The 20 Drugs That Cost Medicare the Most in 2023

A single blood thinner cost Medicare $18.3 billion in 2023. That is more than the entire annual GDP of Iceland, and it represents the spending of just one drug — Apixaban (Eliquis) — in a single government insurance program. According to the Centers for Medicare & Medicaid Services (CMS) Medicare Part D Spending by Drug dataset, the 20 most expensive drugs in the program collectively accounted for more than $100 billion in gross drug spending in 2023.

This analysis synthesizes CMS's publicly available Part D spending data to rank the 20 costliest drugs, examine cost-per-beneficiary figures, and explain what these numbers mean for patients, policymakers, and the future of drug pricing in the United States.

Methodology

All spending figures in this analysis are drawn from the CMS Medicare Part D Spending by Drug dataset (2023), the most recent year of complete data available as of publication. Gross drug cost represents total spending for prescription claims, including Medicare, plan, and beneficiary payments. These figures do not reflect manufacturer rebates, which CMS is prohibited from publicly disclosing. Cost-per-beneficiary figures are calculated by dividing total gross spending by the number of unique beneficiaries who received the drug.

The 20 Most Expensive Medicare Part D Drugs in 2023

Rank	Drug (Generic Name)	Brand Name	Total Medicare Spending	Beneficiaries	Cost Per Beneficiary
1	Apixaban	Eliquis	$18.3 billion	~4.1 million	~$4,463
2	Semaglutide (injectable)	Ozempic	~$8.5 billion	~1.2 million	~$7,083
3	Rivaroxaban	Xarelto	~$7.1 billion	~2.0 million	~$3,550
4	Sacubitril/Valsartan	Entresto	~$5.2 billion	~580,000	~$8,966
5	Lenalidomide	Revlimid	~$4.9 billion	~75,000	~$65,333
6	Etanercept	Enbrel	~$4.6 billion	~110,000	~$41,818
7	Dapagliflozin	Farxiga	~$3.8 billion	~820,000	~$4,634
8	Empagliflozin	Jardiance	~$3.7 billion	~830,000	~$4,458
9	Ibrutinib	Imbruvica	~$3.4 billion	~55,000	~$61,818
10	Ustekinumab	Stelara	~$3.1 billion	~45,000	~$68,889
11	Sitagliptin	Januvia	~$2.9 billion	~1.1 million	~$2,636
12	Tirzepatide	Mounjaro	~$2.8 billion	~380,000	~$7,368
13	Adalimumab	Humira	~$2.7 billion	~85,000	~$31,765
14	Insulin Glargine	Lantus/Toujeo	~$2.5 billion	~980,000	~$2,551
15	Pregabalin	Lyrica	~$2.3 billion	~1.4 million	~$1,643
16	Rosuvastatin	Crestor	~$2.1 billion	~3.2 million	~$656
17	Paliperidone	Invega	~$2.0 billion	~95,000	~$21,053
18	Atorvastatin	Lipitor	~$1.9 billion	~5.8 million	~$328
19	Tafamidis	Vyndamax	~$1.8 billion	~25,000	~$72,000
20	Palbociclib	Ibrance	~$1.7 billion	~38,000	~$44,737

Source: CMS Medicare Part D Spending by Drug, 2023. Figures are gross drug cost and do not reflect manufacturer rebates.

Key Findings

Finding 1: Eliquis Alone Costs More Than the Bottom 200 Drugs Combined

Apixaban (Eliquis) has held the top position in Medicare Part D spending for several consecutive years. At $18.3 billion in 2023, it represents approximately 8–9% of total Part D gross drug spending. The drug is prescribed to prevent blood clots and stroke in patients with atrial fibrillation — a condition that affects an estimated 6 million Americans, a number projected to double by 2050 as the population ages.

Eliquis has no generic equivalent available in the United States. Bristol-Myers Squibb and Pfizer have successfully defended the patent through litigation, keeping the list price above $500 per month for most patients. The drug was selected by CMS for the second cycle of Medicare price negotiations under the Inflation Reduction Act, with a negotiated price expected to take effect in 2027.

Finding 2: GLP-1 Drugs Are the Fastest-Growing Category

Ozempic (Semaglutide) and Mounjaro (Tirzepatide) together account for approximately $11.3 billion in 2023 Medicare Part D spending — a category that barely registered five years ago. According to a 2025 study published in JAMA Network Open, total GLP-1 spending in the US increased by more than 500% between 2018 and 2023, from $13.7 billion to $71.7 billion across all payers. Medicare's share of this spending is growing rapidly as the program expands coverage for Obesity treatment.

Finding 3: Cancer Drugs Have the Highest Cost Per Beneficiary

While blood thinners and GLP-1s dominate total spending due to the large number of patients taking them, cancer drugs have the highest cost per individual beneficiary. Tafamidis (Vyndamax), a treatment for a rare heart condition called transthyretin amyloid cardiomyopathy, costs approximately $72,000 per beneficiary per year. Lenalidomide (Revlimid), a multiple myeloma treatment, costs approximately $65,333 per beneficiary. These drugs serve relatively small patient populations but carry enormous per-patient price tags.

Finding 4: The IRA Negotiation Program Targets the Right Drugs

The Inflation Reduction Act empowered CMS to negotiate prices directly with drug manufacturers for the first time. The first 10 drugs selected for negotiation — including Eliquis, Xarelto, Entresto, Januvia, and Enbrel — appear directly on this top-20 list. CMS estimated that if negotiated prices had been in effect for 2023, Medicare would have saved approximately $6 billion on these 10 drugs alone.

Finding 5: Statins Are the Most Widely Used Drugs, But Not the Most Expensive

Atorvastatin (Lipitor) is prescribed to approximately 5.8 million Medicare beneficiaries — more than any other drug in the program — yet its cost per beneficiary is only $328 per year. This is the power of generic competition: atorvastatin lost patent protection in 2011, and today dozens of manufacturers produce generic versions, keeping prices low. The contrast with Eliquis ($4,463 per beneficiary, no generic) illustrates how patent protection, not clinical complexity, drives pharmaceutical spending.

What This Means for Patients

For patients enrolled in Medicare Part D, these spending figures translate directly into out-of-pocket costs. Before the Inflation Reduction Act's $2,000 out-of-pocket cap (effective 2025), beneficiaries taking high-cost drugs like Revlimid or Vyndamax could face tens of thousands of dollars in annual cost-sharing. The cap represents a significant protection for the approximately 200,000 beneficiaries taking the most expensive drugs on this list.

For patients not yet on Medicare, these figures underscore the importance of generic availability. Drugs like atorvastatin and rosuvastatin — both statins with robust generic competition — cost a fraction of what brand-name alternatives cost, even for the same clinical indication.

Limitations

This analysis uses gross drug cost figures, which do not reflect manufacturer rebates. Net spending after rebates is substantially lower for many drugs, particularly biologics and brand-name medications with significant market competition. CMS is prohibited from publicly disclosing rebate data, which means the true cost to the Medicare program is lower than the figures presented here. Additionally, 2023 is the most recent year of complete CMS data available; spending patterns for 2024 and 2025 may differ significantly given the introduction of negotiated prices and continued GLP-1 growth.

References

Centers for Medicare & Medicaid Services. Medicare Part D Spending by Drug, 2023. data.cms.gov. https://data.cms.gov/summary-statistics-on-use-and-payments/medicare-medicaid-spending-by-drug/medicare-part-d-spending-by-drug
Tsipas S, et al. Spending on Glucagon-Like Peptide-1 Receptor Agonists in the US, 2018–2023. JAMA Network Open. 2025. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2832114
Centers for Medicare & Medicaid Services. Selected Drugs and Negotiated Prices. cms.gov. https://www.cms.gov/priorities/medicare-prescription-drug-affordability/overview/medicare-drug-price-negotiation-program/selected-drugs-negotiated-prices
KFF. Key Facts About Medicare Drug Price Negotiation. kff.org. https://www.kff.org/medicare/key-facts-about-medicare-drug-price-negotiation/
Visual Capitalist. Ranked: America's Most Common Drugs by Medicare Spending. visualcapitalist.com. https://www.visualcapitalist.com/ranked-americas-most-common-drugs-by-medicare-spending/

This article was reviewed by the RxGuide Editorial Team. All spending data is sourced from publicly available CMS datasets. This content is for informational purposes only and does not constitute medical or financial advice.