Hartford, CT — Connecticut’s Office of Health Strategy (OHS) has unveiled a preliminary list of the ten most expensive outpatient prescription drugs for 2025.

The OHS exposes drastic price hikes and staggering costs that put pressure on patients and state healthcare systems.

The list is mandated under Connecticut General Statute § 19a-754b (d) and pinpoints drugs that have surged by at least 16% in wholesale acquisition cost (WAC) over two years and exceed $40 for a month’s supply.

Total spending on the said drugs reached a staggering $560.3 million, making up 6.8% of all retail prescription drug costs in Connecticut.

AbbVie’s Humira, a rheumatoid arthritis drug, dominates the list with an astronomical $362 million in spending, while Acadia Pharmaceuticals’ Nuplazid recorded the highest price jump at 25.5%.

Public comment period until March 12

The OHS has opened a 30-day public comment window. The public comment shall allow drug manufacturers to contest their inclusion by submitting evidence that their drug, after rebates, does not meet the criteria.

“If validated, we will remove the drug from the final list,” the agency noted in its report.

According to the agency, the significance of the public input period extends beyond mere bureaucratic formalities. The transparency move targets to hold pharmaceutical companies accountable while giving the public a glimpse into the true costs of essential medicines.

Connecticut residents, advocacy groups, and healthcare professionals are encouraged to weigh in, as their insights and lived experiences with the mentioned medications may help shape the final version of the list.

State’s top costliest prescription drugs

The drugs identified in the preliminary report are predominantly brand-name, spanning multiple therapeutic classes, including immunosuppressants, pain management, and neurological disorders.

Below is a detailed breakdown of the most expensive outpatient drugs in Connecticut:

Humira (Adalimumab) – Used to treat autoimmune disorders such as rheumatoid arthritis, Crohn’s disease, and psoriasis, Humira leads the list with an astonishing $362 million in spending. Its price has risen by 16% over the last two years.
Skyrizi (Risankizumab) – Another AbbVie product, used for psoriasis and Crohn’s disease, has driven $143 million in spending, with a similar 16% increase in cost.
Rinvoq (Upadacitinib) – A psoriatic arthritis treatment costing $29.4 million and seeing a 16% price increase.
Nuplazid (Pimavanserin) – This Parkinson’s-related psychosis drug recorded the highest WAC price increase on the list at 25.5%, totaling $9.4 million in spending.
Tukysa (Tucatinib) – A medication for breast and colorectal cancer that saw an 18.8% increase in cost, totaling over $5.1 million.
Percocet (Oxycodone & Combination) – A widely known opioid analgesic that experienced a 20.8% price hike, totaling $2.9 million in spending.
Ocaliva (Obeticholic Acid) – Used to treat primary biliary cholangitis (PBC), a rare liver disease, this drug’s cost rose by 18.8%, with a total expenditure of $2.8 million.
Apokyn (Apomorphine) – A non-ergoline dopamine agonist for Parkinson’s disease, Apokyn saw a 19.7% price surge, accumulating $2.6 million in costs.
Lidoderm (Lidocaine & Combination) – A pain-relieving patch used for post-herpetic neuralgia that increased in price by 20.8%, with a total spend of $2.3 million.
Otezla (Apremilast) – Used to treat psoriatic arthritis and plaque psoriasis, Otezla rounds out the list with $2.2 million in spending, with a 16.3% price increase.

Even though legal mandates require at least one generic drug on the list, the OHS found no generic drugs that met the spending threshold necessary for inclusion.

The OHS constructed the list using Connecticut’s All-Payer Claims Database (APCD), with wholesale acquisition cost data from Micromedex Redbook. The APCD consolidates data from commercial insurers, Medicaid, Medicare Advantage, and the state employee health plan.

However, the database lacks rebate information and does not cover self-insured employers regulated under the Employee Retirement Income Security Act (ERISA), creating gaps in the overall analysis. The methodology involved identifying the 1,000 outpatient prescription drugs with the highest total spending across different insurance providers.

The OHS reported that the final selection process applied WAC increases from 2021 to 2023 to determine if each drug met the statutory requirements for inclusion.

The sheer scale of drug spending in Connecticut, as illustrated in the report, has reignited concerns about the affordability of essential medications.

Comparisons with national trends

Connecticut is not alone in addressing the issue of rising prescription drug costs.

Across the country, states have been implementing transparency measures and cost-containment strategies.

For example, California enacted a similar price transparency law requiring drug manufacturers to justify price hikes exceeding a specific threshold.

Meanwhile, at the federal level, the Biden administration has been pushing for drug price reforms, including allowing Medicare to negotiate prices for high-cost drugs, a move fiercely opposed by pharmaceutical companies.

Once the public comment period closes on March 12, OHS will review submitted documentation from drug manufacturers and stakeholders. If a drugmaker successfully argues that their product does not meet the criteria post-rebate, it will be removed from the final list, which is set for release in mid-2025.

Additionally, the finalized list will trigger mandatory reporting requirements for pharmaceutical companies, forcing them to disclose justifications for their price hikes to state regulators.

The pharmaceutical industry’s response to the OHS report will be closely watched, as will any subsequent actions taken by Connecticut lawmakers to curb excessive drug price inflation.

For now, the debate rages on: Should states take a more aggressive role in regulating drug prices, or should market forces dictate pharmaceutical costs?