Any Guesses For Top Selling Drugs? Hint: Opioids Don't Dominate

By Jamie Wells, M.D. — Oct 09, 2017
If you ask yourself: "What segment of the population is most increasing its drug intake?" then the best-sellers come into better focus. From there, think ... cholesterol ... heart ... thyroid.
Credit: Pixabay

What were the top selling prescription drugs last year? What segment of the population is most increasing its drug intake? What are the projections of medication spending in the next five years? The answers were just published and will be addressed here.

A new report “produced independently by the QuintilesIMS Institute as a public service, without industry or government funding” reviewed 2016 medicine use and spending in the United States and provides an outlook through 2021. Among their in-depth analysis includes trends in medicine usage, out-of-pocket costs along with spending and growth dynamics. 

With an ever-changing healthcare landscape, this data can’t tell us everything and requires significant unpacking. But it can give some insight into the leading health conditions warranting such treatments and areas where modifiable lifestyle interventions might play a role. It can affirm successes as it does with respect to advances in hepatitis C therapies and inform about the direction of clinical course, innovation, drug pricing and discovery to name a few. (1) It can explore the impact of policies like those currently surrounding opioids as well as demonstrate the effects of patent expiry on generic use and the rise of biosimilars.

A few highlights abbreviated from the review include (2):

  • Total prescriptions dispensed in 2016 = 4.453 million

    • Reflects a 1.9% increase

    • Largest Growth: chronic prescriptions with 3-month duration dramatically increased since 2014

    • Seniors were largest drivers mostly due to population growth, while younger patients continued to increase per capita usage of medicines. Patients 50 years of age and older = 70% dispensed prescriptions (this is 77% of the growth from 2011).

  • Largest drivers of prescription growth were the most widely used medicines

    • Hypertension (elevated blood pressure) treatments grew slightly faster than market overall, offset by declining use of pain medicines

    • Largest Decline: use of pain medications - narcotic and non-narcotic- declined by 1% attributed to the impact of restrictions on prescribing and dispensing

    • Cholesterol drugs are still widely used but showed modest growth-- due to patent expirations there was rapid shift toward generic usage

    • Oncology retains the greatest activity

  • Outlook to 2021

    • Spending growth has been revised significantly downward due to weaker than expected new product spending and slowing of invoice price increases for branded products

    • Total spending on an invoice price basis in 2016 was $450Bn (up 5.8% from 2015) driven by new brands and protected brands. Spending in 2021 is anticipated to reach $580-619Bn, driven by innovation and offset by loss of exclusivity plus influence of biosimilars (which are expected to be 50% greater in the next 5 years).

Categories assessed by the researchers range from top medicines by prescriptions or invoice spending to top therapeutic classes by invoice spending, payment type as well as location of spending.

In terms of the top 20 medications by prescription, number one is a common thyroid medication, levothyroxine. Blood pressuring lowering agents, heart failure medicines, cholesterol regulators dominate (seen below, lisinopril, metoprolol, amlodipine, atorvastatin). Rounding this out are an oral diabetic drug (metformin), routine asthma bronchodilator (albuterol) and anti-ulcer/gastroesophageal reflux disease medication (omeprazole). Gabapentin, an anticonvulsant, is number 10 and is used for seizure disorders and nerve pain. The only opioid in the top 20 is acetaminophen/hydrocodone at number 4. (Acetaminophen--the non-opioid component-- is the active ingredient in tylenol used for minor pain, fever). To see the complete list, go here

Top 10 Medicines By Prescriptions (Total U.S. Market)

  1. Levothyroxine (low thyroid activity)
  2. Lisinopril (high blood pressure, heart failure)
  3. Atorvastatin (high cholesterol)
  4. Acetaminophen/Hydrocodone (pain)
  5. Metoprolol (high blood pressure, other cardiac uses)
  6. Amlodipine (high blood pressure, other cardiac uses)
  7. Metformin (type 2 diabetes)
  8. Omeprazole (acid reflux)
  9. Albuterol (asthma, lung disease)
  10. Gabapentin (seizures and nerve pain)

The information obtained is good food for thought. It is no surprise that with a growing aging population modern medicine has significantly contributed to this reality. Innovations in drug discovery and therapeutics are frequently responsible for those with cardiovascular diseases possessing enhanced longevity, for example. Certainly lifestyle modifications like improved diet and exercise benefit most chronic disease as well as aid in prevention. But, in lieu of that and since they cannot always do the trick on their own, it is remarkable to live in a time where many treatment modalities and ways to manage such conditions exist, are being studied and hold tremendous promise. When it comes to cures and therapies, who knows what is around-the-corner.  


  1. According to the report, “An estimated 226,000 new patients were treated with hepatitis C medicines in 2016, down 23,000 from the prior year and bringing the total in the last three years to 645,000, potentially curing between 13-22% of the 3-5 million infected patients in the United States.”

  2. The highlights are directly from the report, sometimes paraphrased. To review the entire publication, see here.  

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