Highest Medicare Part D spending per beneficiary
The drug with the highest average Medicare Part D spending per beneficiary in 2023 is Exondys-51 at $1,441,039 per patient that year, ahead of Myalept ($1,317,113) and Strensiq ($1,250,918). Per-beneficiary spending is total spending divided by unique users; the highest are usually specialty medicines used by small populations. This is average program cost, not your out-of-pocket cost. Source: CMS, data year 2023.
Source: CMS Medicare Part D Spending by Drug (data year 2023). Data as of June 2026.
Top 100 by spend per beneficiary (2023)
| # | Brand | Generic | Per beneficiary | Per dosage unit | Beneficiaries |
|---|---|---|---|---|---|
| 1 | Exondys-51 | Eteplirsen | $1,441,039 | $838.21 | 17 |
| 2 | Myalept | Metreleptin | $1,317,113 | $6,437.02 | 13 |
| 3 | <a href="/drug/strensiq-asfotase-alfa/">Strensiq</a> | Asfotase Alfa | $1,250,918 | $6,180.92 | 207 |
| 4 | Vimizim | Elosulfase Alfa | $1,126,213 | $282.75 | 15 |
| 5 | Ravicti | Glycerol Phenylbutyrate | $844,304 | $230.92 | 87 |
| 6 | Lumizyme | Alglucosidase Alfa | $745,049 | $981.67 | 25 |
| 7 | Cinryze | C1 Esterase Inhibitor | $694,215 | $3,202.10 | 50 |
| 8 | Procysbi | Cysteamine Bitartrate | $690,022 | $171.57 | 57 |
| 9 | Kalbitor | Ecallantide | $675,052 | $5,761.69 | 37 |
| 10 | Juxtapid | Lomitapide Mesylate | $620,214 | $1,914.71 | 14 |
| 11 | Nexviazyme | Avalglucosidase Alfa-Ngpt | $615,048 | $1,866.69 | 35 |
| 12 | Actimmune | Interferon Gamma-1b,Recomb. | $611,644 | $10,814.43 | 43 |
| 13 | Berinert | C1 Esterase Inhibitor | $533,540 | $3,770.36 | 55 |
| 14 | <a href="/drug/soliris-eculizumab/">Soliris</a> | Eculizumab | $483,709 | $228.56 | 462 |
| 15 | Chenodal | Chenodiol | $479,440 | $481.42 | 38 |
| 16 | Ruconest | C1 Esterase Inhibitor, Recomb | $466,081 | $7,659.62 | 106 |
| 17 | Evkeeza | Evinacumab-Dgnb | $421,235 | $5,240.14 | 16 |
| 18 | Cablivi | Caplacizumab-Yhdp | $420,046 | $8,068.10 | 48 |
| 19 | <a href="/drug/takhzyro-lanadelumab-flyo/">Takhzyro</a> | Lanadelumab-Flyo | $415,315 | $12,855.79 | 468 |
| 20 | Haegarda | C1 Esterase Inhibitor | $413,242 | $2,904.43 | 191 |
| 21 | <a href="/drug/firdapse-amifampridine-phosphate/">Firdapse</a> | Amifampridine Phosphate | $411,048 | $227.71 | 356 |
| 22 | Vpriv | Velaglucerase Alfa | $402,723 | $1,566.49 | 23 |
| 23 | <a href="/drug/acthar-corticotropin/">Acthar</a> | Corticotropin | $401,104 | $9,272.14 | 942 |
| 24 | Cerezyme | Imiglucerase | $399,070 | $1,867.11 | 38 |
| 25 | Givlaari | Givosiran Sodium | $398,599 | $41,427.37 | 37 |
| 26 | Fabrazyme | Agalsidase Beta | $391,408 | $4,995.99 | 101 |
| 27 | Empaveli | PEGcetacoplan | $370,247 | $235.12 | 68 |
| 28 | <a href="/drug/gattex-teduglutide/">Gattex</a> | Teduglutide | $361,490 | $35,921.06 | 914 |
| 29 | Amvuttra | Vutrisiran Sodium | $345,480 | $239,745.73 | 195 |
| 30 | Asceniv | Immune Globulin,Gamma(IgG)slra | $334,659 | $98.88 | 13 |
| 31 | Orladeyo | Berotralstat Hydrochloride | $331,199 | $1,445.41 | 158 |
| 32 | <a href="/drug/ultomiris-ravulizumab-cwvz/">Ultomiris</a> | Ravulizumab-Cwvz | $323,596 | $2,218.03 | 493 |
| 33 | Crysvita | Burosumab-Twza | $321,659 | $10,968.76 | 120 |
| 34 | Tegsedi | Inotersen Sodium | $317,090 | $6,565.00 | 20 |
| 35 | Cerdelga | Eliglustat Tartrate | $315,714 | $575.87 | 119 |
| 36 | Sabril | Vigabatrin | $313,382 | $218.34 | 59 |
| 37 | <a href="/drug/evrysdi-risdiplam/">Evrysdi</a> | Risdiplam | $312,303 | $161.72 | 424 |
| 38 | Galafold | Migalastat HCl | $305,635 | $2,152.89 | 114 |
| 39 | Onpattro | Patisiran Sodium,Lipid Complex | $305,634 | $2,024.07 | 30 |
| 40 | Miglustat | Miglustat | $300,665 | $195.88 | 22 |
| 41 | <a href="/drug/krystexxa-pegloticase/">Krystexxa</a> | PEGloticase | $296,580 | $28,509.17 | 603 |
| 42 | <a href="/drug/tepezza-teprotumumab-trbw/">Tepezza</a> | Teprotumumab-Trbw | $283,660 | $16,209.70 | 455 |
| 43 | Afinitor Disperz | Everolimus | $281,538 | $690.12 | 19 |
| 44 | Metyrosine | Metyrosine | $276,012 | $328.82 | 20 |
| 45 | Kalydeco | IVacaftor | $275,814 | $480.25 | 91 |
| 46 | Uplizna | Inebilizumab-Cdon | $270,374 | $4,641.61 | 48 |
| 47 | <a href="/drug/trikafta-elexacaftor-tezacaftor-ivacaft/">Trikafta</a> | Elexacaftor/Tezacaftor/IVacaft | $266,190 | $321.58 | 2,534 |
| 48 | Firazyr | Icatibant Acetate | $264,561 | $3,762.79 | 213 |
| 49 | Vyjuvek | Beremagene Geperpavec-Svdt | $262,870 | $10,014.11 | 16 |
| 50 | Xenazine | Tetrabenazine | $244,988 | $310.56 | 37 |
| 51 | <a href="/drug/vyvgart-efgartigimod-alfa-fcab/">Vyvgart</a> | Efgartigimod Alfa-Fcab | $243,312 | $315.30 | 822 |
| 52 | Palynziq | PEGvaliase-Pqpz | $223,156 | $800.98 | 91 |
| 53 | Cortrophin | Corticotropin | $217,093 | $7,182.10 | 326 |
| 54 | <a href="/drug/korlym-mifepristone/">Korlym</a> | Mifepristone | $216,067 | $632.17 | 1,059 |
| 55 | Keveyis | Dichlorphenamide | $210,895 | $343.97 | 98 |
| 56 | Ayvakit | Avapritinib | $206,636 | $1,247.64 | 267 |
| 57 | Vitrakvi | Larotrectinib Sulfate | $205,199 | $548.12 | 144 |
| 58 | Qinlock | Ripretinib | $204,443 | $435.16 | 255 |
| 59 | Symdeko | Tezacaftor/IVacaftor | $204,007 | $452.97 | 71 |
| 60 | Daybue | Trofinetide | $203,917 | $21.91 | 94 |
| 61 | <a href="/drug/uptravi-selexipag/">Uptravi</a> | Selexipag | $203,400 | $353.08 | 3,727 |
| 62 | Buphenyl | Sodium Phenylbutyrate | $200,402 | $37.29 | 17 |
| 63 | Ferriprox (2 Times A Day) | Deferiprone | $193,874 | $211.85 | 143 |
| 64 | Hetlioz | Tasimelteon | $192,289 | $840.58 | 499 |
| 65 | Vijoice | Alpelisib | $192,214 | $1,075.07 | 31 |
| 66 | <a href="/drug/orenitram-er-treprostinil-diolamine/">Orenitram ER</a> | Treprostinil Diolamine | $180,532 | $100.47 | 1,011 |
| 67 | <a href="/drug/panzyga-immun-glob-g-igg-ifas-glycine/">Panzyga</a> | Immun Glob G(IgG)-Ifas/Glycine | $179,520 | $20.85 | 884 |
| 68 | <a href="/drug/vyndaqel-tafamidis-meglumine/">Vyndaqel</a> | Tafamidis Meglumine | $179,045 | $181.48 | 660 |
| 69 | <a href="/drug/vyndamax-tafamidis/">Vyndamax</a> | Tafamidis | $177,844 | $735.47 | 7,589 |
| 70 | Serostim | Somatropin | $177,762 | $705.66 | 604 |
| 71 | Poteligeo | Mogamulizumab-Kpkc | $173,313 | $870.52 | 11 |
| 72 | Pyrukynd | Mitapivat Sulfate | $171,784 | $477.55 | 26 |
| 73 | Ilaris | Canakinumab/PF | $171,527 | $18,235.71 | 229 |
| 74 | Isturisa | Osilodrostat Phosphate | $171,396 | $226.06 | 202 |
| 75 | Kuvan | Sapropterin Dihydrochloride | $165,908 | $136.06 | 41 |
| 76 | Scemblix | Asciminib Hydrochloride | $162,625 | $350.22 | 704 |
| 77 | Koselugo | Selumetinib/Vitamin E Tpgs | $160,401 | $179.64 | 93 |
| 78 | Jynarque | Tolvaptan | $156,717 | $332.15 | 486 |
| 79 | <a href="/drug/tibsovo-ivosidenib/">Tibsovo</a> | IVosidenib | $155,950 | $549.19 | 1,183 |
| 80 | Emflaza | Deflazacort | $155,246 | $409.81 | 99 |
| 81 | Enspryng | Satralizumab-Mwge | $154,081 | $17,518.27 | 220 |
| 82 | <a href="/drug/gammaplex-immun-glob-g-igg-gly-iga-0-50/">Gammaplex</a> | Immun Glob G(IgG)/Gly/IgA 0-50 | $152,294 | $20.41 | 1,742 |
| 83 | Somavert | PEGvisomant | $150,136 | $551.54 | 247 |
| 84 | <a href="/drug/rezurock-belumosudil-mesylate/">Rezurock</a> | Belumosudil Mesylate | $149,394 | $585.19 | 978 |
| 85 | Copiktra | Duvelisib | $147,856 | $439.75 | 148 |
| 86 | <a href="/drug/iclusig-ponatinib-hcl/">Iclusig</a> | Ponatinib HCl | $146,657 | $686.96 | 841 |
| 87 | <a href="/drug/idhifa-enasidenib-mesylate/">Idhifa</a> | Enasidenib Mesylate | $146,255 | $1,086.10 | 813 |
| 88 | <a href="/drug/tyvaso-dpi-treprostinil/">Tyvaso Dpi</a> | Treprostinil | $144,820 | $195.61 | 3,017 |
| 89 | Arcalyst | Rilonacept | $143,236 | $5,616.45 | 173 |
| 90 | <a href="/drug/gammaked-immune-globul-g-gly-iga-avg-46/">Gammaked</a> | Immune Globul G/Gly/IgA Avg 46 | $142,032 | $18.74 | 1,549 |
| 91 | Alunbrig | Brigatinib | $140,717 | $544.24 | 237 |
| 92 | Skyclarys | Omaveloxolone | $140,174 | $357.57 | 321 |
| 93 | <a href="/drug/oxervate-cenegermin-bkbj/">Oxervate</a> | Cenegermin-Bkbj | $139,864 | $1,959.37 | 3,526 |
| 94 | Adcetris | Brentuximab Vedotin | $138,942 | $11,155.93 | 22 |
| 95 | Opdualag | Nivolumab-Relatlimab-Rmbw | $138,882 | $752.68 | 31 |
| 96 | <a href="/drug/imbruvica-ibrutinib/">Imbruvica</a> | Ibrutinib | $138,707 | $486.63 | 17,100 |
| 97 | <a href="/drug/mavenclad-cladribine/">Mavenclad</a> | Cladribine | $138,358 | $10,204.59 | 1,130 |
| 98 | Signifor Lar | Pasireotide Pamoate | $138,232 | $16,975.57 | 42 |
| 99 | <a href="/drug/jakafi-ruxolitinib-phosphate/">Jakafi</a> | Ruxolitinib Phosphate | $138,221 | $297.88 | 14,041 |
| 100 | <a href="/drug/cabometyx-cabozantinib-s-malate/">Cabometyx</a> | Cabozantinib S-Malate | $135,118 | $878.24 | 8,210 |
Source: CMS Medicare Part D Spending by Drug (data year 2023). Data as of June 2026.
Frequently asked questions
What does 'spending per beneficiary' mean?
It is total Medicare Part D spending on a drug divided by the number of unique beneficiaries who used it that year. It approximates the average annual gross drug cost per patient on that medicine — though it still is not what any individual pays out of pocket, which depends on the plan and coverage phase.
Which drug costs Medicare the most per beneficiary?
In 2023, Exondys-51 had the highest average Medicare Part D spending per beneficiary at $1,441,039, followed by Myalept ($1,317,113) and Strensiq ($1,250,918). The highest per-beneficiary drugs are typically specialty medicines used by small patient populations. Source: CMS, data year 2023.
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Last updated: 2026-06-21