The drugs that cost the Medicare Part D program the most are not always the ones with eye-watering sticker prices. They are usually medicines that combine a high per-unit cost with very large patient populations. Using the official CMS Medicare Part D Spending by Drug dataset (data year 2023, the latest annual release), here is what Medicare actually spent.
Top 10 Medicare Part D drugs by total spending (2023)
| Rank | Drug | Total Part D spending | Spend per dosage unit | Beneficiaries | Spending YoY |
|---|---|---|---|---|---|
| 1 | Eliquis (apixaban) | $18.3B | $9.74 | 3,927,848 | +20.1% |
| 2 | Ozempic (semaglutide) | $9.19B | $355.90 | 1,464,468 | +98.7% |
| 3 | Jardiance (empagliflozin) | $8.84B | $20.32 | 1,882,768 | +51.1% |
| 4 | Trulicity (dulaglutide) | $7.36B | $483.21 | 938,731 | +18.3% |
| 5 | Xarelto (rivaroxaban) | $6.31B | $18.23 | 1,324,165 | +9.3% |
The single biggest line is the blood thinner Eliquis at $18.3 billion — roughly double the next drug. The fastest growth at the top of the table belongs to Ozempic, where spending nearly doubled year over year (+98.7%) as GLP-1 use expanded.
See the full ranking on the biggest total spend page.
Why these drugs lead
- Blood thinners and diabetes drugs dominate. Eliquis and Xarelto (anticoagulants) plus Ozempic, Jardiance, Trulicity, Farxiga and Januvia (diabetes / GLP-1 / SGLT2) make up most of the top 10.
- Volume × price. Eliquis is “only” $9.74 per dosage unit but is taken by nearly 4 million beneficiaries. A drug like Humira pen costs over $3,750 per dosage unit but serves far fewer patients.
This is spending, not your price
Every figure here is gross program spending — Medicare, plan and beneficiary payments combined — not the negotiated net price (which is confidential) and not your copay. Your out-of-pocket cost depends on your specific Part D plan, deductible and coverage phase. This page is general information, not medical or pricing advice; always check your plan and ask your pharmacist.
Data source: CMS Medicare Part D Spending by Drug, data year 2023 (released 2025), U.S. public domain.