Healthcare is expensive. Whether you’re seeing your doctor for a case of the flu or undergoing a total hip replacement, the cost of medical care as you get older can add up quickly. You’re probably painfully aware of this fact, especially if you take regular medications.
Each trip to the pharmacy can feel like highway robbery, even if you have Medicare drug coverage. We’re not going to get into the why behind the high cost of prescription drugs — suffice to say, it’s complicated — but we do want to highlight some of the most expensive drugs covered by Medicare.
The Centers for Medicare and Medicaid Services (CMS), which administers the Medicare program, maintains a dashboard of prescription drug spending for Medicare. Knowing what these medications are, how many people use them and what they’re used for potentially helps Medicare assess where spending goes and what to do about it. But that, too, is a discussion for another day.
More data is never a bad thing, in any case.
As of 2019, the last year for which CMS drug spending data is available, Medicare had spent about $145 billion on Part D prescription drugs and another $37 billion on Part B drugs.
Medicare Part D is one of the private portions of Medicare. These plans only cover prescription outpatient drugs, and you either have to buy one as a standalone policy to go with Original Medicare, or you can get a Medicare Advantage plan that includes Part D coverage.
According to Kaiser Family Foundation, a nonprofit that analyzes healthcare data, about 60% of Part D spending comes from just 7% of covered drugs. And this small fraction of drugs packs a punch. These are medications with only one manufacturer and no generic or biosimilar alternative, making them more expensive than other kinds of drugs.
But the priciest drugs aren’t necessarily the ones with the most prescriptions in Medicare. In fact, a list of the top 10 prescription drugs under Medicare Part D differs from a list ranking the most expensive.
Let’s take a look at both.
Top 10 Most Expensive Medicare Part D Drugs
|Drug name||Brand||Purpose||Spend||# of Beneficiaries|
|Insulin Glargine, Hum.Rec.Anlog||Lantus Solostar||insulin||$2,495,768,702||965,522|
|Dulaglutide||Lyrica||control blood sugar (not insulin)||$2,273,120,393||392,995|
|Symbicort||asthma & COPD||$2,016,077,018||1,103,477|
|Insulin Aspart||Novolog Flexpen||insulin||$1,844,090,302||602,128|
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.
All of the medications in the top 10 have only one manufacturer, and none of them have a generic or biosimilar equivalent. This makes them naturally more expensive.
As you’ll see in the next section, the list of the top 10 prescribed Medicare drugs differs quite a bit from the list of the most expensive ones. But since drugs with more competition tend to be cheaper, the spending is lower overall for these medications.
Top 10 Most Prescribed Medicare Part D Drugs
|Drug name||Brand||Purpose||Spend||# of Beneficiaries|
|Atorvastatin Calcium||Lipitor||high cholesterol||$918,629,086||12,987,601|
|Amlodipine Besylate||Norvasc||high BP & angina||$309,255,513||9,544,618|
|Lisinopril||Qbrelis, Zestril, Prinivil||high BP & heart failure||$286,846,115||8,613,159|
|Levothyroxine Sodium*||Synthroid, Levoxyl||hypothyroidism||$819,411,861||7,860,422|
|Omeprazole||Prilosec OTC||heartburn & GERD||$407,200,690||6,828,406|
|Losartan Potassium||Cozaar||high BP||$293,739,569||6,628,790|
|Gabapentin||Gralise, Horizant, Neuraptine||anticonvulsant (seizures)||$642,665,588||6,413,028|
The drugs on this list have multiple manufacturers, both brand name and generics, ranging from 13 (prednisone) to 41 (gabapentin). This helps lower the cost.
And note that nearly 13 million Medicare members used the top prescribed drug, atorvastatin calcium (brand name Lipitor), in 2019. That’s more than the combined total of all the people using the top 10 most expensive drugs that year (8.1 million) — about 150% more, actually.
Altogether, this list of the top prescribed drugs of Medicare adds up to over 77 million people. This tally represents more than the total number of people enrolled in Medicare, likely indicating overlapping prescriptions.
There’s a big difference in cost for these lists, too. Medicare spent $32.7 billion on the top 10 most expensive Part D drugs in 2019, which is nearly four times as much as it spent on the 10 most prescribed drugs ($4.3 billion).
Some medications, like chemotherapy or high-priced brand name drugs with no generic equivalent, are going to cost significantly more than something like a statin that’s been around for 25 years (e.g., Lipitor). But cost doesn’t always correlate to usage, as the above charts show.
How do you get prescription drug coverage under Medicare?
Under Original Medicare, you can’t. Neither Part A nor Part B covers prescription drugs, though Part B does cover a select set of doctor-administered drugs in some settings (like chemo treatments at a hospital).
If you want or need prescription drug coverage under Medicare, you’ll need to get a standalone Part D policy or a Medicare Advantage plan with drug coverage.
Medicare Part D
Medicare Part D was added to the Medicare lineup in 2006. Before then, there weren’t many options for Medicare enrollees to get affordable drug coverage. Original Medicare on its own only covers limited Part B drugs, which are medications and treatments that a doctor administers, usually in a hospital setting.
Part D covers outpatient drugs, like prescriptions for high blood pressure or insulin. Standalone Part D plans are:
- Sold by private companies
- Available only to people with Original Medicare
- Typically affordable
Coverage for different drugs varies by plan. Part D plans have tiers of coverage. You may not pay anything out of pocket (other than your premium) for certain types of medications, such as tier 1 or tier 2 drugs. Higher-cost drugs, like brand names without generic equivalents or cancer drugs, might cost more.
You can enroll in Medicare Part D when you’re first eligible for Medicare, after you’ve enrolled in either Part A or Part B (or both, if you want both). This is the best time to do it, since if you wait to enroll and decide you need coverage outside of your initial eligibility window, you may pay a penalty fee once you enroll later.
If you didn’t join when you were first eligible and need coverage later, you can enroll during the annual Medicare Open Enrollment Period. This yearly signup window lasts from October 15th through December 7th. You can use it to make any changes that you need to your Medicare coverage, including joining a Part D plan.
Medicare Advantage PDP
Your other option for prescription drug coverage under Medicare is to join a Medicare Advantage plan with drug coverage (also known as an MAPD plan). MAPD plans include the Part D benefit alongside the medical benefits, making them a convenient and affordable option for packaging your benefits together.
Because Medicare Advantage is also sold by private companies, coverage and costs will vary with these plans as well. You get all the same benefits that Original Medicare covers (by law) as well as any additional benefits the plan offers.
If you need drug coverage, make sure the MA plans you’re comparing offer it. Most do, but it’s not universal.
You can enroll in Medicare Advantage when you’re first eligible for Medicare. You need both Parts A and B to sign up for a private plan. If you want to make changes to your coverage or you want to enroll for the first time because you didn’t during your initial signup window, you can use the Medicare Open Enrollment Period from October 15th through December 7th.
Even if you don’t have a chronic condition or need medication regularly, consider getting Part D coverage in one of the two forms, either standalone or as part of a Medicare Advantage plan. As you get older, you may need prescriptions you didn’t need before. This affordable add-on could lower what you pay out of pocket for those prescriptions.