There were 977 price changes on brand drugs in January 2025. Here are all the details.
As a non-profit, we at 46brooklyn have made it our goal to provide insights into U.S. drug pricing data available in the public domain based upon the figures we’ve gathered over the prior month. This month is of course no different – reviewing the latest drug pricing changes from January 2025.
The latest news
Just like the end of the year is a great time to reflect on what has happened over the last 11 months, the beginning of the year is also a fantastic time to focus on the year ahead and what can be done to make it better than the previous year. In order to do so, taking a quick peek back at the previous 46brooklyn January 2024 drug pricing data would not hurt as we seek to contextualize the early 2025 drug price swings against last year’s action. This time last year, we not only reignited our passion for doing these monthly reports that track brand manufacturer list price and generic drug acquisition cost changes, but we also reported some massive brand drug list price decreases (ex. Lantus SoloStar, Novolog FlexPen dropping by around 75%), a smattering of heavy increases (ex. Ferriprox, Verkazia both eclipsing 20% increases), and more of the typical beginning-of-the-year list price patterns we’ve been observing for the last decade-plus.
A New Year brings new challenges as well as new goals. Many people use the start of a new year to focus on themselves, which typically includes eating healthier and losing weight. Weight-loss medications like Zepbound and Wegovy have been booming since their approvals in 2023 and 2021 respectively. However, instead of starting the year off with a bang, Zepbound ended 2024 with a new FDA approval for obstructive sleep apnea (OSA).
Adding a new indication can extend the patent life of a medication like Zepbound, which often means improved returns on investment through prevention of exclusivity loss. Understandably, the incentives are such that pharmaceutical companies seek out ways to extend the time their product has exclusivity in the market. The lifecycle of a medication typically consists of three main stages launch (introduction), maturity (growth), and end of life (decline). The approval of new indications for brand-name medications is an act that seeks to balance innovation with economic impact. On one hand, it extends patent life, delaying generic and biosimilar competition, which can prolong high costs for the healthcare delivery system and limit affordability. On the other hand, through the added incentives to build upon already-existing research, these expanded uses can provide public health benefits, offering new treatment options for patients with conditions that previously lacked effective therapies. While this practice may strain budgets with varying degrees of actual yielded value, it also has the possibility of enhancing patient outcomes. The societal challenge lies in fostering both affordability and continued medical advancement in a semi-balanced way (e.g. sacrificing affordability for advancement will not actually lead to advancements if no one can take the medications).
Although a medication has been FDA-approved, that does not mean the clinical research stops. For example, Phase 4 clinical trials are carried out after a drug has been approved by the FDA and is available to the public. The Phase 4 clinical trials are post-marketing studies that are conducted to monitor the safety of a medication in addition to potentially achieving label expansions or new indications. Sometimes there are “happy little accidents” that are discovered about a medication with widespread usage, which can lead to a new indication. For example, Lumigan is an eye drop that was initially approved to treat glaucoma, but it was found to increase eyelash growth, which spurred a new medication, Latisse, both from the same pharmaceutical company, ALLERGAN.
Zepbound is a blockbuster medication, which generally means that it is an extremely popular drug that generates at least $1 billion in annual sales for the company that sells it. In the instance of Zepbound, we recently learned that Eli Lilly pulled in $1.9 billion off the drug’s sales in just the last quarter of 2024 alone. This medication has become so popular due to the significant amount of weight loss that people on the medication can achieve (along with other follow-on benefits); however, the popularity of the medication caused a prolonged drug shortage. Right around the same time the FDA approved Zepbound for OSA, they also declared that the drug shortage for the product had ended. In an effort to make their weight-loss medication more affordable for self-pay patients, Lilly just announced last week the launch of 7.5 mg and 10 mg Zepbound single-dose vials, available for $499 in addition to also reducing the price of the 2.5 mg and 5 mg vials. There’s an old saying “when there’s a will there’s a way.” This quote is very relatable in the drug pricing world, whether it is the pharmaceutical manufacturer wanting to make their medication more affordable or a patient’s willingness to pay for a medication that they perceive as important and valuable.
The Cliff Notes from last month’s drug price changes
There were a net 963 brand drug list price increases in January. As we’ve already discussed some of the January brand activity a few weeks ago, we’ll try not to revisit what we’ve already discussed, but we typically see price changes all over the board – some of which can impact small dollars (either on a claim basis or in the aggregate [due to low utilization or an already-existing low cost]), whereas others can be hugely impactful (even if the price increase is small). In January, some medications have as low as a 0.5% price increase, whereas others have an increase of up to 52%. Depending on the price of a medication, even a small overall percentage increase could be substantial enough to be thousands or even millions of dollars compounded over time.
In January, seven medications took a price decrease, which was an improvement from even the last two months of 2024, where we had zero brand list price decreases in December and only two decreases in November. As we know though, list price changes can affect rebates and other related discounts; therefore if the list price of a brand medication goes down, so do the rebates and discounts that the drug manufacturer offers as well.
Some of the biggest and/or most interesting movers to take note of for January 2025 (that we haven’t already talked about) were:
Stelara Solution for Injection (4.7% WAC increase; impacting $1.5 billion in gross prior year Medicaid expenditures, or PYME)
Revcovi (4.5% increase; $43.7 million PYME)
Nexavar oral tablet (-50.0% decrease; $3 million PYME)
Januvia oral tablet (-42.4% decrease; $591 million PYME)
Janumet oral tablet (-42.4% decrease; $131 million PYME)
Janumet XR oral tablet, extended-release (-42.4% decrease; $40 million PYME)
Bear in mind that as you read those numbers, that they are the prices before drugmaker rebates, which as we know are growing significantly over time and are at their largest amounts in the Medicaid and 340B programs.
On the generic side of the coin, year-over-year (YoY) generic oral solid price is at 19%. More generic drugs decreased than increased in cost in January 2025; however, the scale of change has been moderating. We attribute this change to ‘smoothing’ CMS undertook in December 2024 and anticipate that large swings in generic pricing will be less likely to occur so long as smoothing remains a part of the methodology (regardless of whether generics are getting much cheaper or not). Consider that the NADAC help desk allows pharmacies to petition for real-time changes in price. As you might imagine, these are basically all requests for NADAC price increases, based upon things product shortages (i.e., faster NADAC price increases than the methodology would otherwise allow). This seem reasonable for a survey that takes a couple months to run. However, there is now no corresponding rapid decline lever for NADAC (if we observe a rapid decline in price, that observation will need to compound over three months before it shows up in the survey). Payers using NADAC for reimbursement methodology may want consider what these delayed savings mean for their finances going forward.
It can be hard to know what changes will occur from one month to the next especially when it comes to medications so, now that the New Year is well underway, and everyone has gotten their drug price increases out of the way, stay tuned next month where medications with (drug price increase) FOMO decide to make some changes.
What we saw from brand-name medications in November
1. A large number of brand drug list price changes, even for a January
There were a total of 970 brand-name medications that saw wholesale acquisition cost (WAC) price increases in January and seven that took decreases, which is featured and contextualized in our Brand Drug List Price Change Box Score, which pulls WAC pricing data from Elsevier.
Price changes this month ranged from -50.7% to +51.5%.
As a reminder, brand price increases in Medicaid are largely held in check thanks to the Medicaid Drug Rebate Program (MDRP), which includes rebate penalties for drug price increases that occur faster then the rate of inflation. Medicare now has similar cost containment provisions. Commercial employers and cash-paying patients may lack protections from price increases – especially those that occur faster than the rate of inflation.
This is one of a number of reasons that solely analyzing brand list price changes provides an incomplete picture of what’s really happening with brand manufacturer economics, thanks to the growing lot of opaque rebates, discounts, and giveaways that drugmakers shave off those list prices. But alas, until drugmakers, PBMs, insurers, wholesalers, 340B covered entities, and rebate aggregators make more granular data on net prices public, we’ll continue working with what we’ve got.
2. Brand price trends over time
To help contextualize brand name drug list price increase behavior, we find it beneficial to review past trends. In comparison to the data from prior months of January, this year’s net (combined increases and decreases) January price changes seem to line up more with 2023 than 2024. In January 2024, there were a net 896 brand price increases, and in January 2023, there were a net of 986 brand price increases. In January 2025, there were a net of 963 brand price increases.
The highest number of net price increases occurred in January 2023, which means that January 2025 is now the second highest January (at least, as contextualized within the dashboard).
To put it into a more recent perspective (over the last five years) here are the net price increases for each January per year:
January 2025: 963 net brand price increases
January 2024: 896 net brand price increases
January 2023: 986 net brand price increases
January 2022: 831 net brand price increases
January 2021: 657 net brand price increases
January 2020: 614 net brand price increases
Figure 1
Source: Elsevier Gold Standard Drug Database, CMS State Drug Utilization Data, 46brooklyn Research
Of course, we should note that it used to be more common to take price increases twice per year, so in some instances, comparisons to past Januarys miss some of the context.
Further examining our brand drug box score visualization, we know that January is increasingly the time of year when most of the brand list price activity occurs. In an era of increasing scrutiny of drug prices, the growth in the number of price increase events is itself noteworthy, but we need to understand the corresponding degree of price increases to better contextualize these changes (i.e., if 100 drugs take a 10% increase, is that more or less impactful than if 1,000 drugs take a 1% increase?).
When we look at the level of price increase change that is occurring, we see a return to normal course of business. As we wrote about last year, 2024 was interesting when attempting to contextualize drug prices, as some pretty significantly used brands (e.g., insulins and inhalers) took price decreases which made our weighted view of brand list price changes go a little wacky. Well, at the start of this year, while there are still some decreases (seven as previously identified), those drugs that are declining are not as significantly utilized as others, and the brand list price changes that are occurring look very similar to past years. In other words, when we identified earlier that the number of brand list price changes in January 2025 looked more like 2023 than 2024, we can also say that the behavior of the degree of list price changes seems more like 2023 than 2024. The average list price change is approximately 4-5% (depending upon which way we try to contextualize price – see Stat Boxes 3 & 4 on in the dashboard; Figure 1 above). This early 2025 behavior is much more like what 2023 was than what 2024 observations were.
3. Brand drug list price changes worth taking note of in January
We identify drugs worth taking note of in a couple different ways. Primarily, we look for medications with a lot of prior Medicaid expenditures (not that Medicaid is the end-all-be-all, but it is the only program that regularly publishes past utilization with some decent granularity). We next look for drugs with large pricing changes (+/- 10%). And finally, we look for drugs that are interesting for us either because we’ve previously written on them or because we find them of unique clinical value. We’ve already looked at the brand drug price increases in early January and don’t see a reason to re-hash those examples. Instead, we’ll focus on some drugs we haven’t already talked about:
Stelara took a 4.7% WAC list price increase, impacting $1.5 billion in gross prior year Medicaid expenditures (PYME). Stelara is noteworthy, as this year, we expect several biosimilars to launch. Will Stelara go the way of Humira whereby biosimilar adoption is delayed by a year by payers and/or PBMs? Or will we see a quicker shift to biosimilar Stelara? Time will tell.
Revcovi took a 4.5% WAC list price increase, impacting $43.7 million in PYME. However, the average gross cost per prescription in Medicaid for this drug is roughly $200K, which means this WAC list price increase is anticipated to add roughly $9K in gross cost per prescription. This is the highest added gross cost per Rx for the brand drugs that took price increases in January 2025.
Nexavar took a 50% WAC list price decrease, impacting $2.6 million in PYME. A generic version launched in 2022, so the significance of this list price may be low, given the utilization is likely shifting to generic anyway.
Januvia & Janumet & Janumet XR took a 42.4% WAC list price decrease, impacting $763 million in PYME for the combined drugs. As part of the Inflation Reduction Act, Medicare negotiated a 79% price cut for Januvia, a drug used to treat Type 2 diabetes. The new price will take effect in January 2026, so perhaps Merck is slowly walking the price down to get closer to that net IRA level? (baseless speculation on our part)
What we saw from generic medications in January
4. A relatively favorable, unweighted price change picture
Each month, we look at how many generic drugs went up and down in the latest month’s survey of retail pharmacy acquisition costs (based on National Average Drug Acquisition Cost, NADAC), and compare that to the prior month (Figure 2).
Basically, the quick way to read Figure 2 is to look for orange bars that are taller than blue bars to the left of the blue line, and exactly the opposite to the right of the line. That would indicate a good month – more generic drugs going down in price compared to the prior month, and less drug prices going up.
Figure 2
Source: Data.Medicaid.gov, 46brooklyn Research
In looking at the above, for every generic drug that increased in price this past month, 1.3 decreased in price – a largely favorable view of generic drug price decreases. But as usual, take this unweighted price change analysis with a grain of salt. To really make heads or tails of all of these pricing changes, let’s weight these changes.
5. Weighted Medicaid generic drug costs come in at $12 million in deflation
The purpose of our NADAC Change Packed Bubble Chart (Figure 3) is to apply utilization (drug mix) to each month’s NADAC price changes to better assess the impact. We use Medicaid’s 2020 drug mix from CMS to arrive at an estimate of the total dollar impact of the latest NADAC pricing update. This helps quantify what should be the real effect of those price changes from a payer’s perspective (in our case Medicaid; individual results will vary).
The green bubbles on the right of the Bubble Chart viz (screenshot below in Figure 3) are the generic drugs that experienced a price decline (i.e. got cheaper) in the latest survey, while the yellow/orange/red bubbles on the left are those drugs that experienced a price increase. The size of each bubble represents the dollar impact of the drug on state Medicaid programs, based on utilization of the drugs in the most recent trailing 12-month period (i.e. bigger bubbles represent more spending). Stated differently, we simply multiply the latest survey price changes by aggregate drug utilization in Medicaid over the past full year, add up all the bubbles, and get the total inflation/deflation impact of the survey changes.
Figure 3
Source: Data.Medicaid.gov, 46brooklyn Research
Overall, in January, there was $32.2 million worth of inflationary drugs, with a offset of $44.5 million of deflationary generic drugs, netting out to approximately $12.2 million of generic drug cost deflation for Medicaid.
One of the things that stands out to us in looking at Figure 3 is the monochrome colors of either the deflation or inflation side of the coin. As we noted recently, in December 2024, CMS changed the methodology for calculating NADAC to add a smoothing effect (whereby the reported value is the average of the last three months). We’re potentially seeing the effect of that smoothing in Figure 3, as for the first time, there is really only pale yellow on the inflation side (no oranges or reds) and only pea-soup green on the deflation side (a few forest and darker greens, but not many). We speculate that for as long as CMS maintains this smoothing methodology, our bubble chart viz will less colorful each month as we update it. These changes don’t just impact the color scheme of our tool; they also mean that NADAC’s more rapid responses to changes in marketplace conditions (for better or worse) has been muted to a degree.
6. Year-over-year generic oral solid deflation at 19.1%
Ever since June 2020, we have been tracking year-over-year generic deflation for all generic drugs that have a NADAC price. We once again weight all price changes using Medicaid’s drug utilization data. This month, deflation on oral solid generics and all generics was at 19.1% and 14.7%, respectively (Figure 4). If you are a purchaser of generic drugs, an increase in this metric is ideal as it means costs are declining. This is right in line with the NADAC packed bubble chart, which also showed the cost of generic drugs decreasing. Businesses generally enjoy it when their input costs go down.
Figure 4
Source: Data.Medicaid.gov, 46brooklyn Research
7. Top/notable generic drug decreases this month
For January, the drug price decrease and increase bubbles were similar in size with the decrease bubble being slightly larger. After reviewing the various sizes and colors that compromise this month-over-month decrease there are some notable decreases.
For the generic drug cost decreases, there are some repeat offenders that continue to pop-up in the data every month. Some of the biggest decreases include an ADHD medication, smoking cessation medication, and a blood pressure medication.
The largest outliers in the packed bubble chart are dexmethylphenidate ER 30mg capsule, which shows the cost decreasing by -20.6%, varenicline 1mg tablet by -18.5%, and bisoprolol 10mg tablets by -15.2%.
Varenicline 1mg tablet has consistently been mentioned at 46brooklyn in these reports from August 2024 and December 2024, where the price of this medication had decreased by -31.7% and -51.0%, respectively. Smoking cessation may be less popular, as many of the products people are using today include vapes, e-cigarettes, and medicinal/medical marijuana, which there just aren’t many studies out there determining if products like varenicline do actually help. However, a recent study from the Yale Cancer Center and Medical University of South Carolina Hollings Cancer Center using varenicline for e-cigarette cessation shows promising results and warrants additional larger-scale trials, the researchers say. So until we understand more about current smoking cessation products and if they can help with the really strong physical dependence that can develop from e-cigarette use, we may continue to see this medication in our NADAC Change Packed Bubble Chart.
In 2018, we reported that bisoprolol doubled in price, and seven years later, we see bisoprolol again but now observe a decrease in price by -15.2.%.
Dexmethylphenidate ER 30mg capsule also graces us with its presence again, as we highlighted this medication in December 2024, where the medication had a decrease in price by -55.5% as well as in March 2021, in which the medication was noted as a key driver in generic drug price deflation in Medicaid for that time period.
8. Top/notable generic drug increases
On the increase side of things, notable this month is that none of the generic drug increases were in the dark to burnt orange bubble color, which means percent changes were on the lower end of the scale. For example, we usually start this section off by noting the most impactful increases of 50% or above; however, no increases were even close this month. However, some notable ones include pregabalin ER 165mg tablet (25.7% increase), dronabinol 10 mg capsule (21.1% increase), and methylphenidate CD 30mg capsules (18.2% increase).
We hate to sound like a broken record, but ADHD medications continue to show up in the generic drug price increases. Just last month, we noted increases in various ADHD medications including methylphenidate CD, where the 20mg capsules took a 62.9% increase in addition to dextroamphetamine-amphetamine 7.5mg tablets, which increased by 57.3%. Several news outlets at the end of January reported ADHD medication shortages for Adderall including U.S. News, Western Mass News, and Michigan Medicine.
Pregabalin ER 165mg tablets (generic for Lyrica CR) is an oral medication used to treat various nerve problems including diabetic peripheral neuropathy and postherpetic neuralgia (PHN). This medication increased by 25.7%, which is not a huge surprise given the prevalence of global diabetes and its continued increase. According to Diabetic Neuropathy Global Market Report 2025, the market is expected to grow from the $5.79 billion in 2024 to $6.27 billion in 2025. Whereas, Precedence Research has the global diabetic neuropathy market size accounting for $4.83 billion in 2025 and is forecasting it to hit around $9.06 billion by 2034.
Dronabinol 10mg capsule (brand name Marinol) is a medication used to treat anorexia in patient with AIDS, chemotherapy-induced nausea, and vomiting, as well as off-label for obstructive sleep apnea (OSA). This medication increased by 21.1%, and we may potentially see more prescribing or use of this medication due to its off-label OSA indication. This potential for increased use may be seen now that Zepbound, the blockbuster weight loss medication from Lilly, recently received its new OSA indication. Payers may start to require additional medical criteria including the trial and failure of less expensive options for OSA such as medications like dronabinol.
Check out local legend Marty Schladen’s pieces on the state of Ohio’s pursuits of sketchy weight loss clinics and data-driven license tracking of pharmacy openings and closures. Big credit to the Ohio Board of Pharmacy for their heavy lifting on pharmacy desert mapping and license tracking in these super cool data visualizations.
Shout-outs to Jared Hopkins at the Wall Street Journal and Kevin Dunleavy at Fierce Pharma for their tracking of brand drug list price changes using our tools.