Medicare Part D drug prices
Part D is the pharmacy benefit — the pills you pick up at a counter, run through private plans that Medicare pays. Those plans negotiate their own prices, and CMS publishes them every quarter: what each plan pays for a 30-day supply of each drug, plus whether the plan covers it at all and what paperwork it demands first. (Clinician- administered drugs run through Part B instead.)
ⓘ How this was built
- CMS Quarterly Prescription Drug Plan Formulary, Pharmacy Network, and Pricing files (SPUF)
- CMS Medicare Part D Prescribers — by Geography and Drug (annual)
- CMS NADAC (pharmacy acquisition cost) for the comparison
Negotiated 30-day point-of-sale unit prices and formulary terms aggregated across every unsuppressed Part D and MA-PD plan in the quarter shown. CMS publishes one representative NDC per drug concept (RxCUI) rather than every package, so these figures come from CMS's representative package for the same drug — matched on generic name, strength, and dosage form. Prices are point of sale — gross of the confidential rebates plans receive afterward. Estimated from MedPAC's program-wide rebate aggregates (June 2023: DIR = 29% of gross Part D spending; brand rebates ≈ 25–40% of gross, generics minimal). Actual rebates are confidential and vary widely by drug — this is a range, not a fact about this drug.
Pipeline and calculations built by Claude (Fable 5) from the public datasets above. Educational only — verify against primary sources before acting.
Where Part D plans pay the most above pharmacy cost
The negotiated price a plan pays at the counter, next to what the pharmacy paid its wholesaler for the same drug, in the same quarter.
This gap is not the pharmacy's profit, and it is not the plan's real cost. Both ends move after the sale:
- The plan pays less than shown. Manufacturer rebates flow back to the plan afterward and are confidential — so the left column is gross, like every public drug price.
- The pharmacy does not keep the difference. The payment has to cover dispensing, not just acquisition, and under spread pricing a PBM can keep part of the gap between what the plan pays and what the pharmacy is paid. Independent pharmacies have famously been reimbursed near or below their own cost on generics.
- Since January 1, 2024CMS requires pharmacy price concessions to be reflected in the price at the counter rather than clawed back later, so this is no longer reduced by after-the-fact DIR fees — but that still does not make the gap anyone's margin.
What it does show is where the money in the middle is largest — which is why generics like these draw scrutiny.
| Drug | Plan pays, per unit (gross)ⓘ | Pharmacy paid (NADAC, per unit) | Gapⓘ |
|---|---|---|---|
| doxycycline hyclate | $23.93 | $0.3816 | 62.7× |
| Dapagliflozin | $6.05 | $0.1845 | 32.8× |
| Teriflunomide | $5.90 | $0.3198 | 18.5× |
| Metformin Hydrochloride | $4.53 | $0.2781 | 16.3× |
| Abiraterone Acetate | $48.49 | $3.02 | 16.1× |
| Ticagrelor | $5.00 | $0.3240 | 15.4× |
| Cyclobenzaprine Hydrochloride | $13.69 | $0.8887 | 15.4× |
| Pirfenidone | $12.47 | $0.8608 | 14.5× |
| Tetrabenazine | $10.94 | $0.8066 | 13.6× |
| Imatinib Mesylate | $8.96 | $0.6632 | 13.5× |
The most-prescribed drugs you need permission to get
Plans cover these, but most of them require prior authorization— your doctor has to get the plan's approval before it will pay. Ranked by how many Part D prescriptions the drug accounts for a year, so these are the gates the most people actually run into.
ⓘ How this was built
- CMS quarterly plan formulary files (restriction rates)
- CMS Medicare Part D Spending by Drug (annual prescriptions and cost)
Both halves are per molecule. CMS publishes utilization by drug name with no NDCs, so prescription counts are inherently molecule-wide; restriction rates are therefore plan-weighted across every product of that molecule rather than taken from one package. (Mixing the two grains is actively wrong: one gated branded combination made hydrochlorothiazide look 100% prior-authorized when the molecule is 0%.) Listed when prior authorization applies to more than half of covering plans. Cost per prescription is gross, before rebates.
Pipeline and calculations built by Claude (Fable 5) from the public datasets above. Educational only — verify against primary sources before acting.
| Drug | Part D prescriptions per year | Avg cost per prescription | Typical tier | Needs prior approval | Has quantity limit |
|---|---|---|---|---|---|
| semaglutide12 products | 11.9 million | $1,276 | 3 | 100%of plans | 97% |
| tirzepatide18 products | 5.1 million | $1,241 | 3 | 100%of plans | 99% |
| Ondansetron2 products | 4.9 million | $15 | 2 | 87%of plans | 23% |
| Dulaglutide4 products | 4.3 million | $1,267 | 3 | 100%of plans | 99% |
| cyclosporine18 products | 2.3 million | $763 | 4 | 83%of plans | 13% |
| Evolocumab2 products | 2.2 million | $874 | 3 | 78%of plans | 83% |
| Benztropine Mesylate3 products | 1.9 million | $12 | 2 | 61%of plans | 0% |
| lidocaine3 products | 1.8 million | $124 | 4 | 65%of plans | 87% |
| hydroxyzine pamoate3 products | 1.6 million | $12 | 3 | 66%of plans | 0% |
| Sildenafil citrate | 839K | $55 | 2 | 100%of plans | 34% |
Tier is the plan's cost-sharing band — 1–2 are usually cheap generics, 4–5 are the specialty tiers where patients pay a percentage of the price rather than a flat copay.
Part D spending by state · 2024
Every Part D prescription filled in each state during 2024, added up. States are listed by total spending, largest first.
Total spentis that state's entire Part D drug bill — every dollar that reached a pharmacy, from all payers combined. It splits into the next two columns: paid by plans (what the drug plan handed the pharmacy) and paid by patients(the copays and coinsurance people paid at the counter). See the note below before reading the plan column as Medicare's budget — it is considerably larger than what Medicare itself ends up spending.
Average cost per 30-day supply is that total divided by the number of one-month prescription fills it bought. In plain terms: for a typical one-month prescription filled in this state, this is what it cost in total — everyone's money combined, not the patient's share alone and not Medicare's share alone. A 90-day prescription counts as three 30-day fills, so states that favor 90-day scripts are not penalized.
ⓘ How this was built
- CMS Medicare Part D Prescribers — by Geography and Drug (annual)
Summed across every drug in each state: total drug cost (ingredient cost + dispensing fee + sales tax, paid by the plan, the beneficiary, and government subsidies together) and 30-day-equivalent fills. The patient column is CMS's beneficiary cost share (low-income-subsidy plus non-LIS recipients) - what patients themselves paid, not what was subsidized on their behalf. The plans-and-Medicare column is everything else: this file carries no separate plan-payment field, so the plan's payment and the federal subsidies funding it cannot be separated at state level and are shown combined. Prescriptions written for 90 days count as three 30-day fills, so per-fill costs stay comparable across states with different prescribing habits. Costs are gross — before the confidential rebates plans receive later. This counts prescriptions by the state of the PRESCRIBER, and cannot be turned into a per-person figure, because CMS's beneficiary counts are per drug and the same patient appears under every drug they take.
Pipeline and calculations built by Claude (Fable 5) from the public datasets above. Educational only — verify against primary sources before acting.
Estimated, not reported — drug-level rebates are confidential by statute. Built from the mix rather than one blended rate: 90% of national Part D spending is brand-name drugs, which carry rebates of roughly 25–40%; generics carry almost none. As a check, MedPAC's independently derived program-wide figure — 29% of gross — falls inside this range.
| State | Total spent on Part D drugsⓘ | Paid by plans (not patients) | Paid by patients | Avg cost per 30-day supply | 30-day supplies filled |
|---|---|---|---|---|---|
| United States (all) | $288.6B | $270.9B | $17.7B (6% of total) | $92 | 3.1 billion |
| California | $27.3B | $25.9B | $1.4B (5%) | $94 | 289.8 million |
| New York | $22.9B | $22.0B | $951M (4%) | $118 | 193.6 million |
| Florida | $21.5B | $20.2B | $1.3B (6%) | $86 | 249.9 million |
| Texas | $20.1B | $18.7B | $1.3B (7%) | $91 | 219.5 million |
| Pennsylvania | $14.0B | $13.1B | $867M (6%) | $94 | 148.4 million |
| Ohio | $11.3B | $10.6B | $719M (6%) | $88 | 128.0 million |
| North Carolina | $10.2B | $9.6B | $651M (6%) | $93 | 109.5 million |
| Michigan | $9.8B | $9.3B | $562M (6%) | $92 | 107.3 million |
| Illinois | $9.6B | $9.0B | $665M (7%) | $86 | 111.6 million |
| Georgia | $9.1B | $8.6B | $539M (6%) | $95 | 96.7 million |
| New Jersey | $8.0B | $7.5B | $500M (6%) | $102 | 78.4 million |
| Massachusetts | $7.6B | $7.2B | $404M (5%) | $109 | 69.6 million |
| Tennessee | $7.1B | $6.7B | $461M (6%) | $88 | 80.7 million |
| Indiana | $6.5B | $6.1B | $415M (6%) | $87 | 74.3 million |
| Virginia | $6.1B | $5.7B | $426M (7%) | $86 | 71.0 million |
| Missouri | $6.0B | $5.6B | $396M (7%) | $86 | 69.6 million |
| Arizona | $5.4B | $5.0B | $392M (7%) | $88 | 60.5 million |
| Alabama | $5.3B | $5.0B | $301M (6%) | $91 | 58.4 million |
| South Carolina | $5.2B | $4.9B | $357M (7%) | $92 | 56.5 million |
| Kentucky | $5.0B | $4.7B | $285M (6%) | $87 | 56.9 million |
| Wisconsin | $4.9B | $4.5B | $364M (7%) | $81 | 60.1 million |
| Washington | $4.8B | $4.5B | $351M (7%) | $85 | 56.9 million |
| Louisiana | $4.8B | $4.5B | $263M (5%) | $93 | 51.8 million |
| Maryland | $4.5B | $4.2B | $281M (6%) | $101 | 44.9 million |
| Minnesota | $4.3B | $4.0B | $339M (8%) | $84 | 51.3 million |
| Connecticut | $4.1B | $3.9B | $215M (5%) | $110 | 37.2 million |
| Colorado | $3.7B | $3.4B | $251M (7%) | $93 | 39.8 million |
| Oklahoma | $3.3B | $3.0B | $246M (7%) | $90 | 36.5 million |
| Puerto Rico | $3.1B | $3.0B | $34M (1%) | $66 | 46.7 million |
| Oregon | $3.0B | $2.8B | $232M (8%) | $82 | 36.8 million |
| Mississippi | $2.7B | $2.6B | $165M (6%) | $84 | 32.6 million |
| Arkansas | $2.7B | $2.5B | $183M (7%) | $81 | 33.4 million |
| Iowa | $2.4B | $2.2B | $222M (9%) | $74 | 32.8 million |
| Kansas | $2.4B | $2.2B | $196M (8%) | $83 | 28.5 million |
| Nevada | $2.0B | $1.9B | $136M (7%) | $86 | 23.7 million |
| West Virginia | $1.9B | $1.8B | $106M (6%) | $80 | 23.5 million |
| Utah | $1.6B | $1.5B | $141M (9%) | $82 | 19.9 million |
| Nebraska | $1.6B | $1.5B | $137M (9%) | $86 | 18.4 million |
| Maine | $1.4B | $1.4B | $79M (6%) | $91 | 15.8 million |
| Idaho | $1.3B | $1.2B | $102M (8%) | $85 | 15.4 million |
| New Mexico | $1.3B | $1.2B | $85M (7%) | $81 | 15.6 million |
| New Hampshire | $1.1B | $1.1B | $91M (8%) | $86 | 13.4 million |
| Hawaii | $997M | $945M | $52M (5%) | $103 | 9.7 million |
| Rhode Island | $953M | $892M | $60M (6%) | $81 | 11.7 million |
| Delaware | $941M | $873M | $67M (7%) | $90 | 10.5 million |
| District of Columbia | $716M | $689M | $27M (4%) | $154 | 4.6 million |
| Montana | $704M | $638M | $66M (9%) | $74 | 9.5 million |
| South Dakota | $699M | $629M | $70M (10%) | $83 | 8.4 million |
| North Dakota | $549M | $489M | $60M (11%) | $72 | 7.6 million |
| Vermont | $541M | $503M | $38M (7%) | $94 | 5.8 million |
| Alaska | $396M | $378M | $18M (5%) | $113 | 3.5 million |
| Wyoming | $259M | $230M | $29M (11%) | $66 | 3.9 million |
| Virgin Islands | $33M | $30M | $4M (11%) | $122 | 273K |
| Guam | $8M | $7M | $2M (20%) | $54 | 153K |
| Northern Mariana Islands | $1M | $924,849 | $184,332 (17%) | $67 | 17K |
A state near the top is not necessarily negotiating badly — cost per 30-day supply mostly tracks which drugs get prescribed there. A state whose doctors write more specialty and brand prescriptions pays more per fill without anyone paying more for the same drug.
These are gross dollars at the pharmacy counter, from every payer, before anything flows back. Published Medicare-cost figures are net, and three things come out between the two:
- Manufacturer rebates. Drugmakers pay plans confidential rebates after the sale — MedPAC put these at 29% of gross Part D spending. None of it is visible in any public per-drug dataset, which is why every price here is gross.
- What patients paid. The column above — $17.7B nationally.
- Premiums and state contributions. Roughly a quarter of Part D funding comes from enrollee premiums and state payments, not the federal government.
Net of all that, Medicare's own Part D cost was about $146 billion in 2024 — roughly half the gross figure in this table. Both numbers are correct; they answer different questions. This table answers “what did these drugs cost at the counter,” which is the one you need to compare drugs, states, and prices.
Not shown above: $20M (0.007% of the national total) that CMS does not attribute to a state — Armed Forces Central/South America, Armed Forces Europe, Armed Forces Pacific, Foreign Country, Unknown. “Unknown” is CMS's bucket for prescriptions whose prescriber state could not be determined.
On rebates: every price here is what changes hands at the pharmacy counter. Manufacturers later pay plans confidential rebates that no public dataset discloses, so the true net cost is lower — see the estimated ranges on individual drug pages and the gross-to-net explainer.
Source: CMS quarterly plan formulary and pricing files, and the annual Part D prescriber summary. Educational only — not coverage, billing, or clinical advice.