Medicare Part D Spending on Top 10 Drugs Reaches $48 billion

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KFF analysis has found that 10 drugs account for 22% of all Medicare Part D spending in 2021.

In 2021, the 10 top-selling Medicare Part D drugs accounted for 0.3% of covered drugs but 22% of total gross Medicare drug spending, according to a recent analysis by KFF. That year, Medicare Part D covered more than 3,500 prescription drug products, with total gross spending of $216 billion, not including rebates paid by drug manufacturers to pharmacy benefit managers (PBMs).

Medicare Part D spent $48 billion for the top 10 drugs in 2021, compared with $22 billion in 2018. (See Table below). These 10 drugs accounted for more than half of the increase in gross Part D spending from 2018 to 2021.

The drug with the highest spend was Eliquis (apixaban), which was developed by Bristol Myers Squibb and is used to reduce the risk of stroke and blood clots. In 2021, Medicare Part D spent $12.6 billion for Eliquis compared with $5 billion in 2018. The list price for a 30-day supply of Eliquis is $561.

Five of the 10 top-selling Part D drugs were to treat patients with diabetes: Trulicity (dulaglutide), Januvia (sitagliptin), Jardiance (empaglifozin), Lantus Solostar (insulin glargine) and Ozempic (semaglutide). Medicare spent $17.9 billion for these five drugs in 2021. Of the diabetes drugs, Lilly’s Trulicity had the highest spend, with $4.7 billion. Spending for Trulicity more than tripled from $1.4 billion in 2018 to $4.7 billion in 2021; and spending on Jardiance increased more than five times from $0.7 billion to $3.7 billion in 2021.

Two cancer drugs on the top 10 list include. Medicare Part D spent $5.9 billion on BMS’s Revlimid (lenalidomide) and $3.2 billion on Pharmacyclics’ Imbruvica (ibrutinib). Revlimid is used to treat patients with myelodysplastic syndrome, multiple myeloma, and mantle cell lymphoma. Imbruvica is used to treat patients with chronic lymphocytic leukemia/small lymphocytic lymphoma.

One version of the arthritis drug Humira (adalimumab) was among the top 10 drugs. The citrate-free pen had gross Medicare spending of $2.9 billion in 2021. Medicare spending across all formulations of Humira totaled $4.7 billion in 2021, including the citrate-free and original versions and various formulations and dosages.

This analysis is based on 2021 Medicare Part D Spending by drug data from the Centers for Medicare & Medicaid Services. The data includes spending for beneficiaries in both traditional Medicare and Medicare Advantage who are enrolled in Medicare Part D plans.

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