Medicare Drug Costs by State: A $214 Billion Map

A Medicare prescription filled in Washington, DC costs $282 on average. The same system in Wyoming averages $102 per claim. That 2.75x gap is not a typo. It reflects real differences in what drugs get prescribed, which specialists write the scripts, and how much specialty medicine concentrates in certain states.

We analyzed 27 million Medicare Part D prescription records from CMS, linking 1.1 million prescribers across all 50 states. The results show a country where geography shapes drug costs as much as the drugs themselves.

TL;DR

Medicare Part D spent $213.6 billion on prescriptions in 2022 across 1.4 billion claims
DC averages $282 per claim (highest), Wyoming averages $102 (lowest)
The South accounts for 39% of all Medicare drug spending ($82.9B)
Specialty drugs (costing over $500 per fill) drive 91% of DC's spending but only 78% in the cheapest states
Eliquis (apixaban) is the #1 drug by spending in nearly every state
GLP-1 drugs (Ozempic, Mounjaro) account for $23.2 billion nationally, with Texas leading at $2.05B
Five states (CA, NY, FL, TX, PA) account for 37% of all Medicare drug spending

How we built this analysis

We used CMS Medicare Part D Prescriber Public Use Files for 2022 (the most recent complete release). Each record links a prescriber's NPI to a specific drug, claim count, patient count, and total cost. We joined this against the NPI provider registry for specialty and state data, and our normalized drug database for drug class categorization.

All figures reflect what Medicare paid plus beneficiary cost-sharing. They do not include manufacturer rebates, which CMS estimates reduce net spending by roughly 25-30%.

Source: CMS Medicare Part D Prescribers by Provider and Drug

The 10 most expensive states for Medicare prescriptions

Cost per claim measures the average price Medicare pays each time a beneficiary fills a prescription in that state. Higher numbers mean providers in that state prescribe a more expensive drug mix.

Rank	State	Cost Per Claim	Total Spending	Total Claims
1	DC	$281.88	$511M	1.8M
2	Hawaii	$198.51	$730M	3.7M
3	New York	$185.65	$17.0B	91.3M
4	Connecticut	$185.56	$3.1B	16.5M
5	Alaska	$177.23	$253M	1.4M
6	Massachusetts	$176.77	$5.5B	31.2M
7	Maryland	$169.29	$3.2B	19.1M
8	New Jersey	$168.24	$5.9B	34.9M
9	Colorado	$160.11	$2.6B	16.2M
10	Delaware	$159.41	$688M	4.3M

The pattern is clear: Northeastern states and areas with major academic medical centers dominate the expensive end. DC stands alone at the top for reasons we unpack below.

The 10 cheapest states for Medicare prescriptions

Rank	State	Cost Per Claim	Total Spending	Total Claims
1	Wyoming	$102.36	$180M	1.8M
2	North Dakota	$106.12	$386M	3.6M
3	Montana	$113.98	$495M	4.3M
4	Iowa	$116.06	$1.8B	15.9M
5	Arkansas	$116.85	$2.1B	17.6M
6	South Dakota	$125.29	$519M	4.1M
7	Kansas	$127.24	$1.8B	13.9M
8	West Virginia	$127.44	$1.4B	11.0M
9	Mississippi	$127.80	$2.1B	16.4M
10	Rhode Island	$130.21	$713M	5.5M

Rural and Midwestern states fill the bottom of the list. These states have fewer academic medical centers, fewer specialists prescribing high-cost drugs, and more primary care providers writing scripts for cheap generics.

Why DC costs 2.75x more than Wyoming

DC is a geographic outlier, and the data explains exactly why. Specialty drugs (prescriptions averaging over $500 per fill) account for 91% of DC's total drug spending. In cheaper states, that figure drops to 78-80%.

What drives DC's costs

Drug	Drug Class	DC Claims	DC Spending	Cost Per Claim
Bictegravir/emtricitabine/TAF	HIV treatment	8,739	$36.6M	$4,186
Apixaban (Eliquis)	Blood thinner	28,126	$27.2M	$967
Empagliflozin (Jardiance)	Diabetes	20,684	$21.0M	$1,013
Tafamidis (Vyndaqel)	Heart disease	754	$19.8M	$26,265
Semaglutide (Ozempic)	GLP-1	14,163	$18.6M	$1,310

DC has the highest HIV prevalence of any US jurisdiction. That shows up directly in the data: Bictegravir (the standard HIV triple-therapy) is DC's #1 drug by spending at $4,186 per fill. Tafamidis, a rare cardiac drug at $26,265 per claim, adds another layer of specialty cost concentration.

Wyoming's drug mix, by contrast, leans toward generic statins, blood pressure medications, and metformin. High-volume, low-cost drugs that reflect a population managed mostly by family medicine providers.

Regional spending breakdown

The South writes more Medicare prescriptions than any other region but pays less per claim than the Northeast.

Region	States	Total Spending	Claims	Cost Per Claim	Prescribers
South	17	$82.91B	568M	$145.96	408,401
Northeast	9	$44.79B	264M	$169.54	226,395
Midwest	12	$44.64B	321M	$139.22	245,958
West	13	$38.17B	250M	$152.77	245,448

The South's dominance in total spending ($82.9B, 39% of the national total) reflects both a larger Medicare population and higher rates of chronic disease. But the Northeast pays 16% more per claim ($169.54 vs. $145.96), driven by greater specialty drug use and higher concentration of academic medical centers.

The Midwest is the cheapest region per claim at $139.22. More generics, more primary care, fewer specialists writing $10,000-per-month prescriptions.

The 5 biggest states by total spending

Five states account for $78 billion in Medicare drug spending, 37% of the national total.

State	Spending	Claims	Cost/Claim	Prescribers
California	$19.9B	125M	$158.72	114,207
New York	$17.0B	91M	$185.65	78,282
Florida	$16.0B	111M	$144.66	78,195
Texas	$14.8B	96M	$154.12	75,550
Pennsylvania	$10.5B	70M	$149.45	51,927

Florida fills the most claims per prescriber (1,418 per provider), suggesting a higher patient-to-doctor ratio. New York pays the most per claim ($185.65) among the top five, consistent with its high specialty drug use. California has the most prescribers (114,207) and the highest total spending ($19.9B).

Eliquis dominates almost every state

Apixaban (brand name Eliquis), a blood thinner used to prevent stroke in atrial fibrillation patients, is the #1 drug by spending in nearly every state. Nationally, it accounts for $19.9 billion in Medicare Part D spending across 23 million claims.

Top drug by spending in selected states

State	#1 Drug	Spending	#2 Drug	Spending
California	Eliquis	$1.48B	Jardiance	$1.13B
Texas	Eliquis	$1.16B	Ozempic	$1.14B
Florida	Eliquis	$1.53B	Ozempic	$877M
New York	Eliquis	$1.33B	Ozempic	$866M
Pennsylvania	Eliquis	$1.11B	Jardiance	$566M
Ohio	Eliquis	$887M	Ozempic	$438M

Eliquis holds the top spot because it has no generic competitor (patent expiration expected 2026), treats a condition common in Medicare's elderly population, and costs roughly $550 per month at list price.

In Texas, Ozempic nearly matches Eliquis at $1.14B vs. $1.16B. Texas leads all states in GLP-1 prescribing.

GLP-1 drugs: $23.2 billion and rising

GLP-1 receptor agonists (Ozempic, Mounjaro, Trulicity, Rybelsus) collectively cost Medicare $23.2 billion in 2022. That makes them the second-largest drug class by spending, behind only blood thinners (Factor Xa inhibitors at $25.3B).

Top 10 states for GLP-1 spending

State	GLP-1 Claims	GLP-1 Spending	GLP-1 Patients	Cost/Claim
Texas	1,577K	$2.05B	272,572	$1,300
California	1,512K	$1.72B	207,143	$1,140
New York	1,230K	$1.58B	196,353	$1,284
Florida	1,249K	$1.57B	194,905	$1,260
Pennsylvania	877K	$1.07B	121,783	$1,217
Ohio	733K	$910M	101,902	$1,241
North Carolina	705K	$875M	98,051	$1,241
Michigan	659K	$852M	93,279	$1,294
Georgia	655K	$829M	104,810	$1,264
Illinois	581K	$742M	80,703	$1,278

Texas leads GLP-1 spending by a wide margin at $2.05 billion. With 272,572 GLP-1 patients, Texas also has the largest GLP-1 patient population on Medicare. The average GLP-1 prescription costs $1,246 nationally, roughly $1,000 per month for these drugs.

Maryland has the highest GLP-1 cost per claim ($1,392), possibly reflecting higher use of the newer, pricier tirzepatide (Mounjaro) over the older dulaglutide (Trulicity).

Which specialties spend the most?

The prescriber's specialty matters as much as the state.

Specialty	Prescribers	Total Spending	Cost/Claim
Internal Medicine	105,837	$39.0B	$127
Family Medicine	98,827	$26.4B	$79
Cardiovascular Disease	17,799	$12.0B	$212
Physician Assistant	78,999	$8.6B	$137
Nurse Practitioner	42,109	$7.3B	$157
Endocrinology	5,742	$5.8B	$456
Rheumatology	4,520	$4.7B	$532
Pulmonary Disease	5,726	$4.6B	$527
Medical Oncology	2,381	$3.5B	$2,275
Gastroenterology	12,040	$3.5B	$376

Family medicine providers write the most claims but at the lowest cost per claim ($79). Medical oncologists write relatively few claims but each one averages $2,275. Hematologists top the list at $2,772 per claim (not shown) because blood cancer drugs like lenalidomide cost over $17,000 per fill.

States with more oncologists and rheumatologists per capita naturally skew toward higher per-claim costs. That is a major reason the Northeast outspends the Midwest per claim.

The specialty drug concentration problem

Across all 50 states, drugs costing over $500 per fill represent just 7-10% of all claims but 78-91% of total spending. That ratio defines the entire cost picture.

State	Specialty % of Claims	Specialty % of Cost	Total Spending
DC	10.0%	91.0%	$511M
Nevada	7.3%	87.2%	$1.5B
Connecticut	9.0%	87.2%	$3.1B
Georgia	7.7%	86.9%	$6.9B
Hawaii	9.1%	86.4%	$730M
Texas	7.8%	86.4%	$14.8B
Florida	7.0%	86.1%	$16.0B
New York	9.6%	85.8%	$17.0B

A small number of expensive fills drive the bill everywhere. In DC, 10% of claims generate 91% of costs. The policy implication is straightforward: reducing per-claim costs in Medicare means addressing specialty drug pricing, not the generic fills that make up 80%+ of prescription volume.

Opioid prescribing by state

Opioid prescribing patterns vary sharply by geography. Florida leads in raw opioid claim volume.

State	Opioid Claims	Opioid Patients	Opioid Prescribers
Florida	2,021,572	617,269	18,278
California	1,651,831	519,917	24,969
Texas	1,500,138	509,014	19,269
Pennsylvania	1,380,932	416,499	15,057
North Carolina	1,214,009	367,213	11,774

Florida's opioid claim count (2M+) reflects its large Medicare population and historical prescribing patterns. California has more opioid prescribers (24,969) but fewer claims per prescriber, suggesting tighter per-provider controls.

The most expensive drug classes per claim

Some drug classes cost hundreds of times more per fill than others.

Drug Class	Spending	Drugs	Claims	Cost/Claim
IL-12 Antagonist (Stelara)	$2.3B	1	85K	$26,474
Prostacycline Vasodilator	$593M	2	25K	$23,339
Thalidomide Analog (Revlimid)	$6.2B	2	346K	$17,809
Kinase Inhibitor (cancer)	$14.8B	59	1.1M	$13,453
Janus Kinase Inhibitor	$3.5B	5	391K	$8,849
TNF Blocker (Humira/Enbrel)	$1.9B	10	272K	$7,143
GLP-1 Agonist	$23.2B	6	18.6M	$1,246
Factor Xa Inhibitor (Eliquis)	$25.3B	4	28.9M	$876
SGLT2 Inhibitor (Jardiance)	$15.5B	4	15.8M	$976

Ustekinumab (Stelara) tops the per-claim chart at $26,474 per fill, treating psoriasis and Crohn's disease. But the mass-market classes (GLP-1s, blood thinners, SGLT2 inhibitors) generate the largest total spending because they serve millions of patients at $800-1,300 per fill.

FAQ

Why does Medicare drug spending vary so much by state?

Three factors drive state-level variation: the specialty mix of local prescribers (oncologists and rheumatologists write expensive scripts), the disease burden of the local Medicare population (DC's high HIV rate pushes up costs), and the share of brand vs. generic drugs prescribed. States with more academic medical centers tend to prescribe newer, costlier drugs.

Which state spends the most on Medicare prescriptions total?

California leads at $19.9 billion in 2022 Medicare Part D spending, followed by New York ($17.0B), Florida ($16.0B), Texas ($14.8B), and Pennsylvania ($10.5B). These five states account for 37% of all national Medicare drug spending.

What is the average cost of a Medicare prescription?

Nationally, the average Medicare Part D prescription cost $148.82 per claim in 2022. That average masks huge variation: generic blood pressure pills cost $5-15 per fill, while specialty cancer drugs run $10,000-26,000 per fill.

Why is DC so expensive for Medicare drugs?

DC has the highest HIV prevalence of any US jurisdiction, and HIV triple-therapy drugs cost over $4,000 per fill. Specialty drugs account for 91% of DC's total drug spending. DC also has a high concentration of academic medical specialists who prescribe newer, costlier treatments.

What is the most prescribed drug in Medicare Part D?

By claim volume, atorvastatin (generic Lipitor) leads with over 93 million annual claims. By spending, Eliquis (apixaban) is the most expensive single drug at $19.9 billion. The most prescribed drugs list and the most expensive list have almost no overlap.

How much do GLP-1 drugs cost Medicare?

GLP-1 receptor agonists (Ozempic, Mounjaro, Trulicity) cost Medicare $23.2 billion in 2022. The average GLP-1 prescription runs $1,246 per fill. Texas leads GLP-1 spending at $2.05 billion. Read more about GLP-1 prescribing data.

Does Medicare Part D cover specialty drugs?

Yes. Medicare Part D covers specialty drugs, but they are typically placed on higher formulary tiers (Tier 4 or 5) with higher copays. Specialty drugs account for just 7-10% of all claims but 78-91% of total spending, depending on the state.

Where can I find Medicare drug spending data by state?

CMS publishes the Medicare Part D Prescriber Public Use Files annually at data.cms.gov. These files include prescriber-level data with drug, claim count, patient count, and cost. MyfitByte normalizes this data across drug identities and links it to adverse events, recalls, and provider registries.

How does the Inflation Reduction Act affect state drug costs?

The IRA's Medicare drug price negotiation program selected the first 10 drugs for negotiation in 2023, with negotiated prices taking effect in 2026. Eliquis and Jardiance are both on the list. Once negotiated prices apply, the states spending the most on these drugs (California, Florida, New York) will see the largest absolute savings.

What percentage of Medicare spending goes to generic drugs?

Generic drugs account for 81-88% of all Medicare Part D claims by volume but only 9-22% of total spending. The exact split varies by state. Wyoming fills 88% generics while DC fills 81%, a difference that partly explains the cost-per-claim gap.

Want this data broken down for your state, drug, or provider? MyfitByte connects CMS prescriber data with FDA safety signals and drug identity resolution across 89 million records from six federal sources. Sign up for API access.

Data source: CMS Medicare Part D Prescribers by Provider and Drug, 2022. Provider data from the NPI Registry. Drug classification from MyfitByte's normalized drug database. Analysis covers 27 million prescription records from 1.1 million prescribers. All spending figures represent gross costs before manufacturer rebates.