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The Top 10 Expensive Medications in Medicare Part D


The Top 10 Expensive Medications in Medicare Part D

Researchers at Skaggs School of Pharmacy and Pharmaceutical Sciences at University of California San Diego found the cost for the 10 “highest spend” medications in Medicare Part D rose almost one-third between 2011 and 2015. In the same time period, the number of patients treated with at least one of these medications also declined 32 percent.

Fewer patients receive the medications that the federal government is spending the most money on. For patients using the drugs without the benefit of subsidies, the average out-of-pocket cost for one of these 10 medications increased from $375 in 2011 to $1,366 in 2015, according to Jonathan Watanabe, PharmD, PhD, associate professor at UCSD.

The highest spend list in 2015: the top 10 drugs and conditions

  1. Lepidasvir/Sofosbuvir (hepatitis C)
  2. Insulin glargine (diabetes)
  3. Rosuvastatin calcium (cardiovascular disease)
  4. Fluticasone/Salmeterol (asthma and chronic obstructive pulmonary disease)
  5. Tiotropium bromide (chronic obstructive pulmonary disease)
  6. Sitagliptin phosphate (diabetes)
  7. Lenalidomide (blood cancers)
  8. Esomeprazole magnesium (dyspepsia, gastroesophageal reflux)
  9. Pregabalin (epilepsy, neuropathic pain, generalized anxiety disorder)
  10. Adalimumab (arthritis, Crohn’s disease)

Some of these are widely used and advertised. Rrosuvastatin marketed as Crestor, one of a class of statins prescribed for treating high cholesterol. Esomeprazole sells under the brand name Nexium and used to reduce stomach acid and prevent ulcers. Adalimumab marketed as Humira for arthritis and other conditions. Only one medication was a generic drug, atorvastatin, the generic version of the brand name Lipitor.

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This is worrisome since the aging US population means more and more Americans will be using the Medicare system for their pharmaceutical needs. The number of Medicare beneficiaries will grow from 59 million in 2017 to 81 million in 2030, compounded by a declining worker-to-Medicare beneficiary ratio.

At this time, one in every six dollars spent in Medicare is on medications. And spending on expensive, specialty medications will likely grow with more approved drugs and a larger population that requires them. The study concludes, “since Medicare Part D is funded by enrollee paid premiums in addition to Congressional appropriations from general revenue, Part D enrollees may expect to face higher premiums on top of increasing copayments or coinsurance payments.”

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