State-by-State Medicare Prescribing Rankings

Medicare Part D spending varies enormously across the United States. We ranked all 50 states (plus D.C.) across five key metrics to reveal where prescribing costs are highest, where opioid use is most concerning, and where the most flagged providers operate.

Most Providers

States with the largest Medicare Part D prescriber workforces:

Highest Total Drug Cost

The states where Medicare Part D spending is highest in absolute terms:

Highest Opioid Prescribing Rate

These states have the highest average opioid prescribing rates among their Medicare providers:

Highest Cost Per Beneficiary

States where Medicare Part D costs the most per patient:

Most Flagged Providers

States with the highest number of providers flagged by our risk model:

Best vs Worst States for Opioid Prescribing

The gap between states with the highest and lowest opioid rates reveals stark geographic disparities. The worst state averages 17.1% opioid claims, while the best manages just 10.6% — a 1.6x difference.

The Bottom Line

Across 51 states and D.C., Medicare Part D spent $272.67B on prescription drugs through 1,368,456 providers. The average state opioid prescribing rate is 14.7%, but this masks enormous variation: some states prescribe opioids at more than double the national average. Meanwhile, 6,696 providers have been flagged by our risk model, with heavy concentration in a handful of states.

These rankings underscore the importance of state-level policy interventions. States with high opioid rates and flagged provider counts may benefit most from prescription drug monitoring programs, prescriber education, and enhanced audit oversight.