The Top Prescription Drugs of 2011

[Skyler]

The Top Prescription Drugs of 2011 in the United States: Antipsychotics and Antidepressants Once Again Lead CNS Therapeutics

 

Craig W. Lindsley (Editor-in-Chief)

ACS Chem. Neurosci., 2012, 3 (8), pp 630–631

DOI: 10.1021/cn3000923

Publication Date (Web): August 15, 2012

Copyright © 2012 American Chemical Society

 

Data for the top prescription drugs of 2011 in the Unites States was recently released by IMS Health,(1) and as we have done each year,(2, 3) we will break down the key stats as they apply to CNS therapeutics. Total prescription drug sales in the United States increased from $308.6 billion in 2010 to $319.9 billion in 2011 (an 3.5% increase despite pressure from generics), with a concomitant increase in prescriptions dispensed (3.99 billion in 2010 compared to 4.02 billion in 2011).(1) As discussed last year,(3) a combination of generic versus brand medications and a weak economy have negatively impacted prescription drug sales. In parallel, patients continuing on therapies for chronic disease shifted from brand name medications to generic equivalents; thus, the lists of the top 200 drugs in terms of sales and that of prescriptions dispensed share no overlap.(1-4) For example, in 2010, Lipitor was number 1 in terms of sales ($7.3 billion) and number 4 in terms of prescriptions dispensed (46 million). With the loss of patent protection in 2011, Lipitor still remained number 1 in terms of sales ($7.7 billion) in 2011 (Table 1), but Lipitor dropped off the top 25 most prescribed medicines in 2011, while simvastatin, generic Zocor, increased to number 3, with 97 million prescriptions dispensed.(1-4)

 

Table 1. Top Pharmaceutical Products by United States Sales(1)

2011 rank drug name 2010 sales (in $ billions) 2011 sales (in $ billions)

1 Lipitor 7.3 7.7

2 Plavix 6.1 6.8

3 Nexium 6.3 6.2

4 Abilify 4.6 5.2

5 Advair Diskus 4.7 4.6

6 Seroquel 4.4 4.6

7 Singulair 4.1 4.6

8 Crestor 3.8 4.4

9 Cymbalta 3.2 3.7

10 Humira 2.9 3.5

 

Approximately one-third of the $319.9 billion spent on prescription drugs was focused on only five therapeutic areas (Table 2): oncology, respiratory agents, lipid regulators, antidiabetics, and antipsychotics.(1) Despite a growing trend of big pharma leaving CNS drug discovery, antipsychotics continue to grow, with $18.2 billion in sales in 2011, up $2.1 billion over 2010. In 2011, 57 million prescriptions were filled for antipsychotic drugs, up 2.4%, and, importantly, 60% were filled with branded drugs.(1) Three drugs, Abilify, 1 ($5.2 billion in 2011 sales), Seroquel, 2 ($4.6 billion in 2011 sales), and Zyprexa, 3 ($3.0 billion in 2011 sales) account for >65% of the total $18.2 billion spent on antipsychotics (Figure 1). These statistics are intriguing, as Zyprexa lost patent protection in October 2011, Seroquel follows in 2012, and Abilify falls to generic competition outside the United States in 2014 and within the United States in 2015.(1)

 

Table 2. Top Therapeutic Classes by United States Sales(1)

2011 rank therapeutic area 2010 sales (in $ billions) 2011 sales (in $ billions)

1 oncology 22.3 23.2

2 respiratory agents 19.3 21.0

3 lipid regulators 18.8 20.1

4 antidiabetics 17.7 19.6

5 antipsychotics 16.2 18.2

6 autoimmune diseases 10.6 12.0

7 antidepressants 11.6 11.0

8 hiv antivirals 9.3 10.3

9 anit-ulcerants 11.9 10.1

10 narcotic analgesics 8.4 8.3

 

Figure 1. Top CNS drugs of 2011 in terms of United States sales. Three drugs, Abilify (no. 4), Seroquel (no. 6), and Zyprexa (no. 16), accounted for >65% of the $18.2 billion spent on antipsychotics in 2011.

 

Beyond antipsychotics, other CNS therapeutics demonstrated significant growth in 2011, with ADHD therapies increasing 17% ($7.9 billion in sales) and treatments for multiple sclerosis increasing an impressive 22.5% to $7.1 billion in sales.(1) While dropping in sales ($11.0 billion in 2011, a 5.8% decrease over 2010), antidepressants were the most prescribed class of drugs in 2011 (Table 3), with 264 million prescriptions filled (many generics).(1)

 

Table 3. Top Psychiatric Medicines Prescribed in 2011

2011 rank brand drug name (generic name) prescribed/indicated for 2011 prescriptions (in millions)

1 Xanax (alprazolam) anxiety 47.7

2 Celexa (citalopram) depression, anxiety 37.8

3 Zoloft (sertraline) depression, anxiety, OCD, PTSD, PMDD 37.2

4 Atvian (lorezepam) anxiety, panic disorder 27.1

5 Prozac (fluoxetine HCl) depression, anxiety 24.5

6 Lexapro (escitalopram) depression, anxiety 23.7

7 Desyrel (trazodone HCl) depression, anxiety 22.6

8 Cymbalta (duloxetine) depression, anxiety, fibromyalgia 17.7

9 Valium (diazepam) anxiety, panic disorder 14.6

10 Seroquel (quetiapine) bipolar disorder, depression 14.2

 

Beyond individual medications and drug classes, which pharmaceutical companies dominated the United States prescription drug market in 2011 in terms of sales? Once again, Pfizer ranked number 1 with over $25 billion in United States sales, while the biologics sales of Amgen landed the biotech at number 9 and the increasing sales of generics positioned Teva at number 5 (Table 4).(1)

 

Table 4. Top Pharmaceutical Companies Based on United States Prescription Drug Sales(1)

2011 rank company 2010 US sales (in $ billions) 2011 US Sales (in $ billions)

1 Pfizer 27.2 25.1

2 AstraZeneca 19.5 19.9

3 Merck & Co. 18.6 19.3

4 Novartis 18.0 19.2

5 Teva 15.9 15.1

6 Lilly 14.3 1409

7 Roche 13.8 14.5

8 GlaxoSmithKline 15.2 14.2

9 Amgen 12.7 13.1

10 Johnson & Johnson 12.9 12.1

 

Overall, CNS drugs rank high in terms of both sales and prescriptions dispensed in the United States in 2011 (Tables 1–3). Beyond 2012, 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. When one looks at the trends and medications, the United States is suffering from poor lifestyle/diet choices (based on sales of lipid regulators and antidiabetic medications) and an unprecedented increase in patients taking antidepressants and antipsychotics. Importantly, increases in both sales and prescriptions dispensed are positive signs for a struggling pharmaceutical industry. Link

[Altostrata]

Ugly, ugly, ugly. Pharmageddon, indeed.

[alexjuice]

Great link, Schuyler.

 

I'd emphasize that the top revenue drugs are not the top selling drugs.

 

I'm not sure everyone is aware of the extraordinary cost of the antipsychotics. Since government health funds assume the cost of 85% of these scripts, in my state according to the suit filed against JNJ for Risperdal, it is a robbery of the public purse and a curse to the poor (usually poor) folks who end up on the costly doses.

 

My 'schizophrenic' dose of abilify, for instance, was $700 or so if memory serves. By contrast, I can get generic valium for $5.

 

EDIT: In looking at the link, it appears the only antipsychotic in the top 10 is seroquel; and it's last on the list. Seroquel is frequently prescribed for off-label purposes at lower doses, specifically as a sleep aid which I think inflates it's prescription totals. For instance, Xanax had 3x more scripts written than seroquel. The other 9 are ADs and benzos.

 

EDIT AGAIN: Xanax at almost 50,000,000 prescriptions written did not exceed $3.5B and therefore didn't make the cut for top 10 Revenue Drugs. While Seroquel, prescribed short of 15,000,000 times, generated $4.6B which made it the #6 cash cow of '11. Abilify, with fewer total Rx written, was the blockbuster of all psych drugs raking in $5.2B. I am very foggy today hence the edits.

[Barbarannamated]

Interesting. Xanax (alprazolam) is still leading in total number of RXs despite knowledge that benzos produce dependence, addiction, and horrendous withdrawal. A bit surprising. I forget how IMS counts scripts, but I suspect that raw number is comprised of many "acute" prescriptions. The thinking must be that the short halflife is safer. Scary.

 

Would be very interesting to see a breakout of drug by usage and new vs. repeat script. For example, I suspect Cymbalta is being used for pain conditions more than mood alone. SSRIs (citalopram, sertraline, escitalopram, fluoxetine) are being written far more than SNRIs (no (des)/venlafaxine). Strange.

I suspect Abilify usage is for depression.

Trazodone for depression, anxiety? I thought its primary use was for sleep though it's labeled for depression.

 

I do see that this article is focused on CNS segment which explains my next observation:

 

Table 2 (top therapeutic areas) doesn't seem to correlate to the top revenue makers. Oncology, autoimmune disorders.. The only drug I see for AI is Humira. No oncology drug. I know many oncology drugs are used off-label and are outrageously expensive. Perhaps not accounted for in this report? There are also increasing number of programs to use biologics and oncology agents prior to approval on some version of "compassionate use" basis. That's a whole different can o' worms. Liability waivers are involved with desperate, terminally ill patients signing away right to damages should they be harmed. Who better to experiment on than someone whose death is imminent..?

 

Disposable people.

 

Sad. Ugly.