The 2022 Prescription Drug Report

Healthcare costs in America have risen dramatically over the last several decades. With an expanding and aging population and an increase in chronic illnesses contributing to the rising costs of Medicare and Medicaid and higher out-of-pocket spending, costs are projected to reach $6.2 trillion by 2028. With prescription medication taking up 10% of this spending, more and more Americans are becoming concerned about the cost of their medications.

With this in mind, the healthcare experts here at NiceRx have created this report which will cover spending on prescription drugs by state, both by total annual spending and changes in out-of-pocket spending over recent years. It will also cover the cost of some of the least and most expensive prescription drugs, comparing an average of their prices over the last ten years as well as comparing the US to the rest of the world in spending per capita and deviation from the global median.

Total annual spending on retail prescription drugs by state

Texas spends the most on prescription drugs, a total of over $35 billion in 2019, unsurprising for the state with the second-highest population. This state also has the highest level of cash spending at over $926 million. California comes next, spending a total of $32 billion on medication, almost $745 million of which was cash. California also spends the most on both Medicare and Medicaid.

North Dakota has the lowest total spend of $589.86 million on prescription medications as well as the lowest amount paid for by Medicare. Next is Wyoming, spending a total of $622.54 million on prescription drugs, with cash making up $22 million of the total.








Changes in annual out-of-pocket spending per person 2016-2019

2017-2018 saw the highest annual change in out-of-pocket spending, rising by 3.3%. This could be due to the rise of prescription drug prices during this time, which increased by 4.2%. After this sharp increase, out-of-pocket spending dropped by 0.6% from 2018 to 2019.

Although out-of-pocket prices have decreased year-on-year, dropping by an average of 2.5% between 2015 and 2019, annual price hikes have resulted in a cumulative change of 2.6% for out-of-pocket spending per person between 2015 and 2019. Spending per person also dramatically increased over this time, rising by 28.4%.

Key Annual change spending per person Annual change out of pocket spending per person Annual change price Annual change out of pocket price Cumulative change spending per person Cumulative change out of pocket spending per person

The prices of common prescription drugs

The most expensive



Hepatitis C












The most expensive common prescription drug is Harvoni, used to treat Hepatitis C, with a wholesale acquisition cost of $29,238.50 in 2022, a drop of over $2,500 from $31,752 in 2012. Stelara, for treating those with autoimmune disorders comes second with a wholesale acquisition price of $19,607 as of January 2022, $10,000 more than its 2017 price and $12,145 higher than its cost in 2012.

The least expensive



Thyroid hormone deficiency












The least expensive common prescription drug is Synthroid, prescribed for thyroid hormone deficiency. In January 2022 the drug cost $50 per prescription and has increased by an average of 89.3% over 10 years. Vyvanse for the treatment of ADHD is the second cheapest at $311.50 in 2022, up from $162 in 2012, an average change of 58.1%

The most expensive prescription drugs

1. Zolgensma - Annual cost: $2,125,000

By far the most expensive prescription drug on our list, this prescription gene therapy medication is used to treat spinal muscular atrophy a rare disease that can cause respiratory issues, paralysis and progressive loss of movement. An annual Zogensma prescription costs around $2,125,000, or $177,000 a month.

2. Zokivny - Annual cost: $1,032,480

The second drug on our list to treat a rare and fatal genetic condition, Hutchinson-Gilford progeria syndrome, a condition that causes rapid aging in children. Zokivny, manufactured by Eiger BioPharmaceuticals, combats the buildup of harmful proteins and can extend the lives of those with progeria by up to two and a half years. An annual prescription for this medication is $1,032,480, or $86,040 a month.

3. Danyelza - Annual cost: $977,664

The third drug on our list is used to treat pediatric and adult patients with neuroblastoma in the bone or bone marrow, a rare form of cancer. Danyelza has an annual cost of $977,664, or $81,472 per month.

Changes in drug prices over time 2012-2022

From 2012 to 2022 only one prescription drug on our list has dropped in price, as Harvoni has fallen by an average of 5.3%. The prescription drug with the smallest average increase is Isentress, an antiretroviral used in combination with other medications to treat HIV. The medication has risen in price by an average of 11.5% over the last ten years.

Humulin, a brand of insulin, had the biggest price hike over the last ten years, rising by an average of 1,070.1% from $67 in 2012 to $1,512 in 2022, which is 714.9% more than the prescription drug with the second-biggest increase, Renvela. This drug is used for treating chronic kidney disease and has increased by an average of 355.1% over the last ten years, with a rise of 235.7% over the last five.

Median Cost



Treatment or

Jan 2012

Dec 2017

Median Gross
Price Jan 2022


Global retail pharmaceutical spending per capita

The country with the lowest level of individual spending on prescription drugs is Sweden at $351. This is just over three times less than the US, with the highest individual spend of $1,011 per person. This is followed by Switzerland at $783.

Global drug price deviations

According to the Medbelle Medicine Price Index, a study comparing the average costs of 13 generic pharmaceutical compounds as well as their branded alternatives in 50 countries, the US has the highest overall rate of inflation compared to the global median average at 307%. The highest standard deviation for an individual prescription drug was 2,683% for Zestril, a blood pressure medication.

Next is Germany with a standard deviation of less than half than that of the US at 126% of the global median price. Ventolin is the prescription drug with the highest deviation in this country at 273% and Zestril has the lowest, 2=% below the median price. The UAE comes third with an average deviation of 122%.

Overall, Thailand has the least expensive prescription medications, 94% below the average median price, its highest deviation from the global median price is Prograf at 85.5%, an immunosuppressant used with a combination of other medicines to lower the risk of organ rejection in transplant patients. Next is Kenya, with -94% of the average median price, followed by Malaysia with -91%.

Key Branded drug Pharmaceutical Compound Deviation














Insulin Glargine




Drospirenone /











% Average
Deviation from
Median Price


Total annual spending on retail prescription drugs by state was taken from KFF data on retail sales for prescription drugs filled at pharmacies by payer in 2019.

Changes in annual out-of-pocket spending per person 2015-2019 were sourced from the Healthcare Cost Institute’s 2019 healthcare cost and utilization report.

The prices of common prescription drugs for January 2022 were taken from the 46Brooklyn.

Changes in drug prices over time 2012-2017 were taken from the ECBI report on trends in prices of popular brand-name prescription drugs in the united states.

Global retail pharmaceutical spending per capita was taken from The Commonwealth Fund.

Global drug price deviations were taken from Medbelle’s 2019 Medicine Price Index.