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What are the most expensive prescriptions in the United States?

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Most costly drugs listWhat affects costs?Reducing costsSummary
Zolgensma, a gene therapy for spinal muscle atrophy or muscle thinning, has a price tag of more than $2 million for one dose. Other medications can come close to $1 million.
Medically reviewed by Monica Kean, PharmD
Written by Charlotte Parker
Updated on

As prescription prices continue to rise, individuals and their families often have to cope with the financial and emotional stress of trying to afford essential medications.

In fact, a 2021 study found that the average prescription costs in the United States are 256 times greater than those in 32 other countries.

Most expensive drugs

Pills and capsules covering a dollar bill as we look at the most expensive drugs
Cagkansayin/Getty Images

Below, we look at some of the most expensive medications.


Priced at over $2 million for a single dose, Zolgensma is prescribed to treat spinal muscular atrophy. It is a groundbreaking form of gene therapy that offers potential long-term benefits. For some people, this can justify its high cost by offsetting lifelong treatments.


Costing around $850,000 for both eyes, Luxturna provides a new treatment for a rare inherited retinal disease, called biallelic RPE65 mutation-associated retinal dystrophy. It is the first gene therapy for a genetic disease that’s been approved by the Food and Drug Administration (FDA).


Ravicti is priced at approximately $790,000 annually. It helps manage urea cycle disorders by removing ammonia from the bloodstream.


Actimmune costs $572,000 annually. Doctors prescribe it for chronic granulomatous disease (a genetic disorder affecting white blood cells) and severe, malignant osteopetrosis (a group of bone disorders). This medication belongs to a class of drugs called interferons.

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With a price tag of $500,000 per year, Soliris treats some rare conditions by reducing the destruction of red blood cells.


Takhzyro, with an annual cost of around $450,000, treats hereditary angioedema by preventing episodes of swelling.


Brineura treats a specific form of Batten disease, a rare neurological disorder. It costs about $730,000 annually.


Myalept is priced at $300,000 annually. It addresses complications of a deficiency in leptin (a hormone related to hunger) in people with generalized lipodystrophy.


Gattex costs around $295,000 per year. It is used to help manage short bowel syndrome.


Blincyto is used to treat a form of leukemia. It is priced at $173,000 for a standard 28-day course of treatment.

Factors affecting prescription drug costs

Understanding prescription drug pricing is important, especially when you are trying to make the best decisions for your health while also managing expenses.

Several factors can influence the price you pay for prescription medications:

  • Research and development: Pharmaceutical companies invest significant resources into the research and development of new drugs. This process can take years and involves multiple stages of testing to make sure a medication is safe and works properly. This is often the reason given for the high cost of newly developed drugs.
  • Patent protection: When a new drug is patented, it blocks other companies from creating generics, allowing the original company to set the price. A new patent typically lasts for 20 years. Once the patent ends, prices usually come down.
  • Manufacturing costs: The complexity of producing some medications — especially biologics, which are drugs made from living organisms — can be high. These costs get passed to the people prescribed the medication.
  • Insurance coverage: Whether you have health insurance and what sort you have plays a significant role in determining your out-of-pocket costs. Depending on your plan, you might have copays, deductibles, or coinsurance that affect the final amount you pay. Your plan might not cover some drugs at all, or they might be on a higher pricing tier, leading to higher costs.
  • Regulatory environment: The Biden-Harris Administration is taking steps to reduce prescription drug costs by allowing Medicare to negotiate prices directly. Starting with 10 major medications, the plan aims to expand to 60 drugs over 4 years, with over 20 added each year. These measures challenge large pharmaceutical companies’ (sometimes called Big Pharma) pricing and aim to ease the financial burdens for people who need these medications.
  • Demand and competition: If a drug is designed to treat a rare condition, it might be priced higher because demand will naturally be low. Conversely, if there are multiple treatment options for a condition or generic versions of the medication available, competition might drive prices down.
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How can you reduce the cost of expensive prescriptions?

A poll by the Kaiser Family Foundation in July 2023 revealed that over a quarter of Americans have difficulty affording their prescription medications. With their rising costs, it is more important than ever to explore different ways to manage and potentially reduce your prescription expenses.

Here are some effective ways:

  • Understand your insurance formulary: If you have insurance that covers prescription drugs, it’s helpful to familiarize yourself with its formulary, or drug list. This list groups drugs into tiers, which determine your out-of-pocket costs. Typically:
    • Tier 1: This level includes generic drugs and possibly some brand-name drugs, often with minimal copayments.
    • Tier 2: This tier encompasses a broader range of brand-name medications preferred by the insurer and some higher-priced generics.
    • Tier 3: This group consists of nonpreferred drugs, which might have higher copayments or coinsurance. If you require a medication from a higher tier or one not listed, consider discussing coverage exceptions with your insurer.
  • Check out prescription assistance programs: For households with limited incomes, state pharmaceutical assistance programs can offer financial support. The National Conference of State Legislatures provides a list of these programs by state.
  • Get the Optum Perks Discount Card: This free card can save you up to 80% on prescription drug costs. The Optum Perks Mobile App, available for both iOS and Android, makes it easy to store and share your drug coupons.
  • Consider generic drugs: Once the patent for a brand-name drug expires, other manufacturers can produce generic versions with the same active ingredients. These generics tend to be cheaper because the initial research and testing have already been done.
  • Look for manufacturer discounts: Some drug manufacturers offer exclusive discounts on their medications, which can sometimes be more cost-effective than insurance.
  • Buy in bulk: Purchasing a larger quantity of medication can lead to bigger discounts and ensures a longer supply.
  • Use mail-order pharmacies: These offer potential savings and are especially convenient for people in rural areas.
  • Try subscription services: Some pharmacies offer a lower price if you use their subscription services for medications that you require regularly.


The cost of prescription drugs in the United States, especially for unique and cutting-edge treatments, can be overwhelming. Keeping informed and taking active steps to manage these expenses can help you can get the treatments you need without added financial stress.

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