{
  "study": {
    "slug": "most-expensive-medicare-part-d-drugs",
    "title": "The most expensive Medicare Part D drugs are rarely the most prescribed",
    "standfirst": "Eliquis cost Medicare Part D $19.88 billion in 2024 — the single costliest drug in the program, yet only its 12th most-prescribed. That inversion defines Part D: brand-name drugs are 23.9% of prescriptions but 90.1% of the dollars, while cheap generics carry the volume and almost none of the cost.",
    "desk": "financial-distress",
    "article_type": "Original Research",
    "published": "2026-06-12",
    "issue": 57,
    "doi": "10.5072/fonteum/most-expensive-medicare-part-d-drugs-2026",
    "url": "https://fonteum.com/research/most-expensive-medicare-part-d-drugs",
    "methodology_version": "part-d-costliest/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": "$19.88B",
      "finding": "Medicare Part D cost for Eliquis in 2024 — the single costliest drug in the program, yet only the 12th most-prescribed",
      "dataset": "cms-part-d-prescribers"
    },
    {
      "number": "90.1%",
      "finding": "of Part D drug cost goes to brand-name drugs, which are only 23.9% of all prescription claims",
      "dataset": "cms-part-d-prescribers"
    },
    {
      "number": "72.5M",
      "finding": "claims for atorvastatin, the most-prescribed Part D drug — at $749 million, costing less per claim than a single Eliquis fill costs the program many times over",
      "dataset": "cms-part-d-prescribers"
    },
    {
      "number": "$17,431",
      "finding": "average Part D cost per claim for the cancer drug Revlimid — among the highest in the program, on just 217,318 claims",
      "dataset": "cms-part-d-prescribers"
    }
  ],
  "faqs": [
    {
      "q": "What is the most expensive drug in Medicare Part D?",
      "a": "In 2024 it was Eliquis, a blood thinner, at $19.88 billion in total Part D drug cost. Ozempic was second at $12.38 billion and Jardiance third at $10.68 billion. All three are brand-name drugs with no generic competition, which is why they top the spending table."
    },
    {
      "q": "What is the most prescribed drug in Medicare Part D?",
      "a": "Atorvastatin, a generic cholesterol statin, with 72.5 million claims in 2024 — far more than any other drug. It cost the program only $749 million, because as a generic it runs about ten dollars a fill. The 11 most-prescribed Part D drugs are all inexpensive generics."
    },
    {
      "q": "Why isn't the most-prescribed drug also the most expensive?",
      "a": "Because price and volume run in opposite directions in Part D. The drugs prescribed most often are cheap generics that treat common chronic conditions. The drugs that cost the most are patent-protected brand-name products with high list prices. Eliquis is the costliest drug overall but only the 12th most-prescribed."
    },
    {
      "q": "How much of Medicare Part D spending goes to brand-name drugs?",
      "a": "Brand-name drugs account for 90.1% of Part D drug cost — $204.4 billion of the $226.74 billion total — while making up just 23.9% of prescription claims. Generic drugs are the mirror image: 76.1% of claims but only 9.9% of the dollars."
    },
    {
      "q": "Which drugs cost the most per prescription in Medicare Part D?",
      "a": "Specialty drugs with tiny patient populations. The cancer drug Revlimid averaged about $17,431 per Part D claim in 2024 and the heart drug Vyndamax about $25,279, versus roughly $153 across all Part D prescriptions. These drugs drive large totals on very few claims."
    },
    {
      "q": "Does a high drug cost mean Medicare is overpaying?",
      "a": "Not on its own. These are gross costs before confidential manufacturer rebates, and a high total can reflect a large patient population, a high list price, or both. The data shows where the dollars concentrate; it does not judge whether any price or prescription was appropriate."
    },
    {
      "q": "Can I reproduce these drug-cost rankings?",
      "a": "Yes. The costliest-drug and most-prescribed rankings come from two materialized views over the CMS Medicare Part D Prescribers 2024 file; the brand-versus-generic split comes from the overview view. 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). The most expensive Medicare Part D drugs are rarely the most prescribed. Fonteum Research, Issue 57. https://doi.org/10.5072/fonteum/most-expensive-medicare-part-d-drugs-2026",
    "url": "https://fonteum.com/research/most-expensive-medicare-part-d-drugs"
  },
  "reproducible_sql": "-- Most expensive vs most-prescribed Medicare Part D drugs, 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:    the frozen materialized views from\n--           supabase/migrations/20260612150000_part_d_prescribing_research_views.sql.\n--           The two top-drug views are each GROUP BY brand_name, generic_name over\n--           the 2024 base rows, ranked by cost and by claims respectively; the\n--           overview view carries the brand-vs-generic partition.\n--\n-- The whole study is the contrast between two orderings of the same drugs.\n\n-- 1. The 12 costliest drugs (the \"price economy\"):\nSELECT rank, brand_name, generic_name, claims, cost,\n       round(cost::numeric / claims, 2) AS cost_per_claim\nFROM public.part_d_top_drugs_by_cost_mv\nORDER BY cost DESC\nLIMIT 12;\n--  1 Eliquis    Apixaban       22,996,543  $19,876,304,796  $864     <- costliest drug; 12th by claims\n--  2 Ozempic    Semaglutide     9,930,484  $12,375,986,475  $1,246\n--  3 Jardiance  Empagliflozin  10,654,599  $10,678,957,372  $1,002\n--  4 Mounjaro   Tirzepatide     4,694,896  $5,825,295,741   $1,241\n--  5 Xarelto    Rivaroxaban     5,888,827  $5,436,701,739   $923\n--  6 Trelegy …                  5,725,949  $4,832,494,643   $844\n--  7 Trulicity  Dulaglutide     3,816,376  $4,786,817,612   $1,254\n--  9 Humira(Cf) Adalimumab        437,072  $3,795,159,532   $8,683   <- giant bill on few claims\n-- 10 Revlimid   Lenalidomide      217,318  $3,788,009,700   $17,431  <- specialty cancer drug\n-- 11 Vyndamax   Tafamidis          98,896  ~$2,500,000,000  $25,279  <- specialty heart drug\n--    (Vyndamax cost ≈ $2.50B; cost_per_claim = cost / 98,896 claims = $25,279)\n\n-- 2. The 12 most-prescribed drugs (the \"volume economy\"):\nSELECT rank, brand_name, generic_name, claims, cost,\n       round(cost::numeric / claims, 2) AS cost_per_claim,\n       lower(brand_name) = lower(generic_name) AS is_generic\nFROM public.part_d_top_drugs_by_claims_mv\nORDER BY claims DESC\nLIMIT 12;\n--  1 Atorvastatin Calcium  72,474,420  $748,890,955   $10.33  generic\n--  2 Amlodipine Besylate   49,241,894  $310,756,194   $6.31   generic\n--  3 Levothyroxine Sodium  42,465,073  $456,346,665   ...     generic\n--  ...  (ranks 1-11 are ALL generic)\n-- 12 Eliquis   Apixaban     22,996,543  $19,876,304,796        brand   <- first brand on the list\n\n-- 3. The brand-vs-generic partition (the structural inversion):\nSELECT\n  generic_claims, brand_claims,\n  generic_cost,   brand_cost,\n  round(100.0 * generic_claims / total_claims,    1) AS generic_claims_pct,  -- 76.1%\n  round(100.0 * generic_cost   / total_drug_cost, 1) AS generic_cost_pct,    --  9.9%\n  round(100.0 * brand_claims   / total_claims,    1) AS brand_claims_pct,    -- 23.9%\n  round(100.0 * brand_cost     / total_drug_cost, 1) AS brand_cost_pct       -- 90.1%\nFROM public.part_d_prescribing_overview_mv;\n-- generic + brand claims sum exactly to total_claims; generic + brand cost to\n-- total_drug_cost — the partition is by lower(brand_name) = lower(generic_name).",
  "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."
}