Based on total gross spending, Eliquis (apixaban) is the most expensive drug in Medicare Part D, with annual spending reaching approximately $12.6 billion to $18.3 billion. It is a widely used blood thinner that, along with others like Xarelto and Januvia, consistently ranks at the top of Part D expenditures due to high utilization and lack of generic alternatives.
At over $7.3 billion, the most expensive drug covered under Medicare Part D is apixaban, brand name Eliquis, which is used for blood clots. In 2019, nearly 2.2 million Medicare beneficiaries used this drug.
Under Medicare Part D, $48 Billion Spent on Top 10 Drugs in 2021
Lenmeldy (atidarsagene autotemcel) is the most expensive drug on the market with a steep price tag of $4.25m. The gene therapy is developed for children with metachromatic leukodystrophy (MLD), a potentially fatal disorder caused by a mutation in the arylsulfatase-A (ARSA) gene, which leads to the buildup of fats.
Yes, there is a $2,000 annual cap on out-of-pocket prescription drug costs for seniors in Medicare Part D, which started in 2025 as part of the Inflation Reduction Act, with the cap increasing to $2,100 in 2026, automatically protecting all Part D enrollees from very high drug expenses.
The top 5 most prescribed medications consistently include statins (like Atorvastatin) for cholesterol, diabetes drugs (like Metformin), thyroid medication (Levothyroxine), and blood pressure drugs (like Lisinopril and Amlodipine) for heart conditions, reflecting treatments for common chronic issues like heart disease, diabetes, and hypothyroidism, though rankings vary slightly by year and data source.
The average estimated monthly Part D plan premium in 2026 is $34.50. Other factors can affect the cost of Part D including monthly premium, yearly deductible and copayments. High-income earners may pay a surcharge known as the “income-related monthly adjustment amount” (IRMAA).
Our study shows that antibiotics top the list of drugs most overprescribed in the U.S. In 2022, U.S. healthcare providers issued 236. 4 million antibiotic prescriptions. This works out at 7 prescriptions per 10 people in an outpatient (non-hospital) medical setting.
All prescription medications, including specialty medications, covered by Part D plans are included under this cap. The cap includes deductibles, copayments, and coinsurance for covered drugs. In 2025, the annual Medicare Part D cap is $2,000.
Yes, Medicare Part D is generally considered worth it for seniors, even if they don't take many drugs now, because it provides crucial prescription drug coverage, protects against future high costs, helps avoid costly late enrollment penalties, and offers significant savings through negotiated drug prices and new benefits like the $2,000 annual out-of-pocket cap (increasing to $2,100 in 2026). While it involves monthly premiums, deductibles, and copays, the overall financial protection and access to medications often outweigh the costs, especially for those with chronic conditions or who want to avoid penalties for signing up later.
Drugs in the Select Care tier (Tier 6) have a $0 copay for up to a 90-day supply in the Initial Coverage stage. This includes a select number of medications used to treat high blood pressure, diabetes and high cholesterol.
Yes, doctors often receive payments from pharmaceutical companies, not directly per prescription, but for activities like speaking, consulting, and research, and studies show a strong link between these payments (and gifts like meals) and increased prescribing of the company's brand-name drugs, raising ethical concerns about potential bias and patient harm, though direct kickbacks for referrals are illegal. The CMS Open Payments portal publicly tracks these industry payments, revealing billions in payments to over 800,000 physicians, with some doctors earning millions, influencing prescribing patterns across many specialties.
You may have to pay more, depending on your income. Who pays a higher Part D premium because of income? You'll pay an extra 1% for each month you could have signed up for Part D, but didn't, and didn't have creditable drug coverage. We'll add this penalty to your monthly Part D premium.
Medicare Part D generally excludes drugs for weight loss/gain, cosmetic purposes (like hair growth), fertility, and most cough/cold relief, plus non-prescription (OTC) meds and most vitamins (except prenatal/fluoride). Specific examples include Viagra (for ED), Propecia (hair loss), Xenical (weight loss), and Robitussin AC. Coverage varies by plan, but these categories are national guidelines.
Keytruda was the world's top-selling pharmaceutical drug in the first half of 2025, generating 1.5 billion U.S. dollars in global sales. Ozempic from Novo Nordisk followed, with a sales value of 9.5 billion U.S. dollars.
Medications in tier 5 include the highest-cost versions of specialty drugs because they also have a generic option. Examples of higher-cost specialty drugs you may find in tier 5 include: Specialty drugs for autoimmune conditions. Specialty drugs for certain cancers.
Commonly Used Medications for Older Adults