Top 10 Prescription Drugs by Total Spending

Sovaldi tops the list of highest total annual drug spending by user.

The Centers for Medicare and Medicaid (CMS) recently released a new dashboard that looks at Medicare prescription drugs.

Each category included drugs with high unit cost increases in recent years, high spending on per user basis, and high spending overall.

CMS created the list by taking data for 80 drugs from 2014. The products selected were based on whether the drug is ranked in the top 15 of total program spending for Part B or D, if it was associated with a high annual per user spending based on claims data analyses, if it was ranked in the top 15 of overall program spending, or if the drug ranked among the top 10 high unit cost increases.

Top 10 Drugs by Total Spending

1. sofosbuvir (Sovaldi)

  • Total spending: $3,106,960,981
  • Total annual spending per user: $94,056
  • Average annual beneficiary cost $5,054
  • Annual change in average cost per unit: 0%.

The FDA approved sofosbuvir on December 6, 2013. It is used with other antiviral medicines for the treatment of patients suffering from chronic hepatitis C genotypes 1-4.

2. esomeprazole magnesium (Nexium)Coverage type: part D

  • Total spending: $2,660,421,777
  • Total annual spending per user: $1,892
  • Average annual beneficiary cost $250
  • Annual change in average cost per unit: 11%.

Nexium was approved in February 2001 for the treatment of heartburn, acid reflux, ulcers and other gastroesophageal issues. It was also approved for healing an erosive esophagitis. This drug is classified as a proton pump inhibitor (PPI). It takes 1 to 4 days for the drug to take full effect.

3. rosuvastatin calcium (Crestor)Coverage type: part D

  • Total spending: $2,543,786,426
  • Total annual spending per user: $1,451
  • Average annual beneficiary cost $309
  • Annual change in average cost per unit: 10%.

Crestor is most commonly used to lower cholesterol and triglyceride levels in the blood. This is to help reduce the risk of developing hearth disease, stroke, heart attack, and other related health issues. It was approved by the FDA on February 8, 2010.

4. aripiprazole (Abilify) Coverage type: part D

  • Total spending: $2,527,319,032
  • Total annual spending per user: $6,238
  • Average annual beneficiary cost $552
  • Annual change in average cost per unit: 17%.

Abilify treats the symptoms of psychotic conditions such as schizophrenia and bipolar disorder. The drug can also be used in combination with other medications for major depressive disorder in adults. It was approved by the FDA in 2002.

5. fluticasone/salmeterol (Advair Diskus) Coverage type: part D

  • Total spending: $2,276,374,749
  • Total annual spending per user: $1,602
  • Average annual beneficiary cost $265
  • Annual change in average cost per unit: 8%.

Fluticasone/salmeterol is used to aid patients who experience wheezing and shortness of breath caused by asthma or lung disease such as COPD, including chronic bronchitis and emphysema. This prescription contains 2 types of medicine, fluticasone and salmeterol. The 250/50 and 500/50 was approved by the FDA in 2000 for ages 12 and up and dosage 100/50 was approved in 2003 for ages 4 and up.

6. tiotropium bromide (Spiriva)

  • Total spending: $2,158,439,227
  • Total annual spending per user: $1,781
  • Average annual beneficiary cost $317
  • Annual change in average cost per unit: 5%.

Spiriva was approved by the FDA for the treatment of chronic obstructive pulmonary disease (COPD) on January 20, 2004. By December 2009, it was approved for the reduction of COPD exacerbations.Spiriva is a bronchodilator that relaxes muscles in airways in order to increase air flow to the lungs. It helps prevent bronchospasm in COPD patients, including bronchitis and emphysema. It is also used to reduce any flare ups and worsen COPD symptoms.

7. insulin glargine, hum.rec.anlog (Lantus Solostar) Coverage type: part D

  • Total spending: $2,016,972,757
  • Total annual spending per user: $2,073
  • Average annual beneficiary cost $369
  • Annual change in average cost per unit: 27%.

Lantus Solostar is a long lasting and disposable prefilled insulin pen used to treat adults who have type 2 diabetes. It is also used to treat adults and children 6 years and up with type 1 diabetes in order to control high blood sugar.

8. sitagliptin phosphate (Januvia)

  • Total spending: $1,775,295,533
  • Total annual spending per user: $2,247
  • Average annual beneficiary cost $351
  • Annual change in average cost per unit: 15%.

Januvia is used to treat patients with type 2 diabetes. This medication is taken orally and is used in combination with other diabetes medications. This product regulates the levels of insulin in the body and helps control the blood sugar levels. The drug was approved by the FDA in October 2006.

9. insulin glargine,hum.rec.anlog (Lantus)

  • Total spending: $1,725,595,629
  • Total annual spending per user: $2,192
  • Average annual beneficiary cost $379
  • Annual change in average cost per unit: 41%.

Lantus is insulin that is used to treat adults with type 2 diabetes as well as adults and children who are 6 years and older with type 1 diabetes. This medication is similar to lantus solostar, however instead of being administered with a refillable pen, it is injected using a vial and syringe. The drug should be administered at the same time every day in order to keep insulin levels steady. Furthermore, in order to get the right dose, it’s recommended that patients always use a U-100 insulin syringe.

10. lenalidomide (Revlimid)

  • Total spending: $1,671,622,657
  • Total annual spending per user: $61,586
  • Average annual beneficiary cost $3,896
  • Annual change in average cost per unit: 8%.

Revlimid is a chemotherapy drug that is used in combination with dexamethasone to treat patient suffering from multiple myeloma. It affects the immune system in order to promote an immune response to slow tumor growth. It is also used to treat anemia, mantle cell lymphoma, and people with myelodysplastic syndrome. Revlimid should not be used to treat chronic lymphocytic leukemia, unless in a controlled study, because it can cause serious heart issues and increase the risk of death. In 2005, Revlimid’s PDUFA date was extended 3 months by the FDA. In June 2013, it was FDA approved for the treatment of relapsed or refractory mantle cell lymphoma.