The Top Prescription Drugs of 2010 in the United States: Antipsychotics Show Strong Growth

It is that time of year: Figures were just released for the top 200 prescription drugs of 2010 in terms of both sales and prescriptions dispensed in the United States (Table 1). As reported by the IMS Institute for Healthcare Informatics¹ and the Pharmacy Times,² total prescription drug sales grew by 2.3% over 2009 to $307 billion, and 3.99 billion prescriptions were dispensed, marking a 1.2% increase over last year (and a historic low). A combination of generic versus brand medications and the economic turndown have taken a huge toll on the prescription drug sales. For example, both visits to doctor offices and the number of patients placed on new treatments dropped significantly in 2010.^1,2 In parallel, patients continuing on therapies for chronic disease shifted from brand name medications to generic equivalents. In fact, 78% of the prescriptions dispensed in the United States in 2010 were for generics. As such, the lists of the top 200 drugs in terms of sales and that of prescriptions dispensed share little overlap. It is estimated that a brand name drug loses ∼80% of sales to generics within 6 months of patent expirations, and this was observed for Merck’s Zocor (simvastatin) in 2006 which continues to impact the statin class.^1,2 While Pfizer’s Lipitor once again held the number 1 spot in the top 200 drugs in 2010 for sales ($7.2 billion), prescriptions dispensed dropped to 45,817,079 (no. 4 in 2010), while prescriptions dispensed for generic simvastatin totaled over 650,000,000 (manufactured by Lupin (no. 7), Teva (no. 12), Dr. Reddy’s (no. 31), and Zydue (no. 156)). AstraZeneca’s Crestor was also impacted, sliding to number 8 in sales ($3.7 billion), and prescriptions dispensed fell to 24,383,965 (no. 16). These figures cut deeply into an already ready struggling United States pharmaceutical industry faced with even more “patent cliffs” in 2010, including Lipitor (no. 1 in 2010 sales) and Plavix (no. 3 in 2010 sales). However, the situation is not hopeless. In 2010, 44 new brand therapeutics were released, and of these 21 were considered New Chemical Entities (NCEs), 10 represented fundamentally new mechanisms of action, and 5 targeted orphan diseases.^1,2

Table 1. Top 20 Prescription Drugs in Terms of United States Sales in 2010².

rank	product	sales ($)	rank	product	sales ($)
1	Lipitor	7,244,084,266	11	Remicade	3,301,801,836
2	Nexium	6,309,921,500	12	Enbrel	3,288,832,959
3	Plavix	6,129,209,654	13	Cymbalta	3,153,018,806
4	Advair Diskus	4,711,436,220	14	Avastin	3,089,178,817
5	Abilify	4,551,769,585	15	OxyContin	3,084,262,027
6	Seroqeul	4,349,322,,433	16	Neulasta	3,009,378,915
7	Singulair	4,072,796,545	17	Zyprexa	2,957,556,830
8	Crestor	3,758,220,585	18	Humira	2,925,455,932
9	Actos	3,534,387,850	19	Lexapro	2,811,913,951
10	Epogen	3,323,462,389	20	Rituxan	2,760,661,034

In terms of classes of prescription drugs, oncology therapeutics ranked first with over $22 billion in United States sales in 2010, followed by respiratory agents, lipid regulators, diabetes treatments, and antipsychotics.^1,2 This represents a significant change from the leading classes in 2009,^3,4 where antipsychotics were first, followed by lipid regulators, proton pump inhibitors, and antidepressants. Biologics still hold prominent positions as well, with Amgen’s Epogen once again in the top 10 with United States sales of $3.2 billion. Of particular importance for CNS medications, antipsychotics grew 10% in 2010 to achieve class sales of $16.3 billion, driven by Abilify (Otsuka/BMS, $4.5 billion, no. 5 in 2010 sales), Seroquel (AstraZeneca, $4.3 billion, no. 6 in 2010 sales), and Zyprexa (Lilly, $2.9 billion, no. 17 in 2010 sales).^1,2 Overall, CNS drugs rank high in terms of both sales and prescriptions dispensed in the United States in 2010 (Figure 1). Moving forward, generic competition for antipsychotics, antidepressants, and other CNS therapeutics further underscores the need for the development of therapeutic agents with novel mechanisms of actions/novel molecular targets.

Figure 1.

Top CNS drugs in 2010 in terms of United States sales: The antipsychotics, Abilify (no. 5), Seroquel (no. 6), and Zyprexa (no. 17); the pain medication, OxyContin (no. 15); and the antidepressants, Cymbalta (no. 13) and Lexapro (no. 19).