{
  "study": {
    "slug": "medicare-part-d-prescribing-by-state",
    "title": "Medicare Part D drug spending by state: where the dollars concentrate",
    "standfirst": "California 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.",
    "desk": "access",
    "article_type": "Original Research",
    "published": "2026-06-12",
    "issue": 59,
    "doi": "10.5072/fonteum/medicare-part-d-prescribing-by-state-2026",
    "url": "https://fonteum.com/research/medicare-part-d-prescribing-by-state",
    "methodology_version": "part-d-geography/v1"
  },
  "data_as_of": "2026-04-04",
  "datasets": [
    {
      "slug": "cms-part-d-prescribers",
      "name": "CMS Medicare Part D Prescribers",
      "publisher": "CMS — Medicare Part D Prescribers, by Provider and Drug",
      "upstream_url": null
    }
  ],
  "key_findings": [
    {
      "number": "$21.26B",
      "finding": "in Medicare Part D drug cost attributed to California prescribers in 2024 — the most of any state, ahead of New York ($18.17B) and Florida ($16.84B)",
      "dataset": "cms-part-d-prescribers"
    },
    {
      "number": "31.8%",
      "finding": "of all Part D drug cost is attributed to prescribers in just four states — California, New York, Florida, and Texas",
      "dataset": "cms-part-d-prescribers"
    },
    {
      "number": "$190.82",
      "finding": "average Part D cost per claim in New York — the highest among the large states, against $136.29 in Missouri, a roughly 40% spread",
      "dataset": "cms-part-d-prescribers"
    },
    {
      "number": "61",
      "finding": "states and territories reporting Part D prescribing in 2024, attributed by the prescriber's practice location rather than where the patient lives",
      "dataset": "cms-part-d-prescribers"
    }
  ],
  "faqs": [
    {
      "q": "Which state has the highest Medicare Part D drug spending?",
      "a": "California, at $21.26 billion in 2024 — the most of any state. New York ($18.17 billion), Florida ($16.84 billion), Texas ($15.75 billion), and Pennsylvania ($11.13 billion) follow. The ranking closely tracks state population and the number of Medicare prescribers, so the largest states lead."
    },
    {
      "q": "How concentrated is Medicare Part D spending geographically?",
      "a": "Highly. Prescribers in just four states — California, New York, Florida, and Texas — account for 31.8% of all Part D drug cost, nearly a third of the $226.74 billion program. Spending scales with population and provider supply, so it concentrates in the most populous states."
    },
    {
      "q": "Why does cost per prescription differ by state?",
      "a": "Cost per Part D claim ranged from about $136 in Missouri to about $191 in New York in 2024. The spread reflects differences in the drug mix prescribed — more brand and specialty drugs in some states — along with prescriber specialty composition and local practice patterns, not a single cause."
    },
    {
      "q": "Are these figures based on where patients live or where doctors practice?",
      "a": "Where the prescriber practices. The Part D file attributes each claim to the prescriber's practice state, not the patient's home state. A state's total reflects the prescribing done by clinicians located there, which usually but not always matches where the medicines are taken."
    },
    {
      "q": "Which states have the highest Part D cost per prescription?",
      "a": "Among the large states, the Northeast leads: New York at $190.82 per claim, Massachusetts at $183.00, and New Jersey at $173.39, all above the $153 national average. Lower-cost-per-claim states include Missouri ($136.29) and Ohio ($145.17)."
    },
    {
      "q": "How many states report Medicare Part D prescribing?",
      "a": "61 states and territories appear in the 2024 prescriber file with a valid two-letter code. That includes all 50 states, the District of Columbia, and U.S. territories such as Puerto Rico. A small amount of spending with no valid state code is excluded from the geographic totals."
    },
    {
      "q": "Can I reproduce these state figures?",
      "a": "Yes. Every figure comes from the by-state materialized view over the CMS Medicare Part D Prescribers 2024 file, which sums cost and claims for each prescriber state. The exact SQL is in the reproducibility block below and traces to a federal snapshot dated 2026-04-04."
    }
  ],
  "citation": {
    "apa": "Fonteum Research. (2026, June 12). Medicare Part D drug spending by state: where the dollars concentrate. Fonteum Research, Issue 59. https://doi.org/10.5072/fonteum/medicare-part-d-prescribing-by-state-2026",
    "url": "https://fonteum.com/research/medicare-part-d-prescribing-by-state"
  },
  "reproducible_sql": "-- Medicare Part D prescribing by state, 2024 — reproducible query.\n--\n-- Source:   CMS Medicare Part D Prescribers, \"by Provider and Drug\".\n-- Snapshot: cms-part-d-prescribers / data year 2024 / CMS release 2026-04-04.\n-- Base:     public.cms_part_d_prescribers (~28.0M prescriber × drug rows).\n-- Reads:    part_d_by_state_mv (one row per prescriber_state) +\n--           part_d_prescribing_overview_mv (program totals), from\n--           supabase/migrations/20260612150000_part_d_prescribing_research_views.sql.\n--           The view is GROUP BY prescriber_state over the 2024 base rows where\n--           length(prescriber_state) = 2, summing total_claims and total_drug_cost.\n--           State is the PRESCRIBER'S practice location, not the patient's home.\n\n-- 1. Top states by total drug cost:\nSELECT state, claims, cost,\n       round(cost::numeric / claims, 2) AS cost_per_claim\nFROM public.part_d_by_state_mv\nORDER BY cost DESC\nLIMIT 10;\n--  CA  129,565,592  $21,262,400,165  $164.11  <- highest total\n--  NY   95,240,368  $18,174,131,281  $190.82  <- highest cost/claim among large states\n--  FL  113,582,265  $16,838,937,918  $148.25\n--  TX   98,638,359  $15,746,441,934  $159.64\n--  PA   72,980,145  $11,128,347,140  $152.48\n--  OH   62,294,899  $9,043,071,424   $145.17\n--  NC   52,430,568  $8,138,215,348   $155.22\n--  MI   49,623,865  $7,821,347,989   $157.61\n--  IL   51,867,241  $7,536,982,736   $145.31\n--  GA   47,568,589  $7,304,129,570   $153.55\n\n-- 2. Four-state concentration (CA + NY + FL + TX):\nWITH top4 AS (\n  SELECT sum(cost) AS cost\n  FROM public.part_d_by_state_mv\n  WHERE state IN ('CA','NY','FL','TX')\n)\nSELECT top4.cost,\n       round(100.0 * top4.cost / ov.total_drug_cost, 1) AS top4_cost_pct  -- 31.8%\nFROM top4, public.part_d_prescribing_overview_mv ov;\n\n-- 3. Cost-per-claim spread across large states (the figure):\nSELECT state, round(cost::numeric / claims, 2) AS cost_per_claim\nFROM public.part_d_by_state_mv\nWHERE state IN ('NY','MA','NJ','CA','TX','OH','MO')\nORDER BY cost_per_claim DESC;\n--  NY $190.82 ; MA $183.00 ; NJ $173.39 ; CA $164.11 ; TX $159.64 ; OH $145.17 ; MO $136.29\n--  Program average = $153.24 (overview_mv.total_drug_cost / total_claims).\n\n-- 61 reporting jurisdictions (50 states + DC + territories with a 2-letter code):\nSELECT count(*) AS n_jurisdictions FROM public.part_d_by_state_mv;   -- 61",
  "license": "U.S. Government Works (federal sources; 17 U.S.C. §105)",
  "generated_by": "Fonteum — https://fonteum.com",
  "notes": "Aggregate, source-traced figures frozen to the snapshot above. Reproduce by running reproducible_sql against the cited federal dataset; no per-entity records are included."
}