The Top 10 Medications Medicare Spends the Most On
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Last Updated September 16, 2026
Medicare beneficiaries account for a large share of U.S. prescription drug spending. According to the Centers for Medicare & Medicaid Services, total U.S. prescription drug expenditures reached about $370 billion in 2019, with roughly 41% flowing through federal health programs including Medicare Part B, Medicare Part D, and Medicaid. This article breaks down which drugs Medicare spends the most on (using 2020 CMS Part D spending data), what they cost seniors out of pocket, and practical ways to lower your bill. For the latest program updates, see 2025 changes to the Medicare Part D prescription drug plan.
Understanding Medicare drug spending
Of that $370 billion, spending through Department of Health and Human Services (HHS) programs accounted for 41 percent, or $151 billion. Those programs include Medicaid, Medicare Part B, and Medicare Part D.
Recent legislation has already started to move those numbers. See 2025 changes to Medicare from the Inflation Reduction Act for what changed and when.
Top-spending drugs in 2020
In 2020, one of the top-spending drugs for Medicare was Eliquis, a blood thinner. More than 2.6 million Medicare Part D enrollees were prescribed this medication, with a total cost of nearly $10 billion.
Does Medicare cover the cost of blood thinners?
Your Medicare Part D prescription drug plan will cover blood thinners. The most popular of these now is Eliquis and then here is the low-cost Warfarin which (unlike Eliquis) requires ongoing blood testing and here are a few more: dabigatran (Pradaxa), edoxaban (Lixiana) and rivaroxaban (Xarelto). Medicare Advantage plans include prescription drug coverage if they are MAPD (Medicare Advantage with Prescription Drug coverage) plans otherwise the standalone Part D insurance covers blood thinners, too.Which Part D plans cover the most medications?
Every Part D plan and Medicare Advantage prescription drug plan publishes its own formulary, which is the list of covered medications. Two plans in the same ZIP code can have very different formularies, so the cheapest premium doesn't always mean the best coverage for the drugs you actually take.
Raw formulary size is a bad way to shop. Plan A might list 3,500 drugs and Plan B 2,800, and Plan B can still be the better deal for you. What matters is whether your prescriptions are on the list, and where they land once they are.
Two things decide that:
- Tier placement. Same drug, different tier, wildly different copay. A medication sitting on a preferred tier might run you $10 a month. On a specialty or non-preferred tier, the same pills can cost $90 or a percentage of the retail price.
- Restrictions. Prior authorization, step therapy, and quantity limits don't show up in a formulary count, but they decide whether you get the drug this month or spend three weeks on paperwork.
Formularies also reset every January 1. A plan that covered your prescription beautifully this year can drop it or bump it a tier for next year, which is why the comparison is worth redoing annually even if nothing about your health changed.
The most reliable way to check is to enter your medication list into a plan comparison tool. Both the official Medicare.gov Plan Finder and the free tool on Medicare Agents Hub will rank the plans in your area by how well they cover your specific prescriptions, including tier placement and estimated annual out-of-pocket cost. Running the same drug list through both tools once a year during Open Enrollment is one of the simplest ways to avoid overpaying.
Is there a list of medications Medicare covers?
There's no single national Medicare drug list. Each Part D plan and each Medicare Advantage drug plan builds its own formulary, and CMS reviews it before the plan can sell it.
CMS does set floors. Every plan has to cover at least two drugs in each therapeutic category, and it has to cover all or substantially all drugs in six protected classes:
- Antidepressants
- Antipsychotics
- Anticonvulsants
- Immunosuppressants for transplant patients
- Antiretrovirals for HIV
- Antineoplastics (cancer drugs)
That makes "is this drug Medicare approved?" a plan-by-plan question. Pull up your plan's formulary on its own website, or run your drug list through the plan comparison tools above, and you'll have your answer in about two minutes.
A few categories are excluded by law no matter which plan you pick: over-the-counter drugs, drugs for weight loss or weight gain, fertility treatment, and cosmetic uses like hair growth.
Reducing the cost of drug coverage
While the cost of drug coverage can be high for Medicare beneficiaries, there are ways to reduce these expenses. Some options include shopping around for the best prices, using generic medications when possible, and taking advantage of discounts or financial assistance programs. Low-income beneficiaries may also qualify for Medicare Extra Help, which can significantly reduce Part D premiums and copays. It is important to speak with a healthcare professional or insurance provider to explore the options available to you. Our article on how to save money on prescriptions with Medicare covers additional strategies.
How will the new 2025 Medicare Part D out-of-pocket cap impact seniors and prescription drug costs?
The $2,000 out-of-pocket cap is a major step forward for seniors. It provides a clear limit on how much you’ll spend on medications each year and ensures that those with high prescription drug costs won’t be burdened with endless out-of-pocket expenses. This cap will especially help those on expensive medications or those with chronic conditions who need a lot of prescriptions. It offers greater predictability, affordability, and peace of mind for seniors, making their medications more accessible and reducing financial stress.Ways to lower prescription drug costs for Medicare beneficiaries
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Consider Medicare Advantage (Part C) plans that include prescription drug coverage. These plans have their own set of pros and cons, with costs and providers varying depending on your location. Learn more in our Medicare Advantage vs. Medicare Supplement comparison. It is highly recommended to speak to a local Medicare Advantage agent to explore the options available in your area. You can use our free Zip Code directory to find one in your area.
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Compare Medicare drug plans based on the specific drugs you take. Medicare Agents Hub provides access to a free tool that you can use without entering personal information. Simply enter your Zip Code and the drugs you take, and the tool will show the best plan for your area. You can also run the same comparison directly on the official Medicare.gov Plan Finder.
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Utilize discount drug plan codes, such as GoodRx. Even with the best Medicare drug plan, it can be beneficial to check the prices on discount plans like GoodRx. Many major pharmacies, such as CVS and Costco, accept these codes, so it pays to compare prices even with great Medicare Plan D coverage.
Top medications consumed by Medicare recipients
We've compiled a list of the top 10 drugs that Medicare has spent the most on. Actual out-of-pocket costs vary significantly based on your specific Part D plan, coverage phase, and whether you qualify for Extra Help, so treat the averages here as a starting point rather than what every senior will pay.
One thing has changed since this spending data was collected. Part D now has a hard annual out-of-pocket ceiling, $2,000 in 2025 and $2,100 in 2026, so the five-figure annual costs listed below for specialty drugs like Revlimid and Ibrance are retail and pre-cap figures, not what a Part D enrollee pays today.
Can Medicare Part D deny coverage for a brand-name drug if a generic isn't available?
Yes. Part D plans cover drugs based on their formulary, so a brand-name drug can be non-covered even if no generic exists (they may prefer a different brand or therapeutic alternative, or require prior auth/step therapy).Lack of a generic doesn’t guarantee coverage—it just means the plan can’t force you to take a generic of that exact drug.
If your prescriber says the brand is medically necessary and alternatives won’t work, you can request a coverage exception/appeal with supporting clinical notes.
There are also transition fills for new members and special protections for certain “protected classes” of drugs, which can help in the short term.
| # | Drug | Treats | 2020 Medicare spending | Part D beneficiaries |
|---|---|---|---|---|
| 1 | Eliquis | Atrial fibrillation (blood thinner) | $9.9 billion | 2,641,941 |
| 2 | Revlimid | Multiple myeloma and other blood cancers | $5.4 billion | 43,747 |
| 3 | Xarelto | Atrial fibrillation (blood thinner) | $4.7 billion | 1,184,718 |
| 4 | Januvia | Type 2 diabetes | $3.9 billion | 934,686 |
| 5 | Trulicity | Type 2 diabetes | $3.3 billion | 497,327 |
| 6 | Imbruvica | Chronic lymphocytic leukemia and other blood cancers | $3 billion | 26,847 |
| 7 | Jardiance | Type 2 diabetes and heart failure | $2.4 billion | 594,859 |
| 8 | Humira (Cf) Pen | Rheumatoid arthritis, plaque psoriasis, other autoimmune conditions | $2.2 billion | 42,406 |
| 9 | Ibrance | Advanced breast cancer | $2.1 billion | 21,394 |
| 10 | Symbicort | Asthma and COPD | $2 billion | 1,017,530 |
All 10 of these are Part D drugs, which is why they turn up in CMS Part D spending data rather than under Part B. Medicare covers them through a standalone Part D plan or through the drug benefit built into a Medicare Advantage plan, as long as the drug is on that plan's formulary. If yours isn't, you can request a formulary exception or ask your doctor whether a covered drug in the same class would work.
1. Eliquis
A blood thinning medication for people with atrial fibrillation, Eliquis is manufactured by Bristol-Myers Squibb. The cost of a 30-day supply without insurance was listed as $522 on the manufacturer's website in 2022. Those who have prescription coverage through Medicare pay an average of $37, according to the manufacturer. With 2.6 million Part D enrollees filling it, Eliquis sits on the formulary of nearly every Part D plan. Tier placement is where the plans actually differ.
Treats: Atrial fibrillation (blood thinner)
2020 Medicare spending: $9.9 billion
Beneficiaries: 2,641,941
2022 price increase: 6 percent
2. Revlimid
Another commonly used drug among Medicare beneficiaries, Revlimid is primarily utilized as part of cancer treatment. Spending on specialty drugs like Revlimid varies widely from one Part D plan to the next. Because it's an antineoplastic, it falls in one of the six protected classes, so plans have to carry it. That doesn't make it cheap.
The average annual out-of-pocket cost for Revlimid was $17,142, according to a report from GoodRx. The minimum price paid for the drug was $2,818, while the maximum out-of-pocket cost was $20,015, a difference of almost $18,000.
Treats: Multiple myeloma and other blood cancers
2020 Medicare spending: $5.4 billion
Beneficiaries: 43,747
2022 price increase: 4.5 percent
3. Xarelto
A medication commonly used as a blood thinner for those with atrial fibrillation, the cost of Xarelto without insurance in 2022 was estimated to be between $400-500 for a 30-day supply. Individuals with prescription insurance through Medicare typically pay between $2-18 on average for a 30-day supply, with the final cost varying depending on factors such as the type of Medicare coverage.
Treats: Atrial fibrillation (blood thinner)
2020 Medicare spending: $4.7 billion
Beneficiaries: 1,184,718
2022 price increase: 4.9 percent
4. Januvia
A medication used to aid in the treatment of diabetes (for more on insulin and drug coverage, see Diabetes and Medicare: What You Need to Know About Insulin and Part D Coverage), the average cost for Medicare members ranges from $75 to $175 per month for a 30-tablet supply. That compares to a retail cost of over $450 per month for the same amount. Part D plans cover Januvia broadly, but as a brand-name drug with no generic equivalent it usually sits on a higher tier, which is what stretches that monthly range so wide.
Treats: Type 2 diabetes
2020 Medicare spending: $3.9 billion
Beneficiaries: 934,686
2022 price increase: 5 percent
5. Trulicity
Trulicity is a medication used as part of diabetes treatment. According to the manufacturer, Lilly, the list price of Trulicity in 2022 was $886.36 per month without insurance. For those with prescription insurance through Medicare, approximately 70% pay between $0-100 per month, while the remaining individuals pay an average of $207 per month. Those who qualify for Extra Help may expect to pay $4 to $9 per prescription.
Treats: Type 2 diabetes
2020 Medicare spending: $3.3 billion
Beneficiaries: 497,327
2022 price increase: 5 percent
6. Imbruvica
Used as a treatment for cancer, Imbruvica costs $484 per capsule/tablet, regardless of the strength (70mg, 140mg, 280mg, 420mg, 560mg). That amounts to $13,546 for a supply of 28 tablets/capsules. Most people will not pay this full amount, as insurance plans and Medicare cover the cost of this medicine. 99% of Medicare Part D and Medicare Advantage plans cover Imbruvica.
Treats: Chronic lymphocytic leukemia and other blood cancers
2020 Medicare spending: $3 billion
Beneficiaries: 26,847
2022 price increase: 7.4 percent
7. Jardiance
Jardiance is commonly prescribed as part of diabetes treatment. For patients with Medicare Part D coverage, approximately 63% of patients will pay between $0-$50 a month, according to the company. The remaining 37% pay an average of $161 a month.
Treats: Type 2 diabetes and heart failure
2020 Medicare spending: $2.4 billion
Beneficiaries: 594,859
2022 price increase: 4 percent
8. Humira (Cf) pen
This medication is used to treat conditions such as rheumatoid arthritis and plaque psoriasis. A month's supply of Humira can cost around $7,389.
Treats: Rheumatoid arthritis, plaque psoriasis, and other autoimmune conditions
2020 Medicare spending: $2.2 billion
Beneficiaries: 42,406
2022 price increase: 7.4 percent
9. Ibrance
This drug is used as part of cancer treatment. The cash price for a supply of 21 capsules of Ibrance is around $13,000 to $13,500, with the manufacturer offering an online coupon. It was covered by 100% of Medicare Part D plans as of March 2019.
Treats: Advanced breast cancer
2020 Medicare spending: $2.1 billion
Beneficiaries: 21,394
2022 price increase: 6.9 percent
10. Symbicort
Symbicort is a medication prescribed as part of asthma treatment. The list price for a 30-day supply is $303.42 (80/4.5 mcg) and $346.83 (160/4.5 mcg). According to the manufacturer, individuals with Medicare Part D coverage can expect to pay an average out-of-pocket cost of $31.03 per month. For more on why prices fluctuate, see common reasons generic drug prices increase under Part D.
Treats: Asthma and COPD
2020 Medicare spending: $2 billion
Beneficiaries: 1,017,530
2022 price increase: 2 percent