Preliminary figures, built November 4, 2026. Final figures, at that day’s exchange rates, will follow.
Medicare Overpays About $24 Billion A Year For 20 Drugs
Medicare now pays prices it negotiated with drug companies. Even so, for the same brand-name drugs, Norway, Australia and New Zealand pay far less. This page puts the prices side by side, counts the Medicare patients on each drug, and adds up the difference.
- $5.8 billionEliquis alone. 3.9 million Medicare patients take it, about 1 in 14 people with Part D. Medicare pays $231 a month; Norway pays $65 for the same brand.
- 11 of 20For more than half, a Medicare patient’s copay alone is more than a peer nation pays for the whole brand-name drug. Eliquis: the patient’s copay averages $102 a month; Norway pays $65 in full.
- $9 vs. $197New Zealand pays about $9 a month for Xarelto, made by Bayer. Medicare’s negotiated price is $197, 22 times as much. 1.3 million Medicare patients take it.
The 20 Drugs, One By One
Prices are for a 30-day supply in U.S. dollars, compared brand name to brand name. Select a drug for its dose, each country’s price and how the numbers were worked out.
The Patent Extension Cost
For three of these drugs, at least one of the three countries buys a lower-cost generic or biosimilar: Eliquis, Enbrel and Janumet. In the United States, patents, patent extensions and legal settlements have kept such versions off the market or delayed them.
If Medicare could buy those versions at the prices paid abroad, it would pay about $1.6 billion a year less, on top of the $24 billion. We call this the patent extension cost: what Medicare pays because the patents run longer here. It is shown under the yearly overpayment for each of the three drugs.
How To Read This Page
Medicare price is the maximum fair price set in Medicare’s drug price negotiation. The first 10 drugs have had these prices since January 1, 2026; the next 15 take effect January 1, 2027. Twenty of those 25 drugs are shown here. The other five (NovoLog and Fiasp insulin, Stelara, Pomalyst, Austedo and Vraylar) are not included.
Same drug, lowest peer-nation price is the lowest price Norway, Australia or New Zealand pays for the same brand-name drug, so the comparison is brand to brand. It is the price the country’s system pays before pharmacy markup and sales tax. Generic and biosimilar prices are shown in each drug’s details, and counted only in the patent extension cost.
Patient copay is what the patient pays, averaged per month over a year, for someone on this one drug under the standard Part D benefit for 2027: the full price until a $700 deductible is met, then 25%, with yearly out-of-pocket costs capped at $2,400 ($200 a month). Plans may charge less, people with Extra Help pay much less, and people with other drugs reach the cap sooner.
Who pays the overpayment. Of the $23.8 billion, about $1.4 billion a year comes straight out of patients’ pockets in copays, based on the share of costs Medicare patients paid out of pocket for these drugs in 2023 and 2024 (6.9% and 4.0%, from CMS). For 13 million low-income enrollees, Extra Help pays their copays instead, so their share of the overpayment falls on taxpayers. The rest is paid through Medicare and Part D premiums. The $1.4 billion is likely on the high side, since the $2,000 yearly out-of-pocket cap began in 2025.
Medicare patients on the drug is the number of Part D enrollees who used it, as reported by CMS for 2023 (the first 10 drugs) or 2024 (the next 15).
Medicare overpays a year is the number of monthly prescriptions Medicare patients filled that year, times the difference between Medicare’s price and the lowest brand-name price abroad. Prescriptions are estimated from Medicare’s total spending on the drug divided by its list price for a 30-day supply. It counts the months patients actually took the drug, not a full year for everyone.
New Zealand funds 10 of the 20. For the others it buys one lower-cost drug in the same class instead, which is how a single national buyer gets a better price. New Zealand also negotiates confidential discounts on many brand-name drugs, so its true prices are often lower than shown.