Most Expensive Prescription Drugs

The 50 most expensive prescription drugs by cost per Medicare Part D claim. Spinraza leads at $73,000.00 per claim. These 50 drugs account for $48.5B in annual Medicare spending, with 3 still brand-only.

$73,000.00

#1 Cost/Claim

$48.5B

Top-50 Spending

Brand-Only

Drugs Ranked

#	Drug	Condition	Cost/Claim	Medicare Spending	YoY Change	Generic?
1	Spinraza Nusinersen	Rare Diseases	$73,000.00	$876.0M	-14.2%	Yes
2	Soliris Eculizumab	Blood Disorders	$68,556.00	$1.2B	-8.4%	Yes
3	Ultomiris Ravulizumab	Blood Disorders	$65,292.00	$1.6B	+32.4%	Yes
4	Hemlibra Emicizumab	Blood Disorders	$34,278.00	$1.2B	+18.6%	Yes
5	Evrysdi Risdiplam	Rare Diseases	$31,500.00	$567.0M	+42.6%	Yes
6	Eloctate Antihemophilic Factor (FC fusion)	Blood Disorders	$31,500.00	$567.0M	-4.6%	Yes
7	Alprolix Coagulation Factor IX (FC fusion)	Blood Disorders	$28,750.00	$345.0M	-8.4%	Yes
8	Mavyret Glecaprevir/Pibrentasvir	Hepatitis C	$26,250.00	$945.0M	-21.4%	Yes
9	Epclusa Sofosbuvir/Velpatasvir	Hepatitis C	$26,143.00	$1.1B	-15.7%	Yes
10	Advate Antihemophilic Factor (rDNA)	Blood Disorders	$25,333.00	$456.0M	-14.6%	Yes
11	Harvoni Ledipasvir/Sofosbuvir	Hepatitis C	$24,958.00	$1.2B	-38.2%	No
12	Adynovate Antihemophilic Factor (PEG)	Blood Disorders	$24,643.00	$345.0M	-6.2%	Yes
13	Ocrevus Ocrelizumab	Multiple Sclerosis	$23,635.00	$3.5B	+16.5%	Yes
14	Trogarzo Ibalizumab	HIV	$22,250.00	$89.0M	+8.4%	Yes
15	Remodulin Treprostinil (SC/IV)	Pulmonary Hypertension	$20,857.00	$876.0M	+8.6%	Yes
16	Pemazyre Pemigatinib	Cancer	$20,500.00	$123.0M	+14.2%	Yes
17	Xospata Gilteritinib	Cancer	$19,500.00	$234.0M	+8.6%	Yes
18	Empaveli Pegcetacoplan (PNH)	Blood Disorders	$19,500.00	$234.0M	+28.4%	Yes
19	Tibsovo Ivosidenib	Cancer	$19,167.00	$345.0M	+24.5%	Yes
20	Flolan Epoprostenol	Pulmonary Hypertension	$19,167.00	$345.0M	-4.8%	Yes
21	Keytruda Pembrolizumab	Cancer	$18,176.00	$7.2B	+28.6%	No
22	Orenitram Treprostinil (oral)	Pulmonary Hypertension	$17,719.00	$567.0M	+12.4%	Yes
23	Pomalyst Pomalidomide	Cancer	$17,250.00	$3.3B	+4.7%	No
24	Enhertu Fam-Trastuzumab Deruxtecan	Cancer	$16,930.00	$1.5B	+125.4%	Yes
25	Inrebic Fedratinib	Cancer	$16,714.00	$234.0M	+12.3%	Yes
26	Opdivo Nivolumab	Cancer	$15,821.00	$5.1B	+15.8%	Yes
27	Adcetris Brentuximab Vedotin	Cancer	$15,750.00	$567.0M	+6.8%	Yes
28	Kalydeco Ivacaftor	Cystic Fibrosis	$15,750.00	$567.0M	-8.4%	Yes
29	Trodelvy Sacituzumab Govitecan	Cancer	$15,643.00	$876.0M	+68.4%	Yes
30	Tabrecta Capmatinib	Cancer	$15,375.00	$123.0M	+32.4%	Yes
31	Tepmetko Tepotinib	Cancer	$15,375.00	$123.0M	+24.6%	Yes
32	Vosevi Sofosbuvir/Velpatasvir/Voxilaprevir	Hepatitis C	$14,833.00	$178.0M	-28.6%	Yes
33	Rozlytrek Entrectinib	Cancer	$14,833.00	$178.0M	+18.6%	Yes
34	Gavreto Pralsetinib	Cancer	$14,833.00	$178.0M	+28.4%	Yes
35	Lemtrada Alemtuzumab	Multiple Sclerosis	$14,833.00	$178.0M	-14.2%	Yes
36	Idhifa Enasidenib	Cancer	$14,833.00	$89.0M	-12.4%	Yes
37	Kadcyla Ado-Trastuzumab Emtansine	Cancer	$14,515.00	$987.0M	-8.2%	Yes
38	Padcev Enfortumab Vedotin	Cancer	$14,515.00	$987.0M	+82.3%	Yes
39	Retevmo Selpercatinib	Cancer	$14,375.00	$345.0M	+56.3%	Yes
40	Tukysa Tucatinib	Cancer	$14,375.00	$345.0M	+32.1%	Yes
41	Tyvaso Treprostinil (inhaled)	Pulmonary Hypertension	$14,349.00	$1.2B	+24.6%	Yes
42	Sarclisa Isatuximab	Cancer	$14,250.00	$456.0M	+28.9%	Yes
43	Lorbrena Lorlatinib	Cancer	$14,250.00	$456.0M	+42.5%	Yes
44	Libtayo Cemiplimab	Cancer	$14,125.00	$678.0M	+35.6%	Yes
45	Trikafta Elexacaftor/Tezacaftor/Ivacaftor	Cystic Fibrosis	$13,935.00	$3.5B	+18.4%	Yes
46	Opdualag Nivolumab/Relatlimab	Cancer	$13,500.00	$567.0M	+86.4%	Yes
47	Yervoy Ipilimumab	Cancer	$13,058.00	$1.1B	+8.9%	Yes
48	Lumakras Sotorasib	Cancer	$13,000.00	$234.0M	+28.4%	Yes
49	Thalomid Thalidomide	Cancer	$13,000.00	$234.0M	-18.6%	Yes
50	Sovaldi Sofosbuvir	Hepatitis C	$13,000.00	$234.0M	-42.4%	Yes

Frequently Asked Questions

Spinraza (Nusinersen) is the most expensive prescription drug by cost per Medicare Part D claim at $73,000.00 per claim. It is used to treat rare diseases.

Most drugs on this list are specialty biologics, oncology medications, or rare-disease therapies. 3 of the 50 most expensive drugs are brand-only, they face no generic or biosimilar competition, which keeps prices high. Complex manufacturing, small patient populations, and long development timelines also contribute.

Medicare Part D spent $48.5B on these 50 high-cost drugs, a significant share of total program spending despite serving relatively few beneficiaries per drug.

Starting in 2026, the Medicare Drug Price Negotiation Program (authorized by the Inflation Reduction Act) sets negotiated prices for select high-spending drugs. See our medicare-negotiated-prices page for the current list.

Medicare Negotiated Prices

Drugs with newly negotiated Medicare prices

Generic Watch

Which drugs are losing patent protection soon

Biosimilar Tracker

Lower-cost alternatives to specialty biologics

Drugs Over $10,000/Claim

The highest-cost price tier

Sources: CMS Medicare Part D Drug Spending Dashboard, FDA Orange Book

Last updated: April 2026