% of the total bill. The 10 costliest alone are 25.8% of spending, and the top 50 drugs cross half of it.
- Why do so few drugs account for so much spending?
- Two reasons sit underneath the concentration. Most of the costliest drugs are brand-name treatments for common chronic conditions — diabetes, blood clots, COPD — taken by millions of beneficiaries; brand-name drugs hold 90.6% of all Part D dollars while generics carry the volume. A second, smaller group of specialty and rare-disease drugs reaches only hundreds of patients but costs hundreds of thousands of dollars each.
- Are Medicare Part D drug prices rising?
- For most drugs on the file, yes. Of the 3,390 drugs with a year-over-year price recorded, 61.5% cost more per dose in 2023 than in 2022. Over a five-year horizon, 65.0% of priced drugs had a rising average price per dosage unit. The figures describe price per dose, separate from how much total volume changed.
- What is the most expensive drug per patient in Medicare Part D?
- Among drugs with at least $100 million in total spending, Strensiq (asfotase alfa), a treatment for a rare metabolic bone disease, had the highest per-beneficiary cost: an average of $1,250,918 across just 207 beneficiaries in 2023. Soliris ($483,709) and Takhzyro ($415,315) follow.
- Does high spending on a drug mean it is overpriced or overused?
- No. This study counts where Medicare's drug dollars go; it does not assess whether any drug was worth its price, appropriately prescribed, or fairly priced. A large bill can reflect a common condition, a genuinely costly therapy, or a high unit price — the spending figures alone do not distinguish among them, and this study draws no such inference.
- Can I reproduce these figures?
- Yes. Every number is a direct count or ratio over the public cms_part_d_spending_by_drug table — CMS's Medicare Part D Spending by Drug file for data year 2023, source released 2025-05-19 — restricted to the per-drug 'Overall' rows so manufacturer breakouts are not double-counted. The exact SQL for the concentration curve, the top-drug ranking, the per-beneficiary extremes, and the price-change split is published in the reproducibility block below.
Who uses this data
The source data behind this study is public
Compliance teams, journalists, and researchers work from the same federal source families cited above — queried by NPI or facility identifier through Fonteum’s open dataset pages and API. Every figure traces to a frozen, downloadable snapshot you can reproduce yourself.
Datasets used
Reproducibility
Every claim, reproducible
The SQL
-- How concentrated is Medicare Part D drug spending — and are the prices of the
-- drugs that dominate the bill still rising? Fully reproducible query.
--
-- Question: across the drugs Medicare Part D pays for, how much of the program's
-- total drug bill is carried by a handful of products, who are they, and what is
-- happening to their per-unit prices? The lead figure: the 100 costliest drugs —
-- 2.8% of the 3,598 drugs on CMS's published spending file — account for 63.8%
-- of the $275.9B Part D drug bill ($176.2B). These are spending facts over a
-- published drug-level file, NOT a quality, fraud, or pricing-fairness judgment.
--
-- Source:
-- public.cms_part_d_spending_by_drug — CMS "Medicare Part D Spending by Drug"
-- public-use file, published annually via data.cms.gov (Summary Statistics
-- on Use and Payments / Medicare-Medicaid Spending by Drug). Data year 2023;
-- source release 2025-05-19. Public, read-only. License: US-Government-Works
-- (17 U.S.C. Sec. 105). methodology_version = 'cms-part-d-spending/v1'.
--
-- Universe + double-count guard: the file ships TWO kinds of rows. An "Overall"
-- row (manufacturer_name = 'Overall') gives the all-manufacturer total for each
-- drug; additional rows break that total out by manufacturer. Summing every row
-- double-counts. This study reads the 3,598 "Overall" rows ONLY — one per drug —
-- which is the published Part D total. The other 10,711 of the 14,309 rows are
-- manufacturer breakouts and are excluded from every aggregate below.
--
-- Grain: each row is a drug (brand x generic), not a provider. No NPI, no
-- beneficiary, no prescriber is present or named anywhere in this study.
-- ============================================================================
-- (1) Universe reconciliation — the published file at a glance, Overall rows only.
-- ============================================================================
SELECT
count(*) AS drugs,
count(*) FILTER (WHERE manufacturer_name <> 'Overall') AS mfr_breakout_rows_excluded,
(SELECT count(*) FROM public.cms_part_d_spending_by_drug) AS rows_in_file,
sum(total_spending)::numeric::bigint AS total_spend,
max(data_year) AS data_year,
max(source_release_date) AS source_release
FROM public.cms_part_d_spending_by_drug
WHERE manufacturer_name = 'Overall';
-- drugs 3,598 · mfr_breakout_rows_excluded 10,711 · rows_in_file 14,309
-- total_spend 275,924,520,551 ($275.9B) · data_year 2023 · source_release 2025-05-19
-- ============================================================================
-- (2) HEADLINE: spend concentration. Rank drugs by total spend and read the
-- cumulative share. 10 drugs = a quarter of the bill; 50 = half; 100 = 63.8%.
-- ============================================================================
WITH ranked AS (
SELECT total_spending,
row_number() OVER (ORDER BY total_spending DESC) AS rn,
sum(total_spending) OVER () AS grand
FROM public.cms_part_d_spending_by_drug
WHERE manufacturer_name = 'Overall'
)
SELECT
round(100.0 * sum(total_spending) FILTER (WHERE rn <= 10) / max(grand), 1) AS top10_pct,
round(100.0 * sum(total_spending) FILTER (WHERE rn <= 25) / max(grand), 1) AS top25_pct,
round(100.0 * sum(total_spending) FILTER (WHERE rn <= 50) / max(grand), 1) AS top50_pct,
round(100.0 * sum(total_spending) FILTER (WHERE rn <= 100) / max(grand), 1) AS top100_pct,
round(100.0 * sum(total_spending) FILTER (WHERE rn <= 250) / max(grand), 1) AS top250_pct,
(sum(total_spending) FILTER (WHERE rn <= 100))::numeric::bigint AS top100_spend
FROM ranked;
-- top10 25.8% · top25 38.9% · top50 50.7% · top100 63.8% · top250 80.5%
-- top100_spend 176,157,336,695 ($176.2B). 100 of 3,598 drugs = 2.8% of the list.
-- ============================================================================
-- (3) The top of the list — the 10 costliest drugs and their share of the bill.
-- Seven are brand-name diabetes / anticoagulant / respiratory treatments;
-- two (Humira, Revlimid) are specialty drugs reaching far fewer beneficiaries.
-- ============================================================================
WITH o AS (
SELECT *, sum(total_spending) OVER () AS grand
FROM public.cms_part_d_spending_by_drug WHERE manufacturer_name = 'Overall'
)
SELECT
brand_name, generic_name,
total_spending::numeric::bigint AS spend,
round(100.0 * total_spending / grand, 1) AS pct_of_total,
total_beneficiaries AS beneficiaries,
round(avg_spend_per_beneficiary)::bigint AS spend_per_bene
FROM o
ORDER BY total_spending DESC
LIMIT 10;
-- Eliquis Apixaban $18.27B 6.6% 3,927,848 benes $4,652
-- Ozempic Semaglutide $9.19B 3.3% 1,464,468 benes $6,278
-- Jardiance Empagliflozin $8.84B 3.2% 1,882,768 benes $4,695
-- Trulicity Dulaglutide $7.36B 2.7% 938,731 benes $7,844
-- Xarelto Rivaroxaban $6.31B 2.3% 1,324,165 benes $4,765
-- Trelegy Ellipta $4.46B 1.6% 1,050,583 benes $4,241
-- Humira(Cf) Pen Adalimumab $4.42B 1.6% 61,474 benes $71,898 <- few patients, huge bill
-- Farxiga Dapagliflozin $4.34B 1.6% 993,909 benes $4,369
-- Januvia Sitagliptin $4.09B 1.5% 843,391 benes $4,850
-- Revlimid Lenalidomide $3.86B 1.4% 36,967 benes $104,412 <- specialty cancer drug
-- ============================================================================
-- (4) The second road to a big bill — price per beneficiary, not volume. Among
-- drugs with >= $100M total spend, the highest per-beneficiary costs are
-- rare-disease therapies reaching only a few hundred patients each.
-- ============================================================================
SELECT
brand_name, generic_name,
total_spending::numeric::bigint AS spend,
total_beneficiaries AS beneficiaries,
round(avg_spend_per_beneficiary)::bigint AS spend_per_bene
FROM public.cms_part_d_spending_by_drug
WHERE manufacturer_name = 'Overall' AND total_spending >= 100000000
ORDER BY avg_spend_per_beneficiary DESC
LIMIT 5;
-- Strensiq Asfotase Alfa $258.9M 207 benes $1,250,918
-- Soliris Eculizumab $223.5M 462 benes $483,709
-- Takhzyro Lanadelumab $194.4M 468 benes $415,315
-- Firdapse Amifampridine $146.3M 356 benes $411,048
-- Acthar Corticotropin $377.8M 942 benes $401,104
-- ============================================================================
-- (5) Are prices rising? The file carries each drug's 1-year and 5-year change
-- in average spend per dosage unit. A majority of priced drugs rose on both
-- horizons. (Percentages use the non-null base; 208 drugs lack a 1-year
-- change and 175 lack a 5-year CAGR.)
-- ============================================================================
SELECT
count(*) FILTER (WHERE change_avg_spend_per_dosage_unit IS NOT NULL) AS yoy_base,
count(*) FILTER (WHERE change_avg_spend_per_dosage_unit > 0) AS rose_yoy,
round(100.0 * count(*) FILTER (WHERE change_avg_spend_per_dosage_unit > 0)
/ count(*) FILTER (WHERE change_avg_spend_per_dosage_unit IS NOT NULL), 1) AS rose_yoy_pct,
count(*) FILTER (WHERE cagr_avg_spend_per_dosage_unit IS NOT NULL) AS cagr_base,
count(*) FILTER (WHERE cagr_avg_spend_per_dosage_unit > 0) AS cagr_pos,
round(100.0 * count(*) FILTER (WHERE cagr_avg_spend_per_dosage_unit > 0)
/ count(*) FILTER (WHERE cagr_avg_spend_per_dosage_unit IS NOT NULL), 1) AS cagr_pos_pct
FROM public.cms_part_d_spending_by_drug
WHERE manufacturer_name = 'Overall';
-- yoy_base 3,390 · rose 2,084 · 61.5% rose 2022-2023
-- cagr_base 3,423 · positive 2,225 · 65.0% positive 5-yr CAGR (2019-2023)
-- ============================================================================
-- (6) The steepest 1-year per-unit price climbs among material drugs (>= $50M
-- spend), so the list is not dominated by tiny products with noisy ratios.
-- ============================================================================
SELECT
brand_name, generic_name,
total_spending::numeric::bigint AS spend,
round(100.0 * change_avg_spend_per_dosage_unit, 1) AS yoy_unit_price_pct,
change_period
FROM public.cms_part_d_spending_by_drug
WHERE manufacturer_name = 'Overall'
AND total_spending >= 50000000
AND change_avg_spend_per_dosage_unit IS NOT NULL
ORDER BY change_avg_spend_per_dosage_unit DESC
LIMIT 5;
-- Zejula Niraparib $161.5M +43.1% 2022-2023
-- Entyvio Vedolizumab $100.0M +36.5% 2022-2023
-- Lumakras Sotorasib $140.2M +34.9% 2022-2023
-- Erleada Apalutamide $1.06B +32.1% 2022-2023
-- Metformin ER Gastric $191.1M +27.3% 2022-2023
-- ============================================================================
-- (7) Why so concentrated — brand vs generic. The partition is
-- lower(brand_name) = lower(generic_name): a generic is published under its
-- own ingredient name. Generics are 601 of 3,598 drugs but only 9.4% of the
-- dollars; brand-name drugs carry 90.6% of the bill.
-- ============================================================================
SELECT
count(*) FILTER (WHERE lower(brand_name) = lower(generic_name)) AS generic_drugs,
(sum(total_spending) FILTER (WHERE lower(brand_name) = lower(generic_name)))::numeric::bigint AS generic_spend,
round(100.0 * sum(total_spending) FILTER (WHERE lower(brand_name) = lower(generic_name))
/ sum(total_spending), 1) AS generic_spend_pct
FROM public.cms_part_d_spending_by_drug
WHERE manufacturer_name = 'Overall';
-- generic_drugs 601 · generic_spend $25.83B · generic_spend_pct 9.4% (brand = 90.6%)The snapshot
| dataset_id | cms-provider-data-catalog |
| snapshot_date | 2026-06-16 |
| sha256 | |
| doi | 10.5072/fonteum/medicare-part-d-spending-concentration-2023 |
| slsa_provenance_url |
The JOINs
universe: manufacturer_name = 'Overall' rows only -- 3,598 drugs, $275.9B total spend, data_year 2023, source released 2025-05-19 double-count guard: per-manufacturer breakout rows excluded -- 10,711 of the file's 14,309 rows restate the Overall total and are dropped concentration: rank by total_spending desc, cumulative share -- top 10 = 25.8%, top 50 = 50.7%, top 100 = 63.8% ($176.2B), top 250 = 80.5% costliest drug = max(total_spending) -- Eliquis $18.27B = 6.6% of the bill, across 3.93M beneficiaries per-beneficiary extreme = max(avg_spend_per_beneficiary), spend >= $100M -- Strensiq $1,250,918 across 207 beneficiaries; Revlimid $104,412; Humira $71,898 price direction = change_avg_spend_per_dosage_unit / cagr -- 2,084 of 3,390 priced drugs rose 2022-2023 (61.5%); 2,225 of 3,423 positive 5-yr CAGR (65.0%) brand vs generic = lower(brand_name) = lower(generic_name) -- generic = 601 drugs, $25.83B (9.4%); brand-name drugs hold 90.6% of spend
The pipeline version
| git_sha | |
| slsa_provenance | |
| methodology_version | cms-part-d-spending/v1 |
Reproduce this
Run the exact query against the frozen 2026-06-16.
Cite this study
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Check the chain
Each figure is snapshot-attested — re-derive the hash from the federal file.
cms-provider-data-catalog · 2026-06-16SHA-256 a3f1c9…7e6b- FINANCIAL DISTRESS · JUN 2026The most expensive Medicare Part D drugs are rarely the most prescribedEliquis cost Medicare Part D $19.88 billion in 2024 — the single costliest drug in the program, yet only its 12th most-prescribed. That inversion defines Part D: brand-name drugs are 23.9% of prescriptions but 90.1% of the dollars, while cheap generics carry the volume and almost none of the cost.
- CARE QUALITY · JUN 2026GLP-1 drugs now cost Medicare Part D $24.57 billion a yearGLP-1 drugs cost Medicare Part D $24.57 billion in 2024 — 10.8% of the entire program's drug spending on just 1.3% of its prescriptions. Ozempic alone, at $12.38 billion, is the second-costliest drug in Part D; Mounjaro and Trulicity push the class past $24 billion.
- WORKFORCE · JUN 2026Who prescribes Medicare's drug spending? Nurse practitioners now leadNurse practitioners drove $37.48 billion of Medicare Part D drug cost in 2024 — more than any other specialty, including internal medicine and cardiology. But the steepest bills come from oncology: hematology-oncologists averaged $2,441 per prescription, sixteen times the program-wide $153, on a fraction of the claims.
- ACCESS · JUN 2026Medicare Part D drug spending by state: where the dollars concentrateCalifornia prescribers drove $21.26 billion of Medicare Part D drug cost in 2024, the most of any state — followed by New York at $18.17 billion, Florida ($16.84 billion), and Texas ($15.75 billion). The four largest states alone account for nearly a third of the program's $226.74 billion in drug spending.
- FINANCIAL DISTRESS · JUN 2026The 5% of prescribers behind half of Medicare's drug billIn 2024 the top 5% of Medicare Part D prescribers — 56,973 of 1.14 million — accounted for 53.5% of the program's $226.7 billion drug bill, while the bottom half split 0.4%. The top 1% alone drove $53.5 billion. The Gini coefficient across prescribers is 0.841.
Federal source citations
Fonteum Research · June 16, 2026 · All figures trace to the frozen federal-data snapshot cited above.