Medicare Part D Spending by State: Who Pays the Most?
Data sourced from CMS Medicare Part D Public Use Files (2023). This site provides statistical analysis for transparency — not medical advice or accusations.
Read our methodology →Medicare Part D spending varies dramatically across states — driven by population size, drug prices, prescribing culture, and specialty mix. Here's where the money goes.
$275.65B
Total Part D Spending
62
States & Territories
$102.35B
Top 5 States Combined
37%
Share of Top 5
Total Spending Rankings
The top 20 states by total Medicare Part D drug cost:
| # | State | Total Cost | Providers | Claims | Cost/Bene |
|---|---|---|---|---|---|
| 1 | California | $27.10B | 139,057 | 145,933,465 | $1,259 |
| 2 | New York | $22.46B | 104,092 | 105,457,976 | $1,510 |
| 3 | Florida | $20.29B | 93,928 | 124,178,397 | $1,103 |
| 4 | Texas | $19.28B | 92,813 | 108,209,524 | $1,266 |
| 5 | Pennsylvania | $13.21B | 64,171 | 79,288,106 | $1,264 |
| 6 | Ohio | $10.85B | 53,444 | 67,564,944 | $1,219 |
| 7 | North Carolina | $9.76B | 44,019 | 57,197,675 | $1,278 |
| 8 | Michigan | $9.40B | 46,434 | 55,143,115 | $1,257 |
| 9 | Illinois | $9.23B | 53,002 | 55,742,149 | $1,195 |
| 10 | Georgia | $8.63B | 36,843 | 50,501,774 | $1,316 |
| 11 | New Jersey | $7.73B | 36,308 | 39,615,037 | $1,343 |
| 12 | Massachusetts | $7.22B | 39,945 | 36,573,366 | $1,323 |
| 13 | Tennessee | $6.89B | 29,129 | 42,290,238 | $1,306 |
| 14 | Indiana | $6.29B | 26,170 | 37,495,510 | $1,347 |
| 15 | Missouri | $5.75B | 25,377 | 37,581,911 | $1,315 |
| 16 | Virginia | $5.55B | 32,413 | 33,782,359 | $1,146 |
| 17 | Alabama | $5.09B | 17,811 | 30,584,451 | $1,386 |
| 18 | Arizona | $4.97B | 29,429 | 28,675,667 | $1,034 |
| 19 | South Carolina | $4.89B | 21,448 | 28,268,967 | $1,250 |
| 20 | Kentucky | $4.89B | 19,073 | 31,289,707 | $1,392 |
Per-Capita Spending: A Different Picture
Total spending is dominated by large states. Per-beneficiary spending tells a different story — revealing where Medicare pays the most per person:
| # | State | Cost/Bene | Total Cost | Opioid Rate |
|---|---|---|---|---|
| 1 | District of Columbia | $1,718 | $635.5M | 16.0% |
| 2 | Alaska | $1,518 | $393.3M | 15.4% |
| 3 | New York | $1,510 | $22.46B | 13.7% |
| 4 | Virgin Islands | $1,470 | $32.8M | 7.4% |
| 5 | Vermont | $1,442 | $546.6M | 10.6% |
| 6 | Kentucky | $1,392 | $4.89B | 14.4% |
| 7 | Oklahoma | $1,387 | $3.10B | 14.8% |
| 8 | Alabama | $1,386 | $5.09B | 16.6% |
| 9 | West Virginia | $1,359 | $1.86B | 12.4% |
| 10 | Indiana | $1,347 | $6.29B | 15.6% |
| 11 | New Jersey | $1,343 | $7.73B | 13.8% |
| 12 | Connecticut | $1,342 | $3.96B | 15.3% |
| 13 | Hawaii | $1,331 | $931.1M | 14.3% |
| 14 | Massachusetts | $1,323 | $7.22B | 14.3% |
| 15 | Georgia | $1,316 | $8.63B | 14.6% |
Cost Growth: Who's Growing Fastest?
Medicare Part D spending grew approximately 50% nationally from 2019 to 2023. But some states grew much faster:
| # | State | Growth | 2019 Cost | 2023 Cost |
|---|---|---|---|---|
| 1 | Alaska | +61.3% | $243.9M | $393.3M |
| 2 | Puerto Rico | +60.8% | $1.80B | $2.90B |
| 3 | Massachusetts | +57.8% | $4.58B | $7.22B |
| 4 | Maine | +57.6% | $935.0M | $1.47B |
| 5 | Minnesota | +57.5% | $2.51B | $3.96B |
| 6 | Vermont | +57.1% | $347.8M | $546.6M |
| 7 | Utah | +55.9% | $938.1M | $1.46B |
| 8 | Idaho | +55.7% | $775.4M | $1.21B |
| 9 | Louisiana | +55.6% | $2.91B | $4.53B |
| 10 | Alabama | +55.5% | $3.28B | $5.09B |
| 11 | Iowa | +54.9% | $1.56B | $2.42B |
| 12 | Arkansas | +54.4% | $1.65B | $2.55B |
| 13 | Kentucky | +54.3% | $3.17B | $4.89B |
| 14 | Georgia | +54.1% | $5.60B | $8.63B |
| 15 | Nevada | +53.9% | $1.22B | $1.88B |
Opioid Spending by State
Opioid prescribing rates are a key driver of both health outcomes and costs. States with the highest average opioid prescribing rates:
| # | State | Avg Opioid Rate | High-Rate Providers | Opioid Claims |
|---|---|---|---|---|
| 1 | Armed Forces Pacific | 25.1% | 13 | 1,721 |
| 2 | Foreign/Unknown | 21.2% | 12 | 1,952 |
| 3 | Unknown | 17.7% | 2 | 589 |
| 4 | Utah | 17.1% | 1,343 | 495,572 |
| 5 | Colorado | 17.1% | 2,670 | 904,735 |
| 6 | Missouri | 17.0% | 2,493 | 1,534,469 |
| 7 | Alabama | 16.6% | 2,064 | 1,650,802 |
| 8 | Armed Forces Europe | 16.4% | 10 | 1,227 |
| 9 | Arizona | 16.0% | 2,548 | 1,191,278 |
| 10 | District of Columbia | 16.0% | 296 | 51,430 |
| 11 | Kansas | 15.8% | 1,249 | 645,898 |
| 12 | Louisiana | 15.7% | 2,195 | 1,228,936 |
| 13 | Maryland | 15.6% | 2,039 | 823,164 |
| 14 | Ohio | 15.6% | 5,139 | 2,196,252 |
| 15 | Idaho | 15.6% | 792 | 402,781 |
Key Takeaways
- • California, Florida, and New York dominate total spending due to population
- • Per-capita spending tells a different story — smaller states often pay more per beneficiary
- • Southern states consistently have higher opioid prescribing rates
- • Cost growth varies by 2-3x between the fastest and slowest-growing states
- • Geographic variation suggests prescribing culture matters as much as demographics
These state-level patterns have policy implications: federal programs apply uniform rules, but the data suggests state-specific interventions might be more effective. Explore individual state profiles for deeper analysis.
Explore State Data
Related Analysis
Geographic Prescribing Disparities
GeographyRural Prescribing Problem
GeographyState-by-State Prescribing Rankings
OpioidsThe Opioid Prescribing Crisis in Medicare