Zolgensma – $2,125,000
Zolgensma received FDA approval in May 2019. It has remained the most expensive drug in the U.S., with a one-time cost of $2.1 million for a course of treatment.
Of the top ten most-expensive Medicare Part B-covered drugs, Keytruda, Opdivo, Rituxan, and Avastin all treat cancer and are administered in a doctor's office. Thus, these medications receive coverage from Medicare Part B.
Level or Tier 4: Nonpreferred brand-name drugs and some nonpreferred, highest-cost generic drugs. Level or Tier 5: Highest-cost drugs including most specialty medications.
Schedule 4 poisons (labelled 'Prescription Only Medicine') include most other medicines for which prescriptions are required – for example, local anaesthetics, antibiotics, strong analgesics (such as Panadeine Forte®) – and that are not classified as Schedule 8 poisons.
At over $7.3 billion, the most expensive drug covered under Medicare Part D is apixaban, brand name Eliquis, which is used for blood clots. In 2019, nearly 2.2 million Medicare beneficiaries used this drug.
Hepatitis C medications approved in March this year have already topped the list of Australia's most expensive drugs, costing the taxpayer $1 billion.
The cephalosporins are among the most expensive antibiotics in use today; thus, use of these expensive agents must be justified by lower toxicity, greater efficacy, or both in comparison with drugs of more reasonable cost.
From 1 January 2023, the Australian Government reduced the general co-payment from $42.50 to $30 (plus any applicable premiums). This means most PBS medicines now cost no more than $30. If you have a concession card, you'll pay $7.30 for a PBS prescription.
Medicines cost pharmaceutical companies a lot to develop. They involve years of research and development, followed by clinical testing and trials to show they are safe and effective. This is one of the reasons new medicines coming onto the market are expensive.
1. Afinitor. Afinitor, a chemotherapy medication used to treat kidney, pancreatic, breast, and brain cancers, is one of the most expensive medications out there—but those with a prescription need to have it for their treatment plan. Often, the duration of treatment with Afinitor is defined by the medical diagnosis.
Zolgensma's multimillion-dollar price tag is a reflection of the multibillion-dollar cost of drug development. According to a 2016 study published in the Journal of Health Economics, it takes, on average, $2.6 billion and over a decade to create a single new drug.
Most Medicare drug plans have a coverage gap (also called the "donut hole"). This means there's a temporary limit on what the drug plan will cover for drugs. Not everyone will enter the coverage gap. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs.
Anabolic androgenic steroids, barbiturates and benzodiazepines (such as diazepam and nitrazepam) are examples of S4Ds.
Schedule 5
Poisonous substances of a dangerous nature commonly used for domestic purposes, such as methylated spirits, kerosene and bleaches which should be readily available to the public but which require caution in their handling, use and storage.
Schedule 8 drugs are 'poisons to which the restrictions recommended for drugs of dependence by the 1980 Australian Royal Commission of Inquiry into Drugs should apply'. These include morphine, hydromorphine, pethidine, methadone, codeine phosphate and oxycodone.
The Pharmaceutical Benefits Scheme (PBS) began as a limited scheme in 1948, with free medicines for pensioners and a list of 139 'life-saving and disease preventing' medicines free of charge for others in the community.
There is a cap of $7.30 for people with a Pension, Concession or Veteran's card. If you have a Veteran's White Card, the lower price only applies for prescriptions for specific conditions. Your doctor can advise if your medicine will be covered by your white card.
o When concession card holders reach the safety net threshold, after 36 full priced concessional scripts, they will receive PBS medicines at no charge for the balance of the year.