What Your Prescriptions Cost
How much do generic drugs cost with Medicare?
Last reviewed: · Big Sioux Benefits Data Desk
Very little, and the gap between generics and brand-name drugs is larger than most people imagine. Medicare Part D spent an average of $10.75 per claim on atorvastatin and $8.93 per claim on metformin in 2025 (CMS Part D spending data). Those are the two most widely used drugs in the entire program, taken by 18.5 million and 5.8 million Medicare beneficiaries respectively.
The qualifier: at those prices, your cost is usually driven by your plan's tier copay rather than by the drug's price, because the drug barely costs anything. Many plans place preferred generics on a tier with a small flat copay, and many exclude that tier from the deductible entirely. So the question for a generic is not what the drug costs, it is what your plan charges for its lowest tier.
Generics against brand-name drugs
| Drug | Average Part D spending per claim, 2025 | Approximate cost for a year |
|---|---|---|
| Metformin (generic, diabetes) | $8.93 | About $36 per beneficiary |
| Atorvastatin (generic, cholesterol) | $10.75 | About $44 per beneficiary |
| Eliquis (brand, blood clots) | $399.01 in Q1 2026 | Thousands |
| Ozempic (brand, type 2 diabetes) | $1,302.82 | About $7,900 per beneficiary |
Two things follow. If everything you take is generic, the $2,100 out-of-pocket cap will almost certainly never come into play for you, and the plan features worth comparing are the monthly premium and the preferred generic tier copay, not the cap or the coinsurance percentage. And if you take one brand-name drug among several generics, that single drug is driving essentially your entire drug budget, which makes it the one worth discussing with your prescriber and checking against the negotiated price list.
Sources
- CMS — Medicare Part D Spending by Drug — CY2025 full year and CY2026 Q1 files; accessed 2026-08-21
- Medicare.gov — Costs for Medicare drug coverage — accessed 2026-08-21
- CMS — Announcement of Calendar Year 2026 Medicare Advantage Capitation Rates and Part C and Part D Payment Policies (Part D benefit parameters) — CY2026 parameters; accessed 2026-08-21
Related questions
Are generic drugs as good as brand-name drugs?
The FDA requires generics to have the same active ingredient, strength, dosage form, and route of administration as the brand, and to demonstrate bioequivalence. Whether a generic is right for you is a question for your prescriber and pharmacist, particularly for narrow therapeutic index drugs where small differences matter more.
If my drugs are all generic, do I still need a Part D plan?
Usually yes, for two reasons. Going without creditable drug coverage builds a permanent late enrollment penalty that grows every month you go uncovered. And coverage protects you against a future expensive prescription you cannot predict today, which is exactly when the $2,100 cap becomes valuable.
Drug costs turn on your specific prescriptions, so the arithmetic is worth doing once, properly: book a free, no-pressure conversation, see your county's South Dakota plan lineup, or browse all answers. SHIINE, the state's free counseling program, is at 1-800-536-8197 and sells nothing.
Big Sioux Benefits is a licensed insurance agency, not affiliated with or endorsed by the U.S. government or the federal Medicare program. We do not offer every plan available in your area. Contact Medicare.gov, 1-800-MEDICARE, or SHIINE (South Dakota's SHIP) for all of your options.