Oncology is crowding out everything else
Cancer immunotherapy leads the top 10 and shows no sign of slowing. When spend concentrates in a handful of checkpoint inhibitors, it becomes a policy target.
New report · CMS Part B drug spending
The Drugs Driving Medicare Spending and Where Care Is Moving
Part B drug spending is on pace for roughly $58 billion in 2025, outrunning the Medicare program as a whole. We mapped the drugs behind that growth, the treatments quietly shifting out of hospital infusion suites, and the utilization management pressure landing next on providers.
A strategic analysis for home infusion and post-acute care providers · Based on CMS Quarterly Drug Spending Data, 2024 full year & 2025 Q1–Q3.
- $58.0B 2025 annualized Part B drug spend, excluding skin substitutes
- +9.5% year-over-year growth, ahead of the ~7.7% Medicare-wide rate
- ~10¢ of every Medicare drug dollar now flows to a single oncology drug
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What the data shows
Three forces are reshaping where drug spend lands
The full report breaks each one down drug by drug. Here’s the shape of it, and a few of the numbers that made us write it.
Section 1 · The biggest spenders
One drug is now 10 cents of every Medicare drug dollar
KEYTRUDA is on pace to top $6.3 billion in 2025 — the single largest drug in Medicare, with checkpoint inhibitors clustered right behind it.
Two drugs broke into this year’s top 10, pushing two others out. The full ranking shows every spend figure, per-claim price change, and which drugs are gaining ground — including the ophthalmology shake-up quietly rearranging the middle of the list.
Section 2 · The battleground for cost control
The treatments leaving the hospital suite
VYVGART HYTRULO grew +235% and is designed for home or office administration from day one — the highest-priority near-term opportunity we found.
Alongside it: a quarterly injection at roughly $74,000 a dose where a 10–20 patient panel can mean $3M–$6M in annual revenue. The report profiles nine shift-ready drugs, split into high and moderate potential, with dosing schedules, per-patient economics, and where payers are steering the volume.
Section 3 · Utilization management risk
The drugs payers will tighten first
We scored every drug on four factors — total spend, per-claim cost, growth rate, and whether a cheaper alternative exists — and sorted them into Critical, High, and Moderate risk.
The critical tier is anchored by the largest drug in Medicare and a pair of overlapping immunotherapies where payers will enforce preferred-agent policies. For providers, that translates directly into prior-auth burden and shifting coverage. The full landscape names each drug and the specific driver behind its risk.
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The full analysis, free to read.
Twelve pages of CMS-sourced analysis built for home infusion and post-acute care leaders.
