ClinCalc DrugStats 2021 Update – The Most Commonly Prescribed Drugs in the United States

ClinCalc has released this year’s update to the DrugStats database — “The Top 200 Drugs of 2019”. DrugStats provides free access to prescription drug utilization data estimates for the United States.  Using this data set, users can identify trends in prescribing practice and an official, reputable “top 200 drugs” list based on data provided by the U.S. Government.

Where does the DrugStats data come from?

All medication utilization data comes from the annual Medical Expenditure Panel Survey (MEPS), a survey conducted by the Agency for Healthcare Research and Quality (AHRQ) via the United States government. This data is publicly available on the MEPS website for free.  In order for the ClinCalc DrugStats database to implement the MEPS data, basic data sanitization and standardization measures are necessary to maintain an accurate and reliable data set.  Read more about the data set by clicking here.

Changes to DrugStats Versioning and Year Numbering

To avoid confusion, DrugStats versioning and year numbering has been updated.  Historically, the DrugStats year (“Top 200 Drugs of 2021”) corresponded to the upcoming calendar year.  Instead, the year now represents when the AHRQ MEPS survey was completed.  For this year (2021), the name of the DrugStats dataset is the “The Top 200 Drugs of 2019”.

DrugStats Database Updates and Improvements

A number of substantial changes have been made to improve both the quality of the DrugStats dataset as well as the amount of information provided on the website.  Examples include:

  • Including the estimated number of unique patients filling a prescription each year (not just the number of prescriptions filled)
  • Average drug cost is now represented as per day of therapy and per prescription
  • Drug cost is divided into total drug cost (insurance/third-part cost plus out-of-pocket) and a patient’s direct out-of-pocket cost
  • Additional information about typical dose/dosage forms and the days supplied — this is an example for acetaminophen-hydrocodone (Norco):

Acetaminophen; hydrocodone

DrugSpell Dictionary Updates

The ClinCalc DrugSpell dictionary adds thousands of proprietary brand names, generic medication names, and established pharmacologic classes (EPC) words so that word processing applications can provide an accurate and reliable spell check. This dictionary file is completely free and simple to install.

Along with the 2019 DrugStats update, DrugSpell has also been updated to incorporate additional drug and drug-related terms to provide more accurate spell checking in word processing applications like Microsoft Word.

For more information, see the ClinCalc DrugSpell Dictionary File.

Newest Trends in Drug Prescribing in 2019

The current DrugStats release (version 2021.09) represents the MEPS data set from January through December 2019.  Each year, a number of medications or medication classes rises or falls in popularity due to changes in prescribing patterns.  The following drug or drug classes have made major changes in the market in the DrugStats 2019 data set:

SGLT-2 Inhibitors, Especially Empagliflozin (Jardiance®)

SGLT-2 inhibitors, such as canagliflozin, dapagliflozin, and empagliflozin, were first FDA approved in 2013.  Over several years, this drug category demonstrated cardiovascular and mortality benefits in patients with type II diabetes as well as non-diabetic patients who had heart failure.  It’s no surprise that we see an increase in SGLT-2 inhibitor prescriptions — in particular, empagliflozin has taken a big lead in the market despite being the third drug approved in this category:

SLGT-2 Inhibitors by Market Share

SLGT-2 Inhibitor Prescribing Trends by Year

Valsartan’s Nose Dive

After several FDA warnings and recalls of carcinogenic impurities in valsartan (and some other angiotensin II receptor blockers [ARBs]), the number of valsartan prescriptions in 2019 made a dramatic decline:

Valsartan Total Prescriptions and Patients Per Year

Despite the decline, ARB drug class prescriptions have remained steady with losartan commanding about 80% of the entire drug class market.

CGRP Inhibitors for Migraine Breaks into the Top 300 Drug List

Erenumab (Aimovig®) was FDA approved in 2018 and is the first calcitonin gene-related peptide (CGRP) receptor inhibitor for the prevention of migraine.  Erenumab, unlike other monoclonal antibodies that target the CGRP pathway, made it to rank #294 for the 2019 top drug list.  Not surprisingly, erenumab is one of the most expensive drugs in 2019 with an average out-of-pocket cost of $14.74 per day.

Increasing Popularity of Mirabegron

Mirabegron (Myrbetriq®) was FDA approved in 2012 for overactive bladder and represented a completely different mechanism of action (beta-3 adrenergic agonist) compared to the numerous anticholinergic agents on the market.  Although oxybutynin is still the most commonly prescribed urinary antispasmodic (with about 50% of the market), mirabegron now commands about 25% of the market and has steadily increased in popularity since 2016 and is now ranked as #189 for total prescriptions in the United States.

Urinary Antispasmodics by Market Share

The Top 10 Most Prescribed Medications

With one exception, the drugs ranked in the top 10 most prescribed medications have essentially stayed the same from 2018 to 2019.  Simvastatin dropped from #10 to #13 (and has been on an obvious decline for years) to be replaced with gabapentin in the #10 slot.  These top 10 medications represent about 750 million prescriptions and 167 million patients per year — about 25% of all prescriptions in the United States.

Rank Drug Name Total Prescriptions (2019) Total Patients (2019)
1 Atorvastatin 112,104,359 24,493,971
2 Levothyroxine 102,595,103 19,698,087
3 Lisinopril 91,862,708 19,990,170
4 Metformin 85,739,443 17,430,765
5 Metoprolol 74,578,817 15,177,787
6 Amlodipine 73,542,114 16,419,181
7 Albuterol 60,679,987 19,085,418
8 Omeprazole 52,546,641 12,869,290
9 Losartan 51,773,869 11,760,646
10 Gabapentin 47,149,505 9,818,634

Many, Many Other Data Trends and Interesting Facts

Between the 3 billion prescriptions and about 500 unique drug compounds covering years of prescribing patterns in the United States, the ClinCalc DrugStats database has plenty of other interesting data trends and facts to explore.

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