What health systems spend on each medicine
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.
Showing medicines matching “Metformin”: 10 in England, 13 in Medicaid (first 100 of each).
NHS England: cost by medicine
Aug 2025 to Jul 2026, net ingredient cost| # | Medicine (BNF chemical substance) | Cost, 12 months | Change | Items | Cost per item |
|---|---|---|---|---|---|
| Metformin hydrochloride Endocrine System |
£66.4m | -26.6% | 27,597,345 | £2.40 | |
| Empagliflozin/metformin Endocrine System |
£5.5m | -1.0% | 139,223 | £39.64 | |
| Dapagliflozin/metformin Endocrine System |
£4.7m | +4.4% | 114,477 | £40.83 | |
| Linagliptin/metformin Endocrine System |
£1.5m | -15.4% | 43,933 | £33.48 | |
| Alogliptin/metformin Endocrine System |
£1.3m | -20.1% | 43,729 | £29.09 | |
| Metformin hydrochloride/sitagliptin Endocrine System |
£954k | -44.3% | 111,853 | £8.53 | |
| Metformin hydrochloride/vildagliptin Endocrine System |
£793k | -28.2% | 25,189 | £31.48 | |
| Metformin hydrochloride/pioglitazone Endocrine System |
£322k | -25.5% | 7,154 | £45.05 | |
| Canagliflozin/metformin Endocrine System |
£269k | -8.5% | 6,337 | £42.50 | |
| Saxagliptin/metformin Endocrine System |
£13k | -91.2% | 339 | £38.24 |
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.
US Medicaid: spending by drug
2025, amount Medicaid reimbursed| # | Drug (active ingredient) | Medicaid paid, 2025 | Change on 2024 | Prescriptions | Per prescription |
|---|---|---|---|---|---|
| Metformin hydrochloride Metformin Hydrochloride, Metformin Hydrochloride, Metformin, Metformin hydrochloride |
$149.2m | -1.4% | 9,291,329 | $16.05 | |
| Empagliflozin and metformin hydrochloride Synjardy |
$113.2m | +25.8% | 146,140 | $774.60 | |
| Sitagliptin and metformin hydrochloride Janumet, Sitagliptin and metformin hydrochloride, Zituvimet |
$96.2m | -45.3% | 209,796 | $458.47 | |
| Linagliptin and metformin hydrochloride Jentadueto, Jentadueto XR |
$35.7m | -12.9% | 62,216 | $574.23 | |
| Dapagliflozin and metformin hydrochloride Xigduo, dapagliflozin and metformin hydrochloride |
$31.4m | +10.2% | 43,826 | $717.44 | |
| Empagliflozin, linagliptin, metformin hydrochloride Trijardy XR |
$21.2m | +26.0% | 31,305 | $676.03 | |
| Alogliptin and metformin hydrochloride alogliptin and metformin hydrochloride, Kazano |
$6.0m | -23.9% | 28,908 | $207.51 | |
| Ertugliflozin and metformin hydrochloride Segluromet |
$5.1m | -25.0% | 11,750 | $432.52 | |
| Canagliflozin and metformin hydrochloride Invokamet, Invokamet Xr |
$3.5m | -39.3% | 4,608 | $755.26 | |
| Glipizide and metformin hcl Glipizide and Metformin Hydrochloride, Glipizide and Metformin HCl |
$1.2m | -13.9% | 31,601 | $36.66 | |
| Glyburide-metformin hydrochloride glyburide-metformin hydrochloride, Glyburide and Metformin Hydrochloride |
$496k | +9.1% | 20,035 | $24.77 | |
| Saxagliptin and metformin hydrochloride Saxagliptin and Metformin Hydrochloride, Saxagliptin and Metformin |
$467k | +8.7% | 1,203 | $388.27 | |
| Pioglitazone hydrochloride and metformin hydrochloride Pioglitazone Hydrochloride and Metformin Hydrochloride, Pioglitazone and metformin hydrochloride, Actoplus Met, Pioglitazone HCL and Metformin HCL |
$174k | -15.9% | 4,255 | $40.86 |
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.
How this page is built
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.
- NHSBSA Prescription Cost Analysis, monthly ↗ net ingredient cost and items by BNF presentation, England, Open Government Licence v3.0
- CMS State Drug Utilization Data 2025 ↗ national totals (state XX) by NDC, US public domain
- FDA National Drug Code Directory ↗ brand, active ingredient and labeler for each NDC product, including delisted products
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 8 Oct 2026. How every register is built: methodology · fixes we have made: corrections log.