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Top CMS Pharmaceutical Expenditures: Analyzing High-Expenditure Medications

Updated: Feb 5

DRUGS ON WHICH CMS SPENT THE MOST IN 2021


1. Eliquis (Apixaban):

  • Indications: Eliquis is an anticoagulant medication designed to lower the risk of stroke and the formation of blood clots in individuals diagnosed with atrial fibrillation, deep vein thrombosis, or pulmonary embolism.

  • Mechanism of Action: It inhibits the action of factor Xa, an essential component in the blood clotting cascade, thereby preventing the formation of blood clots.

2. Revlimid (Lenalidomide):

  • Indications: Revlimid is primarily used to treat multiple myeloma and myelodysplastic syndrome.

  • Mechanism of Action: It has immunomodulatory and antiangiogenic properties, suppressing the growth of cancer cells and supporting the body's immune system in fighting cancer.


3. Xarelto (Rivaroxaban):

  • Indications: Xarelto is an anticoagulant used to prevent or treat deep vein thrombosis, pulmonary embolism and reduce the risk of stroke in atrial fibrillation.

  • Mechanism of Action: Similar to Eliquis, it inhibits factor Xa, disrupting the blood clotting cascade.

4. Trulicity (Dulaglutide):

  • Indications: Trulicity is prescribed to manage type 2 diabetes by improving blood sugar control.

  • Mechanism of Action: It belongs to the class of GLP-1 receptor agonists, which stimulate the release of insulin and suppress glucagon secretion, thus lowering blood sugar levels.

5. Januvia (Sitagliptin):

  • Indications: Januvia is used for the treatment of type 2 diabetes.

  • Mechanism of Action: It works by inhibiting the enzyme DPP-4, increasing the levels of incretin hormones and enhancing insulin release while reducing glucagon secretion.

6. Humira (Adalimumab):

  • Indications: Humira is a tumour necrosis factor (TNF) inhibitor indicated for autoimmune diseases such as rheumatoid arthritis, Crohn's disease, and psoriasis.

  • Mechanism of Action: It binds to TNF-alpha, a pro-inflammatory cytokine, and inhibits its effects, reducing inflammation.

7. Jardiance (Empagliflozin):

  • Indications: Jardiance is prescribed to manage type 2 diabetes.

  • Mechanism of Action: It is an SGLT2 inhibitor, which reduces glucose reabsorption in the kidneys, increasing glucose excretion and lowering blood sugar levels.


8. Imbruvica (Ibrutinib):

  • Indications: Imbruvica treats certain types of blood cancers, including chronic lymphocytic leukaemia (CLL) and mantle cell lymphoma.

  • Mechanism of Action: It is a Bruton's tyrosine kinase (BTK) inhibitor that interferes with the growth and survival of cancer cells.

9. Lantus Solostar (Insulin Glargine):

  • Indications: Lantus Solostar is a long-acting insulin used to control high blood sugar in individuals with diabetes.

  • Mechanism of Action: It mimics the effects of natural insulin, helping the body regulate glucose levels over an extended period.

10. Ozempic (Semaglutide):

  • Indications: Ozempic is prescribed for the management of type 2 diabetes.

  • Mechanism of Action: It is a GLP-1 receptor agonist that enhances insulin release and reduces glucagon secretion, improving blood sugar control.

11. Xtandi (Enzalutamide):

  • Indications: Xtandi treats prostate cancer that has spread or recurred.

  • Mechanism of Action: It inhibits the binding of androgens (male hormones) to receptors in cancer cells, slowing cancer growth.


12. Trelegy Ellipta (Fluticasone Furoate/Umeclidinium/Vilanterol):

  • Indications: Trelegy Ellipta is an inhaler medication for chronic obstructive pulmonary disease (COPD).

  • Mechanism of Action: It combines three medications to reduce airway inflammation, relax airway muscles, and improve lung function.

13. Biktarvy (Bictegravir/Emtricitabine/Tenofovir Alafenamide):

  • Indications: Biktarvy is an antiretroviral medication used to treat HIV-1 infection.

  • Mechanism of Action: It inhibits HIV replication by blocking the activity of HIV integrase and reverse transcriptase enzymes.

14. Myrbetriq (Mirabegron):

  • Indications: Myrbetriq is prescribed to treat overactive bladder, reducing urinary urgency and frequency.

  • Mechanism of Action: It relaxes the bladder muscle, allowing it to hold more urine and reducing symptoms of overactive bladder.

15. Symbicort (Budesonide/Formoterol):

  • Indications: Symbicort is an inhaler used to manage asthma and COPD.

  • Mechanism of Action: It combines a corticosteroid (budesonide) to reduce inflammation with a long-acting bronchodilator (formoterol) to open airways.

16. Ibrance (Palbociclib):

  • Indications: Ibrance is combined with other drugs to treat certain types of breast cancer.

  • Mechanism of Action: It hinders cyclin-dependent kinases (CDKs), which results in a deceleration of the advancement of cancer cells through the cell cycle.


17. Novolog Flexpen (Insulin Aspart):

  • Indications: Novolog Flexpen is a rapid-acting insulin that controls blood sugar in individuals with diabetes.

  • Mechanism of Action: It works like natural insulin, helping the body process glucose quickly after meals.

18. Entresto (Sacubitril/Valsartan):

  • Indications: Entresto is prescribed for heart failure with reduced ejection fraction.

  • Mechanism of Action: It combines a neprilysin inhibitor (sacubitril) with an angiotensin receptor blocker (valsartan) to improve heart function and reduce symptoms.

19. Restasis (Cyclosporine):

  • Indications: Restasis is used to treat chronic dry eye disease.

  • Mechanism of Action: It suppresses the immune system in the eye, reducing inflammation and increasing tear production.

20. Pomalyst (Pomalidomide):

  • Indications: Pomalyst is used to treat multiple myeloma.

  • Mechanism of Action: It has immunomodulatory properties and works against cancer cells, inhibiting their growth.

21. Stelara (Ustekinumab):

  • Indications: Stelara treats conditions like psoriasis and Crohn's disease.

  • Mechanism of Action: It targets specific inflammation-related cytokines, reducing immune system activity.

22. Enbrel Sureclick (Etanercept):

  • Indications: Enbrel is used for autoimmune diseases like rheumatoid arthritis.

  • Mechanism of Action: It binds to TNF-alpha, reducing inflammation.


23. Breo Ellipta (Fluticasone Furoate/Vilanterol):

  • Indications: Breo Ellipta is an inhaler for treating asthma and COPD.

  • Mechanism of Action: It combines a corticosteroid (fluticasone) with a long-acting bronchodilator (vilanterol).

24. Invega Sustenna (Paliperidone Palmitate):

  • Indications: Invega Sustenna is an injectable antipsychotic used to treat schizophrenia.

  • Mechanism of Action: It acts on dopamine and serotonin receptors, helping to control symptoms of psychosis.

25. Ofev (Nintedanib):

  • Indications: Ofev is prescribed for idiopathic pulmonary fibrosis.

  • Mechanism of Action: It inhibits specific pathways involved in the progression of lung fibrosis.

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