Medicare Spent the Most on Blood Thinners, Diabetes Drugs

The 10 top-selling prescription drugs accounted for nearly one-quarter of the $216 billion total gross Medicare drug spending in 2021.

The Inflation Reduction Act, passed in 2022, will require the federal government to negotiate the price of certain high-spending drugs covered by Medicare Part D.

Under the new program, the government will negotiate 10 drugs for 2026. These medications will be chosen from the top 50 negotiation-eligible Part D drugs with the highest total Medicare expenditures.

In 2021, Medicare Part D covered more than 3,500 prescription drug products, with total gross spending of $216 billion, according to the analysis by the Kaiser Family Foundation (KFF), a non-profit organization focused on health policy.

However, the analysis did not account for rebates paid by drug manufacturers to pharmacy benefit managers, which may have reduced net spending.

The 10 top-selling Part D drugs represented just 0.3% of covered medications and 22% of total gross Medicare drug spending in 2021, costing $47.7 billion.

The top 100 drugs accounted for 3% of covered medications and 61% of total gross spending that year. In total, Medicare spent $131.2 billion on these drugs in 2021.

Blood thinners, cancer drugs, and diabetes treatments dominate the list of the 10 drugs the highest total gross spending:

• Eliquis ($12.6 billion), a blood thinner used to reduce the risk of stroke and blocked arteries in patients with nonvalvular atrial fibrillation.
• Revlimid ($5.9 billion), a drug used to treat multiple myeloma, a type of bone marrow cancer, in patients who received at least one prior therapy.
• Xarelto ($5.2 billion), a blood thinner used in patients with nonvalvular atrial fibrillation.
• Trulicity ($4.7 billion), a glucagon-like peptide-1 receptor agonist intended to treat type 2 diabetes in adults.
• Januvia ($4.1 billion), a drug that controls high blood sugar in patients with type 2 diabetes.
• Jardiance ($3.7 billion), a medication intended to improve blood sugar control in children 10 years and older with type 2 diabetes.
• Imbruvica ($3.2 billion), a cancer drug used to treat adult patients with chronic lymphocytic leukemia.
• Humira (CF) Pen ($2.9 billion), a drug approved for the treatment of rheumatoid arthritis.
• Lantus Solostar ($2.8 billion), an insulin analog used to control blood sugar in patients with type 1 and type 2 diabetes.
• Ozempic ($2.6 billion), a glucagon-like peptide-1 receptor agonist used in adults with type 2 diabetes. Although it has recently gained popularity as a weight-loss drug, Medicare only covers Ozempic when prescribed for diabetes.

Between 2018 and 2021, aggregate gross spending on these 10 drugs increased from $22 billion to nearly $48 billion, accounting for more than half of the increase in gross Medicare spending across all covered Part D drugs.