The cost of every medicine dispensed in the community in England, and every drug reimbursed by US Medicaid, from the two systems' own published data.
NHS England spent £11.89bn on medicines and appliances dispensed in the community from Aug 2025 to Jul 2026, +6.6% on the previous 12 months, at list price before discounts. Tirzepatide cost the most, at £795.3m, and the ten costliest items took 22.6% of the total. US Medicaid paid $111.94bn for outpatient drugs in 2025 before manufacturer rebates, led by semaglutide (Ozempic, Wegovy, Rybelsus) at $6.50bn. Both figures are gross: neither system publishes the discounts and rebates it receives per drug.
Net ingredient cost of all items dispensed in the community in England each month, £ million.
| # | Medicine (BNF chemical substance) | Cost, 12 months | Change | Items | Cost per item |
|---|---|---|---|---|---|
| 1 | Tirzepatide Endocrine System |
£795.3m | +305.4% | 3,552,149 | £223.89 |
| 2 | Detection Sensor Interstitial Fluid/Gluc Appliances |
£384.1m | +21.4% | 4,672,000 | £82.21 |
| 3 | Influenza Immunological Products and Vaccines |
£229.2m | +87.0% | 13,458,460 | £17.03 |
| 4 | Catheters Appliances |
£219.0m | +5.7% | 1,620,410 | £135.16 |
| 5 | BeclometDiprop/Formoterol/Glycopyrronium (Corticosteroids) Respiratory System |
£190.2m | +88.5% | 3,837,816 | £49.56 |
| 6 | Edoxaban Cardiovascular System |
£189.7m | -19.2% | 3,828,639 | £49.54 |
| 7 | Empagliflozin Endocrine System |
£173.3m | -3.1% | 4,422,111 | £39.18 |
| 8 | Budesonide Respiratory System |
£171.2m | +23.1% | 5,039,842 | £33.98 |
| 9 | Sacubitril/valsartan Cardiovascular System |
£170.1m | +16.2% | 1,988,210 | £85.53 |
| 10 | BeclometDiprop/Formoterol Respiratory System |
£168.7m | BNF code changed Jan 2026 | 5,497,517 | £30.69 |
| 11 | Beclometasone dipropionate Respiratory System |
£153.2m | BNF code changed Jan 2026 | 7,345,952 | £20.85 |
| 12 | Dapagliflozin Endocrine System |
£150.6m | -58.8% | 12,960,363 | £11.62 |
| 13 | Ileostomy Bags Stoma Appliances |
£147.7m | +4.4% | 856,546 | £172.46 |
| 14 | Semaglutide Endocrine System |
£139.2m | -3.3% | 1,598,318 | £87.07 |
| 15 | Wound Management & Other Dressings Dressings |
£135.4m | +2.3% | 3,443,519 | £39.31 |
| 16 | Colecalciferol Nutrition and Blood |
£123.6m | +10.9% | 29,526,422 | £4.19 |
| 17 | Colostomy Bags Stoma Appliances |
£116.8m | +1.9% | 486,594 | £240.02 |
| 18 | Insulin aspart Endocrine System |
£115.7m | +2.2% | 2,767,474 | £41.81 |
| 19 | Estradiol Endocrine System |
£114.1m | +21.2% | 6,753,459 | £16.89 |
| 20 | Omeprazole Gastro-Intestinal System |
£98.5m | -2.8% | 35,214,426 | £2.80 |
| 21 | Lisdexamfetamine dimesylate Central Nervous System |
£94.3m | +46.7% | 1,428,451 | £66.03 |
| 22 | Insulin glargine Endocrine System |
£94.2m | +4.6% | 2,133,372 | £44.14 |
| 23 | Mesalazine (Systemic) Gastro-Intestinal System |
£93.2m | +0.3% | 1,620,793 | £57.51 |
| 24 | Mirabegron Obstetrics, Gynaecology and Urinary-Tract Disorders |
£87.1m | +11.0% | 3,210,848 | £27.12 |
| 25 | Fluticasone/umeclidinium/vilanterol Respiratory System |
£84.0m | +4.9% | 1,634,901 | £51.40 |
| 26 | Macrogol 3350 Gastro-Intestinal System |
£80.7m | +16.0% | 7,923,352 | £10.19 |
| 27 | Estradiol with progestogen Endocrine System |
£77.9m | +5.8% | 2,425,140 | £32.10 |
| 28 | Co-codamol (Codeine phosphate/paracetamol) Central Nervous System |
£77.6m | +16.9% | 14,734,657 | £5.27 |
| 29 | Methylphenidate hydrochloride Central Nervous System |
£77.2m | +16.1% | 2,495,775 | £30.92 |
| 30 | Eye Products Appliances |
£75.7m | +7.4% | 9,681,244 | £7.82 |
| 31 | Pancreatin Gastro-Intestinal System |
£75.5m | +16.0% | 789,147 | £95.63 |
| 32 | Atorvastatin Cardiovascular System |
£74.1m | -17.5% | 79,305,933 | £0.93 |
| 33 | Linagliptin Endocrine System |
£73.7m | -9.4% | 2,498,279 | £29.49 |
| 34 | Paracetamol Central Nervous System |
£73.1m | -8.1% | 15,739,340 | £4.65 |
| 35 | Glucose blood testing reagents Endocrine System |
£67.2m | -14.0% | 5,045,413 | £13.31 |
| 36 | Emollients Appliances |
£67.0m | +4.2% | 11,024,621 | £6.07 |
| 37 | Metformin hydrochloride Endocrine System |
£66.4m | -26.6% | 27,597,345 | £2.40 |
| 38 | Adrenaline Respiratory System |
£66.3m | +9.6% | 499,309 | £132.83 |
| 39 | Fluticasone propionate (Inhalation) Respiratory System |
£63.2m | -18.7% | 2,127,858 | £29.70 |
| 40 | Other Appliances Appliances |
£61.5m | -4.4% | 10,715,300 | £5.74 |
| 41 | Calcipotriol Skin |
£60.6m | -2.9% | 1,202,156 | £50.44 |
| 42 | Venlafaxine Central Nervous System |
£59.5m | +25.7% | 6,528,730 | £9.11 |
| 43 | Ramipril Cardiovascular System |
£58.7m | +39.6% | 36,635,970 | £1.60 |
| 44 | Lymphoedema Garments Appliances |
£55.5m | +13.7% | 699,902 | £79.28 |
| 45 | Anal Irrigation System Appliances |
£54.5m | +19.9% | 267,450 | £203.90 |
| 46 | Ready to serve 2.4 kcal/ml milkshake lower volume (0913011) Nutrition and Blood |
£53.3m | -3.3% | 820,309 | £64.97 |
| 47 | Umeclidinium bromide/vilanterol Respiratory System |
£52.9m | +8.2% | 1,412,277 | £37.48 |
| 48 | Tiotropium bromide Respiratory System |
£52.0m | -10.4% | 1,840,118 | £28.28 |
| 49 | Quetiapine Central Nervous System |
£51.2m | -2.9% | 4,716,522 | £10.86 |
| 50 | Leuprorelin acetate Malignant Disease and Immunosuppression |
£50.1m | -1.8% | 255,017 | £196.34 |
| 51 | Salbutamol Respiratory System |
£49.3m | -20.1% | 15,488,897 | £3.18 |
| 52 | Sertraline hydrochloride Central Nervous System |
£48.4m | -5.3% | 26,188,839 | £1.85 |
| 53 | Melatonin Central Nervous System |
£46.8m | -4.9% | 3,172,758 | £14.74 |
| 54 | Buprenorphine Central Nervous System |
£46.5m | -2.7% | 2,787,449 | £16.68 |
| 55 | Skin Fillers And Protectives Stoma Appliances |
£46.1m | +3.3% | 4,092,448 | £11.26 |
| 56 | Progesterone Endocrine System |
£44.6m | -1.8% | 3,520,528 | £12.66 |
| 57 | Insulin degludec Endocrine System |
£43.9m | +1.9% | 738,899 | £59.35 |
| 58 | Bempedoic acid/Ezetimibe Cardiovascular System |
£43.4m | +78.5% | 706,642 | £61.45 |
| 59 | Lansoprazole Gastro-Intestinal System |
£43.3m | -9.3% | 38,150,620 | £1.13 |
| 60 | Dulaglutide Endocrine System |
£42.7m | -20.4% | 523,816 | £81.58 |
| 61 | Levothyroxine sodium Endocrine System |
£42.6m | -11.5% | 35,099,530 | £1.21 |
| 62 | Ready to serve 1.5 kcal/ml milkshake (0913011) Nutrition and Blood |
£42.0m | +0.2% | 950,121 | £44.22 |
| 63 | RtS 2.4 kcal/ml m/sk lower volume, higher protein (0913011) Nutrition and Blood |
£41.7m | +9.7% | 452,539 | £92.23 |
| 64 | Bisoprolol fumarate Cardiovascular System |
£41.7m | +67.0% | 31,608,160 | £1.32 |
| 65 | Aspirin Cardiovascular System |
£39.8m | +151.5% | 20,293,328 | £1.96 |
| 66 | Alginic acid compound preparations Gastro-Intestinal System |
£39.2m | +15.9% | 4,419,366 | £8.86 |
| 67 | Goserelin acetate Malignant Disease and Immunosuppression |
£38.6m | -3.4% | 240,926 | £160.30 |
| 68 | Other emollient preparations Skin |
£36.4m | -0.4% | 4,509,192 | £8.08 |
| 69 | Powder extensively hydrolysed formula (0913101) Nutrition and Blood |
£36.3m | +3.5% | 483,721 | £75.03 |
| 70 | Amlodipine Cardiovascular System |
£35.8m | +0.6% | 41,537,272 | £0.86 |
| 71 | Lamotrigine Central Nervous System |
£35.1m | +2.4% | 4,554,048 | £7.71 |
| 72 | Urostomy Bags Stoma Appliances |
£34.7m | +5.5% | 177,281 | £195.63 |
| 73 | Sodium fluoride Nutrition and Blood |
£34.5m | +7.1% | 1,480,859 | £23.28 |
| 74 | Powder amino acid formula (0913107) Nutrition and Blood |
£33.9m | -3.5% | 185,069 | £183.32 |
| 75 | Sumatriptan succinate Central Nervous System |
£33.4m | +31.1% | 2,710,483 | £12.33 |
| 76 | Estriol Obstetrics, Gynaecology and Urinary-Tract Disorders |
£33.2m | +18.8% | 2,015,340 | £16.49 |
| 77 | Indapamide Cardiovascular System |
£33.2m | +197.8% | 6,220,724 | £5.34 |
| 78 | Skin Protectors Stoma Appliances |
£32.9m | +10.3% | 374,521 | £87.80 |
| 79 | Sodium valproate Central Nervous System |
£32.7m | -2.8% | 2,051,305 | £15.96 |
| 80 | Colesevelam hydrochloride Cardiovascular System |
£32.6m | +57.7% | 267,744 | £121.83 |
| 81 | Canagliflozin Endocrine System |
£32.5m | -8.3% | 784,275 | £41.42 |
| 82 | Levetiracetam Central Nervous System |
£30.7m | -9.7% | 3,385,480 | £9.08 |
| 83 | Adhesive Removers (Sprays/Liquids/Wipes) Stoma Appliances |
£30.6m | +7.1% | 1,403,699 | £21.81 |
| 84 | Doxazosin mesilate Cardiovascular System |
£29.9m | +49.3% | 7,907,749 | £3.78 |
| 85 | Nitrofurantoin Infections |
£29.9m | -8.6% | 4,424,744 | £6.75 |
| 86 | Fexofenadine hydrochloride Respiratory System |
£29.8m | +96.2% | 7,280,525 | £4.09 |
| 87 | Oxycodone hydrochloride Central Nervous System |
£29.7m | -4.0% | 1,867,446 | £15.90 |
| 88 | Morphine sulfate Central Nervous System |
£29.2m | -5.3% | 4,998,174 | £5.83 |
| 89 | Biphasic insulin aspart Endocrine System |
£28.6m | -9.6% | 602,034 | £47.52 |
| 90 | Estradiol Obstetrics, Gynaecology and Urinary-Tract Disorders |
£28.5m | +16.1% | 2,172,355 | £13.14 |
| 91 | Alogliptin Endocrine System |
£28.5m | -25.1% | 1,029,192 | £27.70 |
| 92 | Leg Bags Incontinence Appliances |
£27.9m | +3.8% | 811,617 | £34.37 |
| 93 | RtS 2-2.4 kcal/ml m/sk higher protein,higher energy(0913011) Nutrition and Blood |
£27.5m | +4.1% | 258,116 | £106.37 |
| 94 | Methotrexate Musculoskeletal and Joint Diseases |
£27.2m | +7.0% | 2,249,007 | £12.08 |
| 95 | Propranolol hydrochloride Cardiovascular System |
£26.9m | +18.2% | 8,441,955 | £3.19 |
| 96 | Docusate sodium Gastro-Intestinal System |
£26.7m | +36.7% | 2,909,944 | £9.17 |
| 97 | Brivaracetam Central Nervous System |
£26.0m | +32.5% | 215,289 | £120.95 |
| 98 | Fluticasone furoate/vilanterol Respiratory System |
£25.9m | -12.9% | 846,814 | £30.58 |
| 99 | Rifaximin Infections |
£25.6m | +9.3% | 141,230 | £181.17 |
| 100 | Apixaban Cardiovascular System |
£24.7m | -52.5% | 11,537,909 | £2.14 |
Net ingredient cost is the list price of what was dispensed, before discounts, fees and patient charges. It covers prescriptions dispensed in the community in England, including appliances such as glucose sensors and catheters, not hospital medicines. Where the BNF moved products to a new code during the year, no change is shown because the two periods count different products. Cost per item is calculated here.
| # | Drug (active ingredient) | Medicaid paid, 2025 | Change on 2024 | Prescriptions | Per prescription |
|---|---|---|---|---|---|
| 1 | Semaglutide Ozempic, Wegovy, Rybelsus |
$6.50bn | +30.0% | 5,892,661 | $1,103.72 |
| 2 | Adalimumab Humira, Hadlima, Adalimumab, Simlandi |
$3.60bn | -15.2% | 494,588 | $7,285.64 |
| 3 | Bictegravir sodium, emtricitabine, and tenofovir alafenamide fumarate Biktarvy |
$3.49bn | +9.9% | 780,134 | $4,476.00 |
| 4 | Tirzepatide Zepbound, Mounjaro |
$3.24bn | +178.7% | 3,140,509 | $1,032.08 |
| 5 | Dupilumab Dupixent |
$2.99bn | +29.5% | 765,807 | $3,902.16 |
| 6 | Empagliflozin Jardiance |
$2.48bn | +13.9% | 2,945,841 | $841.54 |
| 7 | Paliperidone palmitate Invega Sustenna, Invega Trinza, Invega Hafyera, Erzofri extended-release |
$2.38bn | +5.1% | 703,319 | $3,379.58 |
| 8 | Dulaglutide Trulicity |
$1.93bn | -9.6% | 1,940,795 | $992.89 |
| 9 | Risankizumab-rzaa Skyrizi |
$1.72bn | +58.0% | 86,735 | $19,885.92 |
| 10 | Cariprazine Vraylar |
$1.61bn | +14.2% | 1,096,927 | $1,471.32 |
| 11 | Secukinumab Cosentyx |
$1.41bn | +18.5% | 154,503 | $9,136.74 |
| 12 | Apixaban Eliquis |
$1.39bn | +10.5% | 2,188,265 | $635.80 |
| 13 | Ustekinumab Stelara, Yesintek, Selarsdi, Stelara |
$1.36bn | -14.8% | 61,157 | $22,163.56 |
| 14 | Elexacaftor, tezacaftor, and ivacaftor Trikafta |
$1.35bn | -7.0% | 53,971 | $25,084.59 |
| 15 | Lisdexamfetamine dimesylate Vyvanse, Lisdexamfetamine Dimesylate, Lisdexamfetamine Dimesylate, lisdexamfetamine dimesylate |
$1.22bn | -0.2% | 4,052,361 | $301.84 |
| 16 | Buprenorphine hydrochloride, naloxone hydrochloride Suboxone, Buprenorphine and Naloxone, buprenorphine and naloxone, Zubsolv |
$1.19bn | -7.2% | 7,201,264 | $164.86 |
| 17 | Etanercept Enbrel |
$1.10bn | +3.9% | 140,529 | $7,833.23 |
| 18 | Aripiprazole Abilify Maintena, Abilify Asimtufii, Aripiprazole, Abilify |
$1.01bn | +30.8% | 5,012,980 | $201.42 |
| 19 | Buprenorphine Sublocade, Brixadi, Belbuca, Butrans |
$1.01bn | +31.8% | 1,433,172 | $703.27 |
| 20 | Dapagliflozin Farxiga, Dapagliflozin |
$995.3m | +12.8% | 1,365,169 | $729.05 |
| 21 | Emicizumab Hemlibra |
$943.9m | +8.0% | 29,976 | $31,489.79 |
| 22 | Immune globulin infusion (human) GAMMAGARD Liquid, Hizentra, Gamunex-C, Privigen |
$886.2m | +12.6% | 211,443 | $4,191.31 |
| 23 | Upadacitinib Rinvoq |
$815.7m | +43.7% | 111,488 | $7,316.72 |
| 24 | Somatropin Norditropin, Genotropin, Omnitrope, Humatrope |
$792.9m | +13.3% | 153,178 | $5,176.55 |
| 25 | Methylphenidate hydrochloride Concerta, Methylphenidate Hydrochloride, Jornay Pm, Quillivant |
$785.0m | -12.8% | 5,811,941 | $135.06 |
| 26 | Budesonide and formoterol fumarate dihydrate Symbicort, Budesonide and Formoterol Fumarate Dihydrate, Breyna |
$784.8m | +7.5% | 3,376,085 | $232.46 |
| 27 | Pembrolizumab Keytruda |
$753.3m | +2.7% | 78,912 | $9,546.62 |
| 28 | Albuterol sulfate Ventolin, Albuterol Sulfate, Albuterol sulfate, Albuterol Sulfate |
$716.0m | -9.9% | 19,835,679 | $36.10 |
| 29 | Valbenazine Ingrezza, INGREZZA Sprinkle |
$671.9m | +15.2% | 86,668 | $7,753.11 |
| 30 | Rimegepant sulfate Nurtec Odt |
$626.5m | +18.5% | 499,751 | $1,253.60 |
| 31 | Ixekizumab Taltz |
$611.5m | +1.3% | 76,699 | $7,972.29 |
| 32 | Glecaprevir and pibrentasvir Mavyret |
$597.8m | -2.8% | 45,561 | $13,120.52 |
| 33 | Pancrelipase Creon, Zenpep, Pertzye, Viokace |
$582.8m | +4.4% | 281,333 | $2,071.48 |
| 34 | Linaclotide Linzess |
$571.4m | +22.2% | 924,006 | $618.44 |
| 35 | Sacubitril and valsartan Entresto, Sacubitril and Valsartan, sacubitril and valsartan, Sacubitril and valsartan |
$560.4m | -8.6% | 819,093 | $684.21 |
| 36 | Insulin glargine Lantus Solostar, Basaglar, TOUJEO Max, Lantus |
$554.0m | -8.1% | 3,784,212 | $146.40 |
| 37 | Fluticasone furoate, umeclidinium bromide and vilanterol trifenatate Trelegy Ellipta |
$541.5m | +15.4% | 779,112 | $695.07 |
| 38 | Guselkumab Tremfya |
$523.9m | +50.5% | 36,317 | $14,426.08 |
| 39 | Cannabidiol Epidiolex |
$522.8m | +9.9% | 152,460 | $3,428.97 |
| 40 | Brexpiprazole Rexulti |
$522.3m | +12.5% | 351,599 | $1,485.40 |
| 41 | Deutetrabenazine Austedo Xr, Austedo |
$509.5m | +31.5% | 66,688 | $7,640.18 |
| 42 | Fluticasone propionate Fluticasone Propionate, Xhance, Fluticasone Propionate, Rugby Fluticasone Propionate Nasal |
$466.9m | -12.5% | 11,073,135 | $42.17 |
| 43 | Emtricitabine and tenofovir alafenamide Descovy |
$462.3m | -0.1% | 183,537 | $2,518.93 |
| 44 | Rivaroxaban Xarelto, Xarelto, Rivaroxaban, Rivaroxaban |
$460.7m | -3.7% | 673,457 | $684.11 |
| 45 | Insulin lispro Insulin Lispro, Humalog, Admelog, Lyumjev |
$453.5m | -0.8% | 2,373,609 | $191.07 |
| 46 | Ofatumumab Kesimpta |
$441.0m | +34.5% | 44,144 | $9,990.55 |
| 47 | Abemaciclib Verzenio |
$435.1m | +10.5% | 28,782 | $15,117.88 |
| 48 | Velpatasvir and sofosbuvir Sofosbuvir and Velpatasvir, Epclusa |
$427.3m | -10.4% | 49,359 | $8,657.62 |
| 49 | Lumateperone Caplyta |
$421.6m | +35.1% | 256,826 | $1,641.41 |
| 50 | Bimekizumab Bimzelx |
$421.5m | +826.6% | 22,379 | $18,833.20 |
| 51 | Omalizumab Xolair PFS, Xolair, Xolair |
$418.6m | +17.5% | 160,778 | $2,603.52 |
| 52 | Fluticasone propionate and salmeterol Advair, Advair Hfa, Fluticasone Propionate and Salmeterol HFA, Fluticasone Propionate and Salmeterol |
$406.7m | -6.0% | 1,821,671 | $223.23 |
| 53 | Naltrexone Vivitrol, Naltrexone Hydrochloride, Naltrexone Hydrochloride |
$397.5m | +10.0% | 1,073,519 | $370.29 |
| 54 | Lenalidomide Revlimid, Lenalidomide, Lenalidomide, lenalidomide |
$392.0m | -1.0% | 25,312 | $15,485.19 |
| 55 | Ubrogepant Ubrelvy |
$391.6m | +27.6% | 336,246 | $1,164.74 |
| 56 | Ocrelizumab Ocrevus |
$381.9m | +5.9% | 14,698 | $25,986.32 |
| 57 | Ribociclib Kisqali |
$374.2m | +69.9% | 23,710 | $15,782.18 |
| 58 | Risdiplam Evrysdi |
$365.9m | +15.8% | 15,567 | $23,502.39 |
| 59 | Apremilast Otezla |
$364.8m | +12.5% | 70,727 | $5,158.46 |
| 60 | Tiotropium bromide inhalation spray Spiriva Respimat, Spiriva, Tiotropium Bromide |
$364.7m | -19.1% | 752,224 | $484.79 |
| 61 | Dextroamphetamine sulfate, dextroamphetamine saccharate, amphetamine sulfate and amphetamine aspartate Adderall, Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate, Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate and Amphetamine Sulfate, Dextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, and Amphetamine Sulfate |
$358.4m | -27.8% | 8,609,287 | $41.63 |
| 62 | Cabotegravir and rilpivirine Cabenuva |
$351.0m | +33.6% | 59,832 | $5,866.94 |
| 63 | Dolutegravir sodium and lamivudine Dovato |
$349.4m | +17.0% | 104,870 | $3,331.69 |
| 64 | Rifaximin Xifaxan |
$336.3m | -18.2% | 118,261 | $2,843.78 |
| 65 | Treprostinil Tyvaso DPI, Remodulin, Orenitram, Tyvaso |
$332.7m | +10.0% | 24,692 | $13,472.97 |
| 66 | Ruxolitinib Jakafi, Opzelura |
$329.1m | +16.7% | 87,980 | $3,740.09 |
| 67 | Risperidone Uzedy, Risperdal Consta, Risperidone, Risperidone |
$328.3m | +67.2% | 3,486,791 | $94.16 |
| 68 | Selexipag Uptravi, UPTRAVI Titration Pack |
$318.4m | +13.4% | 13,987 | $22,762.84 |
| 69 | Sitagliptin Januvia, Sitagliptin, Zituvio |
$317.8m | -49.1% | 703,273 | $451.90 |
| 70 | Aripiprazole lauroxil Aristada, Aristada Initio |
$312.1m | +2.1% | 115,048 | $2,713.10 |
| 71 | Elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide Genvoya |
$304.8m | -17.3% | 66,171 | $4,606.52 |
| 72 | Antihemophilic factor (recombinant), fc-vwf-xten fusion protein-ehtl Altuviiio |
$292.3m | +58.9% | 8,417 | $34,732.85 |
| 73 | Esketamine hydrochloride Spravato |
$288.6m | +78.1% | 187,774 | $1,537.21 |
| 74 | Epinephrine Epinephrine, epinephrine, Auvi-Q, neffy |
$288.6m | +7.9% | 1,136,087 | $254.03 |
| 75 | Brivaracetam Briviact |
$284.4m | +23.8% | 180,079 | $1,579.24 |
| 76 | Diazepam Valtoco, Diazepam, Diazepam Intensol, Diazepam |
$277.6m | +67.8% | 1,302,523 | $213.11 |
| 77 | Darunavir, cobicistat, emtricitabine, and tenofovir alafenamide Symtuza |
$274.4m | -8.2% | 55,647 | $4,930.65 |
| 78 | Cyclosporine Restasis, Cequa, Cyclosporine, Vevye |
$272.6m | +14.3% | 422,928 | $644.65 |
| 79 | Tofacitinib Xeljanz |
$264.3m | +2.8% | 43,863 | $6,024.47 |
| 80 | Onabotulinumtoxina Botox, Dysport, Xeomin, BOTOX Cosmetic |
$263.1m | +8.9% | 364,992 | $720.76 |
| 81 | Glycerol phenylbutyrate Ravicti, Glycerol Phenylbutyrate |
$260.4m | +1.2% | 4,279 | $60,844.49 |
| 82 | Belimumab Benlysta |
$260.3m | +19.3% | 66,077 | $3,939.86 |
| 83 | Abatacept Orencia |
$256.7m | +7.7% | 58,399 | $4,395.41 |
| 84 | Aflibercept Eylea, Eylea Hd, Pavblu |
$254.9m | +1.1% | 226,693 | $1,124.48 |
| 85 | Eteplirsen Exondys 51 |
$254.9m | -0.1% | 8,928 | $28,545.67 |
| 86 | Vigabatrin Sabril, Vigadrone, Vigabatrin, Vigafyde |
$247.5m | +10.3% | 24,928 | $9,927.20 |
| 87 | Burosumab Crysvita |
$246.3m | +6.1% | 9,175 | $26,840.01 |
| 88 | Leuprolide acetate Lupron Depot-PED, Lupron Depot, Fensolvi, Eligard |
$239.7m | +5.8% | 76,414 | $3,136.34 |
| 89 | Dolutegravir sodium Tivicay, Tivicay PD |
$239.0m | -11.3% | 94,504 | $2,528.94 |
| 90 | Galcanezumab-gnlm Emgality |
$237.7m | +8.4% | 307,374 | $773.21 |
| 91 | Vedolizumab Entyvio, ENTYVIO Pen |
$236.6m | +9.3% | 37,347 | $6,334.89 |
| 92 | Trofinetide Daybue |
$235.5m | +17.5% | 5,345 | $44,065.90 |
| 93 | Teduglutide Gattex |
$234.1m | +7.9% | 5,220 | $44,838.40 |
| 94 | Infliximab Remicade, Inflectra, Infliximab, Renflexis |
$232.4m | +5.3% | 113,956 | $2,039.43 |
| 95 | Macitentan Opsumit |
$231.7m | +5.1% | 18,484 | $12,536.84 |
| 96 | Sotatercept-csrk Winrevair |
$229.2m | +376.5% | 12,448 | $18,410.98 |
| 97 | Palbociclib Ibrance |
$228.2m | -15.1% | 14,391 | $15,859.42 |
| 98 | Fenfluramine Fintepla |
$228.2m | +30.6% | 18,083 | $12,616.93 |
| 99 | Antihemophilic factor (recombinant) Advate, Kovaltry, Nuwiq, Xyntha |
$224.6m | -14.1% | 9,682 | $23,198.13 |
| 100 | Viloxazine hydrochloride Qelbree |
$224.5m | +38.9% | 461,158 | $486.80 |
The amount Medicaid reimbursed pharmacies for outpatient drugs, national totals from all states, before the manufacturer rebates Medicaid receives (CMS does not publish rebates per drug). Rows CMS suppresses because they cover fewer than 11 prescriptions are left out. Products are grouped by active ingredient using the FDA NDC Directory, which named 99.4% of the spending; the rest keeps CMS's short product name and is only in the product totals. Cost per prescription is calculated here.
NHS England: increase on the previous 12 months, £ million
US Medicaid: increase 2024 to 2025, $ million
Increases are calculated here from the two sources' totals. NHS items moved to a new BNF code during the year are left out of this chart.
| # | Product | Company (FDA labeler) | Medicaid paid | Prescriptions | NDC product |
|---|---|---|---|---|---|
| 1 | Biktarvy Bictegravir sodium, emtricitabine, and tenofovir alafenamide fumarate |
Gilead Sciences, Inc. | $3.48bn | 777,316 | 61958-2501 |
| 2 | Humira Adalimumab |
AbbVie Inc. | $2.24bn | 275,510 | 00074-0554 |
| 3 | Dupixent Dupilumab |
Sanofi-Aventis U.S. LLC | $1.83bn | 459,562 | 00024-5915 |
| 4 | Ozempic Semaglutide |
Novo Nordisk Pharmaceutical Industries, LP | $1.33bn | 1,358,870 | 00169-4181 |
| 5 | Jardiance Empagliflozin |
Boehringer Ingelheim Pharmaceuticals, Inc. | $1.32bn | 1,539,108 | 00597-0153 |
| 6 | Invega Sustenna Paliperidone palmitate |
Janssen Pharmaceuticals, Inc. | $1.27bn | 378,755 | 50458-0564 |
| 7 | Ozempic Semaglutide |
Novo Nordisk Pharmaceutical Industries, LP | $1.23bn | 1,225,176 | 00169-4772 |
| 8 | Eliquis Apixaban |
E.R. Squibb & Sons, L.L.C. | $1.21bn | 1,887,469 | 00003-0894 |
| 9 | Stelara Ustekinumab |
Janssen Biotech, Inc. | $1.16bn | 42,550 | 57894-0061 |
| 10 | Jardiance Empagliflozin |
Boehringer Ingelheim Pharmaceuticals, Inc. | $1.16bn | 1,406,733 | 00597-0152 |
| 11 | Ozempic Semaglutide |
Novo Nordisk Pharmaceutical Industries, LP | $1.12bn | 1,111,598 | 00169-4130 |
| 12 | Skyrizi Risankizumab-rzaa |
AbbVie Inc. | $1.06bn | 51,009 | 00074-2100 |
| 13 | Trikafta Elexacaftor, tezacaftor, and ivacaftor |
Vertex Pharmaceuticals Incorporated | $938.3m | 37,627 | 51167-0331 |
| 14 | Enbrel Etanercept |
Immunex Corporation | $895.7m | 112,794 | 58406-0032 |
| 15 | Keytruda Pembrolizumab |
Merck Sharp & Dohme LLC | $753.3m | 78,912 | 00006-3026 |
| 16 | Farxiga Dapagliflozin |
AstraZeneca Pharmaceuticals LP | $725.5m | 930,983 | 00310-6210 |
| 17 | Cosentyx Secukinumab |
Novartis Pharmaceuticals Corporation | $718.2m | 71,371 | 00078-1070 |
| 18 | Wegovy Semaglutide |
Novo Nordisk Pharmaceutical Industries, LP | $711.3m | 547,132 | 00169-4524 |
| 19 | Vraylar Cariprazine |
Allergan, Inc. | $705.6m | 482,277 | 61874-0115 |
| 20 | Humira Adalimumab |
AbbVie Inc. | $679.1m | 45,027 | 00074-0124 |
| 21 | Cosentyx Secukinumab |
Novartis Pharmaceuticals Corporation | $676.6m | 77,980 | 00078-0639 |
| 22 | Suboxone Buprenorphine hydrochloride, naloxone hydrochloride |
INDIVIOR INC. | $655.5m | 1,906,274 | 12496-1208 |
| 23 | Nurtec Odt Rimegepant sulfate |
Pfizer Laboratories Div Pfizer Inc | $626.5m | 499,751 | 72618-3000 |
| 24 | Mavyret Glecaprevir and pibrentasvir |
AbbVie Inc. | $594.2m | 45,186 | 00074-2625 |
| 25 | Taltz Ixekizumab |
Eli Lilly and Company | $576.1m | 71,946 | 00002-1445 |
One NDC product covers every pack size and strength listed under it. The labeler is the company named on the FDA listing, which can be a distributor rather than the manufacturer.
Every amount is the sum of the source's own published figures. Contains public sector information licensed under the Open Government Licence v3.0 (NHSBSA). Changes, shares and costs per item or prescription are calculated here and labelled.
A job downloads both datasets every week, sums them by medicine and keeps the previous version if either source fails or returns far fewer medicines than before. No AI drafting and no editorial pass. See our methodology. The NHSBSA and CMS data on this page was last retrieved on 30 Sep 2026. How every register is built: methodology · fixes we have made: corrections log.
