The State of Prescribing: 2023 Report Card

2023 was a record year for Medicare Part D. $275.65B in drug costs across 1,380,665 prescribers — up 51% from 2019. Here are the ten most important things the data tells us.

1. Drug Costs Hit $275.6 Billion

Part D spending has increased every single year, from $183.05B in 2019 to $275.65B in 2023 — a 51% increase in five years. At this rate, Part D will exceed $350 billion by 2027.

2. The Prescriber Workforce Grew 11%

From 1,240,595 to 1,380,665 prescribers in five years. Most of this growth comes from Nurse Practitioners and Physician Assistants, who now outnumber any single physician specialty.

3. Eliquis Is King — at $7.75 Billion

The blood thinner Eliquis (apixaban) is the most expensive drug in Part D by a wide margin. At $7.75B, it costs more than the next two drugs combined. See all drug rankings →

4. GLP-1 Drugs Are the Fastest Growing Category

Ozempic, Trulicity, and Mounjaro have collectively tripled in cost since 2019. They now account for over $8 billion annually — and Medicare hasn't even started widely covering weight-loss indications yet. Read our GLP-1 analysis →

5. One-Third of Prescribers Write Opioids

450,343 providers prescribed opioids in 2023 — 33% of all prescribers. While the opioid prescribing rate has been declining since the late 2010s, it remains remarkably persistent.

6. The Top 5 States Spend More Than Some Countries

7. Brand Drugs: 13% of Volume, 67% of Cost

Brand-name drugs account for just 13.4% of prescriptions but 67% of total spending. Every 1% shift from brand to generic saves roughly $1.5 billion. Brand vs generic analysis →

8. 372 Excluded Providers Still Active

Despite being on the OIG's exclusion list for fraud, abuse, or other offenses, 372 providers appeared in 2023 prescribing data. This represents a persistent gap in CMS enforcement. See excluded providers →

9. Machine Learning Found 2,579 Providers Rules Missed

Our ML model, trained on confirmed fraud cases, identified 4,100+ suspicious prescribers. Of these, 2,579 were not flagged by our rule-based scoring — suggesting significant blind spots in traditional approaches. ML fraud detection →

10. The Opioid Geography Hasn't Changed

The same states that led in opioid prescribing five years ago still lead today:

The Bottom Line

Medicare Part D is getting more expensive, more complex, and more reliant on high-cost specialty drugs. The IRA's drug price negotiation provisions are a start, but at current growth rates, they'll barely dent the trajectory. Meanwhile, opioid prescribing patterns remain stubbornly persistent, and fraud detection still has significant gaps.

Transparency is the first step. That's why we build tools like OpenPrescriber — to make this data visible, searchable, and actionable for everyone.