Medicaid's Most Costly Outpatient Drugs
Appendix A: Tables
| Appendix Table A1: Medicaid’s 50 Most Costly Drugs, 2014Q1 – 2015Q2 | ||||||||
| Ranking | Drug Name | Specialty Drug | Biologic | Orphan Drug | Single-Source or Brand (B) vs. Multi-Source Generic (G) | Drug Group | Medicaid Spending Per Prescription Percentile* | Number of Prescriptions Percentile** |
| 1 | Abilify | X | B | Antipsychotics/Antimanic Agents | 90th | 99th | ||
| 2 | Sovaldi | X | B | Antivirals | 99th | 75th | ||
| 3 | Vyvanse | B | ADHD/Anti-Narcolepsy/Anti-Obesity/Anorexiants | 75th | 99th | |||
| 4 | Harvoni | X | B | Antivirals | 99th | 75th | ||
| 5 | Truvada | X | B | Antivirals | 90th | 95th | ||
| 6 | Lantus | B | Antidiabetics | 75th | 95th | |||
| 7 | Methylphenidate HCl ER | B & G | ADHD/Anti-Narcolepsy/Anti-Obesity/Anorexiants | 75th | 99th | |||
| 8 | Atripla | X | B | Antivirals | 95th | 95th | ||
| 9 | Advair Diskus | B | Antiasthmatic and Bronchodilator Agents | 75th | 95th | |||
| 10 | Lantus SoloStar | B | Antidiabetics | 75th | 95th | |||
| 11 | Seroquel XR | B | Antipsychotics/Antimanic Agents | 90th | 95th | |||
| 12 | Latuda | B | Antipsychotics/Antimanic Agents | 90th | 95th | |||
| 13 | Humira Pen | X | X | X | B | Anti-Inflammatory Analgesics | 95th | 90th |
| 14 | Adderall XR | B | ADHD/Anti-Narcolepsy/Anti-Obesity/Anorexiants | 75th | 95th | |||
| 15 | Suboxone | X | B | Opioid Analgesics | 75th | 95th | ||
| 16 | Invega Sustenna | B | Antipsychotics/Antimanic Agents | 90th | 95th | |||
| 17 | Flovent HFA | B | Antiasthmatic and Bronchodilator Agents | 75th | 95th | |||
| 18 | Lyrica | B | Anticonvulsants | 75th | 95th | |||
| 19 | Spiriva HandiHaler | X | B | Antiasthmatic and Bronchodilator Agents | 75th | 95th | ||
| 20 | ProAir HFA | B | Antiasthmatic and Bronchodilator Agents | 50th | 99th | |||
| 21 | Symbicort | B | Antiasthmatic and Bronchodilator Agents | 75th | 95th | |||
| 22 | Intuniv | B | ADHD/Anti-Narcolepsy/Anti-Obesity/Anorexiants | 75th | 95th | |||
| 23 | Synagis | X | X | B | Passive Immunizing Agents | 95th | 90th | |
| 24 | Prezista | X | B | Antivirals | 90th | 95th | ||
| 25 | Stribild | X | B | Antivirals | 95th | 90th | ||
| 26 | Advate | X | X | B | Hematological Agents | 99th | 75th | |
| 27 | Ventolin HFA | B | Antiasthmatic and Bronchodilator Agents | 50th | 99th | |||
| 28 | Focalin XR | B | ADHD/Anti-Narcolepsy/Anti-Obesity/Anorexiants | 75th | 95th | |||
| 29 | Strattera | X | B | ADHD/Anti-Narcolepsy/Anti-Obesity/Anorexiants | 75th | 95th | ||
| 30 | Qvar | B | Antiasthmatic and Bronchodilator Agents | 50th | 95th | |||
| 31 | Januvia | B | Antidiabetics | 75th | 95th | |||
| 32 | Humalog | B | Antidiabetics | 75th | 95th | |||
| 33 | Complera | X | B | Antivirals | 95th | 90th | ||
| 34 | Reyataz | X | B | Antivirals | 90th | 90th | ||
| 35 | Copaxone | X | X | B | Psychotherapeutic and Neurological Agents | 95th | 75th | |
| 36 | Duloxetine HCl | G | Antidepressants | 50th | 95th | |||
| 37 | Hydrocodone-Acetaminophen | B & G | Opioid Analgesics | 25th | 99th | |||
| 38 | Tamiflu | B | Antivirals | 75th | 95th | |||
| 39 | Nexium | B | Ulcer Drugs | 75th | 95th | |||
| 40 | Enbrel SureClick | X | X | X | B | Anti-Inflammatory Analgesics | 95th | 90th |
| 41 | Neulasta | X | X | X | B | Hematopoietic Agents | 95th | 90th |
| 42 | Novolog FlexPen | B | Antidiabetics | 75th | 95th | |||
| 43 | NovoSeven RT | X | X | X | B | Hematological Agents | 99th | 50th |
| 44 | Norditropin FlexPro | X | X | B | Endocrine and Metabolic Agents | 95th | 90th | |
| 45 | Isentress | X | B | Antivirals | 90th | 90th | ||
| 46 | Divalproex Sodium ER | G | Anticonvulsants | 50th | 95th | |||
| 47 | Seroquel | B | Antipsychotics/Antimanic Agents | 75th | 95th | |||
| 48 | Budesonide | X | B & G | Antiasthmatic and Bronchodilator Agents | 75th | 95th | ||
| 49 | Invega | B | Antipsychotics/Antimanic Agents | 90th | 90th | |||
| 50 | Amphetamine-Dextroamphet ER | G | ADHD/Anti-Narcolepsy/Anti-Obesity/Anorexiants | 50th | 95th | |||
| *We calculated average spending before rebates per prescription for each drug over the 2014Q1-2015Q2 period and identified notable percentiles. Medicaid Spending Per Prescription Percentile reflects how expensive each drug is before rebates at the prescription level, with respect to other Medicaid-reimbursed drugs, with 99th being the most expensive.
**We summed the number of prescriptions for each drug over the 2014Q1-2015Q2 period and identified notable percentiles. Number of Prescriptions Percentile reflects how frequently prescribed each drug is, with respect to other Medicaid-reimbursed drugs, with 99th being the most prescribed. |
||||||||
| Appendix Table A2: Medicaid’s Most Expensive Drugs by Spending per Rx, 2014Q1 – 2015Q2 | |||||
| Ranking | Drug Name | Average Medicaid Spending Before Rebates Per Rx |
Specialty Drug | Biologic | Drug Group |
| 1 | NovoSeven RT | $58,843 | X | X | Hematological Agents |
| 2 | Koate-DVI | $57,162 | X | X | Hematological Agents |
| 3 | Feiba | $48,366 | X | X | Hematological Agents |
| 4 | Adagen | $44,551 | Miscellaneous Biologicals | ||
| 5 | HP Acthar | $43,877 | X | Endocrine and Metabolic Agents | |
| 6 | Vimizim | $40,571 | X | X | Endocrine and Metabolic Agents |
| 7 | Myalept | $39,945 | X | X | Endocrine and Metabolic Agents |
| 8 | Chenodal | $39,556 | Gastrointestinal Agents | ||
| 9 | Carbaglu | $39,100 | X | Endocrine and Metabolic Agents | |
| 10 | Feiba NF | $36,418 | X | X | Hematological Agents |
| 11 | Ruconest | $33,659 | X | X | Hematological Agents |
| 12 | Gattex | $31,854 | X | Gastrointestinal Agents | |
| 13 | Cinryze | $31,640 | X | X | Hematological Agents |
| 14 | Firazyr | $31,103 | X | Hematological Agents | |
| 15 | Alprolix | $30,743 | X | X | Hematological Agents |
| 16 | Harvoni | $28,977 | X | Antivirals | |
| 17 | Novoeight | $28,897 | X | X | Hematological Agents |
| 18 | Alphanate/VWF Complex/Human | $28,571 | X | X | Hematological Agents |
| 19 | Juxtapid | $28,502 | Antihyperlipidemics | ||
| 20 | Rixubis | $28,330 | X | X | Hematological Agents |
| 21 | Cholbam | $27,422 | Gastrointestinal Agents | ||
| 22 | Berinert | $26,890 | X | X | Hematological Agents |
| 23 | Procysbi | $26,753 | X | Genitourinary Agents | |
| 24 | Sovaldi | $26,612 | X | Antivirals | |
| 25 | Orfadin | $26,562 | Endocrine and Metabolic Agents | ||
| 26 | Actimmune | $26,480 | X | X | Antineoplastics and Adjunctive Therapies |
| 27 | Cerdelga | $26,053 | X | Hematopoietic Agents | |
| 28 | Viekira Pak | $25,952 | X | Antivirals | |
| 29 | Ravicti | $25,840 | X | Endocrine and Metabolic Agents | |
| 30 | Hemofil M | $25,205 | X | X | Hematological Agents |
| 31 | Eloctate | $24,906 | X | X | Hematological Agents |
| 32 | Xyntha Solofuse | $23,846 | X | X | Hematological Agents |
| 33 | Kalydeco | $22,750 | X | Respiratory Agents | |
| 34 | Zavesca | $22,653 | X | Hematopoietic Agents | |
| 35 | Mononine | $22,647 | X | X | Hematological Agents |
| 36 | Ceprotin | $21,859 | X | X | Hematological Agents |
| 37 | Yervoy | $21,354 | X | X | Antineoplastics and Adjunctive Therapies |
| 38 | Olysio | $21,060 | X | Antivirals | |
| 39 | Kalbitor | $20,946 | X | X | Hematological Agents |
| 40 | Incivek | $20,575 | X | Antivirals | |
| 41 | BeneFIX | $20,019 | X | X | Hematological Agents |
| 42 | Kogenate FS | $20,017 | X | X | Hematological Agents |
| 43 | Kynamro | $19,731 | X | Antihyperlipidemics | |
| 44 | Corifact | $19,539 | X | X | Hematological Agents |
| 45 | Arcalyst | $19,014 | X | X | Anti-inflammatory Analgesics |
| 46 | Lumizyme | $18,855 | X | X | Endocrine and Metabolic Agents |
| 47 | Kogenate FS Bio-Set | $18,710 | X | X | Hematological Agents |
| 48 | AlphaNine SD | $18,389 | X | X | Hematological Agents |
| 49 | Ilaris | $18,133 | X | X | Anti-inflammatory Analgesics |
| 50 | Supprelin LA | $18,113 | X | Endocrine and Metabolic Agents | |
| NOTE: This table reflects Medicaid spending before rebates per prescription. A course of treatment for an illness may require multiple prescriptions. For example, a full treatment course for Hepatitis C agents Sovaldi and Harvoni often lasts three months and may require multiple prescriptions. | |||||
| Appendix Table A3: Medicaid’s Most Prescribed Drugs, 2014Q1 – 2015Q2 | ||
| Ranking | Drug Name | Drug Group |
| 1 | Hydrocodone-Acetaminophen | Opioid Analgesics |
| 2 | Amoxicillin | Penicillins |
| 3 | Ibuprofen | Anti-inflammatory Analgesics |
| 4 | Lisinopril | Antihypertensives |
| 5 | Omeprazole | Ulcer Drugs |
| 6 | Azithromycin | Macrolides |
| 7 | Gabapentin | Anticonvulsants |
| 8 | Fluticasone Propionate | Nasal Agents |
| 9 | Metformin HCl | Antidiabetics |
| 10 | Levothyroxine Sodium | Thyroid Agents |
| 11 | Cetirizine HCl | Antihistamines |
| 12 | Montelukast Sodium | Antiasthmatic and Bronchodilator Agents |
| 13 | ProAir HFA | Antiasthmatic and Bronchodilator Agents |
| 14 | Amlodipine Besylate | Calcium Channel Blockers |
| 15 | Albuterol Sulfate | Antiasthmatic and Bronchodilator Agents |
| 16 | Loratadine | Antihistamines |
| 17 | Ventolin HFA | Antiasthmatic and Bronchodilator Agents |
| 18 | Simvastatin | Antihyperlipidemics |
| 19 | Sertraline HCl | Antidepressants |
| 20 | Tramadol HCl | Opioid Analgesics |
| 21 | Oxycodone-Acetaminophen | Opioid Analgesics |
| 22 | Trazodone HCl | Antidepressants |
| 23 | Vitamin D (Ergocalciferol) | Vitamins |
| 24 | Alprazolam | Antianxiety Agents |
| 25 | Atorvastatin Calcium | Antihyperlipidemics |
| 26 | Hydrochlorothiazide | Diuretics |
| 27 | Clonazepam | Anticonvulsants |
| 28 | Citalopram Hydrobromide | Antidepressants |
| 29 | Cyclobenzaprine HCl | Musculoskelatal Therapy Agents |
| 30 | Ranitidine HCl | Ulcer Drugs |
| 31 | Fluoxetine HCl | Antidepressants |
| 32 | Amoxicillin-Potassium Clavulanate | Penicillins |
| 33 | Prednisone | Corticosteroids |
| 34 | Clonidine HCl | Antihypertensives |
| 35 | Risperidone | Antipsychotics/Antimanic Agents |
| 36 | Sulfamethoxazole-Trimethoprim | Anti-Infective Agents |
| 37 | Cephalexin | Cephalosporins |
| 38 | Metoprolol Tartrate | Beta Blockers |
| 39 | Methylphenidate HCl ER | ADHD/Anti-Narcolepsy/Anti-Obesity/Anorexiants |
| 40 | Quetiapine Fumarate | Antipsychotics/Antimanic Agents |
| 41 | Ondansetron HCl | Antiemetics |
| 42 | Triamcinolone Acetonide | Nasal Agents |
| 43 | Naproxen | Anti-inflammatory Analgesics |
| 44 | Vyvanse | ADHD/Anti-Narcolepsy/Anti-Obesity/Anorexiants |
| 45 | Furosemide | Diuretics |
| 46 | Oxycodone HCl | Opioid Analgesics |
| 47 | Zolpidem Tartrate | Hypnotics/Sedatives/Sleep Disorder Agents |
| 48 | Aspirin EC Low Dose | Nonnarcotic Analgesics |
| 49 | Lorazepam | Antianxiety Agents |
| 50 | Pantoprazole Sodium | Ulcer Drugs |
Topics
