As Medicare prepares to negotiate drug prices directly with pharma companies, the White House has selected 10 drugs that make up 20% — one-fifth — of Medicare’s annual spending. Our analysis provides a deep dive into these drugs, including their costs, the number of enrollees depending on them and the significant price hikes since their market debut. Here, we take a look at eight of the drugs with comprehensive data. Data comes courtesy of a CMS fact sheet and AARP research, which quantifies the degree of price escalations since the drugs’ debut.

Top drugs driving Medicare expenditures

This bubble chart displays the average costs per enrollee for a variety of Medicare Part D drugs, highlighting the percentage increase in price since their respective launches. Each bubble’s size corresponds to the total cost of the drug, with its color reflecting the dollar amounts of the price increase.

Leading the pack in terms of Medicare spending is blood clot treatment Eliquis, which drove $16.5 billion in spending from June 2022 to May 2023. Eliquis far surpassed the second-highest spender, the diabetes and heart failure drug Jardiance, which was responsible for just over $7 billion in spending. Close behind it was Xarelto, another blood clot drug, which drove roughly $6 billion in spending based on data gathered by AARP.

Diabetes drugs are a core focus for Medicare policy initiatives

Diabetes drugs were common among the top spenders, with Jardiance, Januvia, and Farxiga jointly accounting for more than $11.2 billion in spending. The White House also selected two other diabetes drugs, Fiasp and NovoLog, for potential price negotiations as part of the federal government’s initiative to control diabetes drug costs for Medicare enrollees. Additionally, President Biden’s Inflation Reduction Act capped the cost of insulin at $35 per month for almost four million seniors on Medicare. Big Pharma companies like Sanofi, which makes the most commonly prescribed insulin in the U.S., have preemptively slashed insulin prices. Earlier this year, Sanofi announced a 78% price reduction for its Lantus insulin and announced a $35 cap on out-of-pocket expenses for its customers. Other insulin makers announced similar moves.

A look at the number of Medicare Part D enrolls sheds light on Medicare’s Eliquis spending. More than 3.7 million enrollees rely on the drug as the drug plays a crucial role in treating and preventing blood clots, a condition common in the older community. Similarly, the collective spending on diabetes drugs Jardiance, Januvia and Farxiga mirrors the swelling diabetes rates among Medicare beneficiaries.

Key drugs straining Medicare’s budget

The table below rounds up eight drugs with an outsized impact on Medicare spending. It summarizes the drug indications, total costs to Medicare, the number of beneficiaries depending on these medications, their average costs per enrollee and the percentage increase in price since their market debut.

Drug Name	Commonly Treated Conditions	Total Part D Gross Covered Prescription Drug Costs (June 2022-May 2023)	Number of Medicare Part D Enrollees (June 2022-May 2023)	Average Part D Covered Prescription Drug Costs Per Enrollee	Share of Current Price due to Price Increases (%)
Eliquis	Prevention and treatment of blood clots	$16,482,621,000	3,706,000	$4,448	55%
Jardiance	Diabetes; Heart failure	$7,057,707,000	1,573,000	$4,487	49%
Xarelto	Prevention and treatment of blood clots; Reduction of risk for patients with coronary or peripheral artery disease	$6,031,393,000	1,337,000	$4,511	63%
Januvia	Diabetes	$4,087,081,000	869,000	$4,703	73%
Entresto	Heart failure	$2,884,877,000	587,000	$4,915	44%
Enbrel	Rheumatoid arthritis; Psoriasis; Psoriatic arthritis	$2,791,105,000	48,000	$58,148	88%
Imbruvica	Blood cancers	$2,663,560,000	20,000	$133,178	52%
Stelara	Psoriasis; Psoriatic arthritis; Crohn’s disease; Ulcerative colitis	$2,638,929,000	22,000	$119,951	65%