DicariaThe 10 drugs Medicare spent the most on in 2024
One drug took 7.3% of everything Medicare spent on outpatient prescriptions. Eliquis cost $20.77 billion in 2024 — not because it is the most expensive drug, but because 4.42 million people take it.
The top ten drugs cost $82.3 billion — 29% of the $285.3 billion Part D spent in 2024. This is not a "most expensive drugs" list. It is where patient count × spend per patient gets big: either millions of people on a chronic drug at around $4,000 a year, or tens of thousands on a rare-disease drug at $100,000 each.
It is eleven drugs, not ten
Something most rankings leave out: in 2024 there were eleven drugs above $4 billion. Number 10, Revlimid, reached $4.18B; number 11, Entresto, $4.02B — a gap of $160 million, under 4%. The real break comes after number 12, Januvia, at $3.81B.
"Top ten" is a line someone drew. A top-ten list should tell you how far ahead number 11 was.
Why these: two paths, almost no middle
Split spending into users × spend per user and the ten separate into two groups with nothing in between:
The first group — Eliquis, Jardiance, Xarelto, Farxiga, Trelegy — looks almost identical: oral, once a day, taken for life, $4,100–4,700 per patient per year. They differ in two things only: how many people have the condition, and how common it is.
The other two work the opposite way. Revlimid costs $107,531 per patient; one Revlimid patient costs as much as 23 Eliquis patients, but there are only 38,868 of them.
So the answer to "why these ten" is not "they sell well". It is: a total-spend ranking only admits two kinds of drug — enormous patient bases, or enormous unit prices. The middle does not get in.
Five years, not one
Our first pass looked only at 2023→2024, where all ten prices per unit fell, and concluded "the growth is users, not price". Pull 2020 in and that holds only halfway:
| Drug | Price 2020 | Price 2024 | Five-year change |
|---|---|---|---|
| Ozempic | $433.67 | $306.48 | −29% |
| Eliquis | $7.90 | $9.64 | +22% |
| Humira (CF) Pen | $2,832 | $3,531 | +25% |
| Trulicity | $400.68 | $467.75 | +17% |
| Xarelto | $15.45 | $17.68 | +14% |
| The other four | — | — | +7% to +9% |
Only one of the ten actually got cheaper over five years. The rest rose. "Prices are falling" is a one-year observation, not a five-year trend — and the difference decides where you look: on one year, volume drives spending; on five, volume and price both push, and only the GLP-1s traded price for volume.
Who is making room for whom
| Class | 2020 | 2024 | Change | What happened inside |
|---|---|---|---|---|
| GLP-1 | $6.71B | $26.93B | +301% | Trulicity peaked at $6.23B in 2022 and fell to $5.45B, users 940k → 790k; Ozempic $1.46B → $12.97B; Mounjaro zero → $6.34B |
| SGLT2 | $3.70B | $17.02B | +360% | Jardiance and Farxiga both multiplied; older Invokana fell from $570M to $270M |
| DOAC | $15.24B | $27.14B | +78% | Eliquis $9.94B → $20.77B; Xarelto only $4.70B → $6.23B with users flat at 1.32M; Pradaxa $600M → $120M |
GLP-1 is the clearest case: the class grew fourfold while its oldest member shrank. Trulicity lost 16% of its users in a single year while Ozempic gained 490,000. One caveat: this file records spending, users, volume and price — not prescription flows. We can show two drugs moving in opposite directions; we cannot show that a patient switched.
Three ways this gets miscounted
Humira is split across six rows. The largest single row is $4.33B; all six together are $5.72B, which would rank 5th rather than 9th. Disagreement between published "most expensive drug" lists usually traces back to this.
Revlimid is the only one going backwards. $5.36B in 2020 to $4.18B in 2024 (−6%), sliding from 2nd to 10th. Users barely moved and the unit price rose 8%, so the decline came from volume per patient.
Mounjaro's "168%" means nothing over five years. It entered the table in 2022 at $54 million. For a drug that new, absolute dollars beat percentages: +$6.28B in two years.
Every figure above comes from one table: 374 qualifying drugs, 2020–2024, same method as this article, recomputable on demand.
FAQ
Why these ten and not others?
Is Medicare spending rising because drug prices are rising?
Why is Trulicity shrinking while Ozempic grows?
Is Humira undercounted at #9?
How often is this updated?
Can I get the full list?
- Source: CMS Medicare Part D Spending by Drug, data year 2024, published 2026-06-25; the series uses the 2020–2024 columns in the same file.
- Method: drug-level "Overall" rows only; CMS-flagged outlier rows removed; spend per user = total spend ÷ users; price = weighted average spend per dosage unit.
- Limits: gross drug cost, not net of rebates; Part D only; class groupings are ours, by generic name.
Pull it by any dimension you want — therapeutic area, year-on-year delta, spend per user — as structured records, not a snapshot file that goes stale. Your agent keeps asking and finds the outliers itself.
2,000 free reads included at sign-up; same method as this article, results recomputable.
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