Meperidine HCl cost Medicare $42.12 per claim in 2013. By 2023, that number had reached $1,068.88. Over the same period, total claims for the drug fell from 13,593 to just 521. Higher prices, far fewer patients, and a cost-per-claim that grew more than 25-fold: this is what a pricing dynamic fully decoupled from demand looks like.

When Volume Collapses but Prices Keep Climbing

The standard assumption in drug pricing is that falling demand puts downward pressure on cost. Meperidine HCl, an older opioid analgesic, ran the opposite direction.

Claims fell steadily through the decade. By 2019, volume had already dropped to 2,187. Then, as the drug became increasingly marginal in clinical practice, prices accelerated. Cost per claim went from $206.58 in 2020 to $489.05 in 2021, then $859.90 in 2022, before reaching $1,068.88 in 2023. The drug's near-disappearance from Medicare prescribing did nothing to restrain what remaining claimants paid.

For the 521 beneficiaries still receiving meperidine in 2023, this means a drug that cost roughly $42 a decade ago now costs more than $1,000 per claim through Medicare. For taxpayers, it means the program is paying premium prices for a drug with almost no utilization base left to distribute costs across.

The Opposite Problem: Cetirizine's Price Climbed Even as Demand Grew

Cetirizine HCl, a common antihistamine, tells a different but equally striking story. Cost per claim rose from $22.61 in 2013 to $366.63 in 2023, a 16-fold increase. Unlike meperidine, cetirizine's volume grew: total claims went from 4,930 in 2013 to 20,183 in 2023.

The price trajectory was not gradual. Cetirizine held below $15 per claim through 2019, then jumped to $120.92 in 2020 and $287.39 in 2021. A drug available over the counter for a few dollars a box was, by 2023, costing Medicare $366.63 per claim.

That combination of rising volume and rising cost per claim is a compounding problem. More patients receiving a drug at a higher price per claim means total program spending grows on both dimensions simultaneously. Cetirizine's trajectory illustrates how even routine, widely-used medications can generate significant fiscal exposure when pricing moves independently of clinical or market logic.

State-Level Inflation Shows No Correlation with Brand-Name Prescribing

One common explanation for cost-per-claim growth is a shift toward brand-name drugs. The state-level data rules that out, at least for the top 20 states by percentage growth. Every one of those states had a brand claim percentage of 100% in both 2013 and 2023, with zero change in brand share over the decade. The price increases happened entirely within a population already receiving brand-name drugs.

The geographic spread of cost growth is wide. AP showed the highest percentage increase at 457.4%, with cost per claim rising from $32.84 to $183.01. Iowa, at the narrow end of the top 20, still posted 132.0% growth. Washington DC had the largest absolute increase, rising $172.93 from $102.95 in 2013 to $275.87 in 2023.

The consistency across states with 100% brand prescribing in both years means the inflation cannot be attributed to formulary shifts or generic-to-brand substitution. Prices rose on the same drugs, in the same therapeutic categories, across a decade. What drove a drug with 521 remaining claims to cost $1,068.88 each is a question the utilization data alone cannot answer.