ClinCalc has released the latest edition of the DrugStats database, featuring “The Top 200 Drugs of 2023.” DrugStats offers complimentary access to estimated prescription drug utilization data for the United States. With this data set, users can discern patterns in prescribing habits and access an evidence-based, reputable “top 200 drugs” (or “top 300 drugs”) list based on data provided by the US 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). This data is publicly available on the MEPS website. To implement MEPS into the ClinCalc DrugStats database, basic data sanitization and standardization are applied to maintain an accurate and reliable data set. Read more about the methodology on the DrugStats About page.
Headline Trends in DrugStats 2023
Statins Remain King
- Atorvastatin (Lipitor®) remains the most commonly prescribed medication in the US, maintaining this title since 2018
- Rosuvastatin (Crestor®) has continued a steady rise in popularity, rising from #28 in 2018 up to #12 in 2023
- Atorvastatin and rosuvastatin currently command about 80% of the statin market share in 2023. This is due both to increased prescribing of these two statins and a steady decline in simvastatin prescriptions over the same period..
Statin Drug Class Prescriptions (2014-2023)
GLP-1 and GIP/GLP-1 Agents Continue Their Surge
- Semaglutide (Ozempic®, Wegovy®) climbed to #19 (from #48 in 2022)
- Tirzepatide (Mounjaro®, Zepbound®) was not ranked in 2022, but is now #110
- Both medications have a total cost of about $1400 per prescription fill on average, which includes the patient’s copay and the reimbursement cost from other parties (e.g., Medicare/Medicaid or third-party insurance)
- Because DrugStats is derived from survey data rather than insurance claims, compounded GLP-1 products, which are commonly sought after by patients for cost reasons, should be captured in the data set
Strong Growth of SGLT2 Inhibitors, Led by Empagliflozin
- Empagliflozin (Jardiance®) rose to #34 (from #56). About two-thirds of prescriptions were for the 25 mg strength, which is the dose used for diabetes (or diabetes plus heart failure)
- Dapagliflozin (Farxiga®) also increased to #92 (from #115), but it only holds about 30% of the SGLT2 inhibitor market share vs. 70% with empagliflozin
SGLT2 Inhibitor Drug Class Prescriptions (2014-2023)
DPP-4 Inhibitors Continue to Decline
- Utilization of DPP-4 inhibitors for diabetes has continued to decline. In 2023, there were about 6.3 million prescriptions, down from their peak of about 13 million in 2018
- This decline is most likely due to the lack of cardiovascular benefit in diabetes from DPP-4 inhibitors as well as the increasing popularity of SGLT2 inhibitors and GLP-1 agonists, which do confer cardiovascular benefits
DPP-4 Inhibitor Drug Class Prescriptions (2014-2023)
Three Anticoagulants Dominate the Market
- Apixaban (Eliquis®) has about 60% of the anticoagulant market share and is currently #28 in 2023
- Rivaroxaban (Xarelto®) holds about 23% of the market share (rank #88)
- Warfarin (Coumadin®), with decreasing popularity (declining from #85 to #116), still holds on with 17% of the anticoagulant market
- Other anticoagulants, such as dabigatran (Pradaxa®), edoxaban (Savaysa®), and even enoxaparin (Lovenox®), were likely prescribed in the US but not commonly enough to be captured in the 2023 MEPS survey
Anticoagulant Therapeutic Class Market Share Comparison (2014-2023)
Entresto® Popularity Has Peaked
- After a steady increase in prescriptions since 2018, sacubitril/valsartan (Entresto®), a drug for heart failure, has peaked and is now declining in popularity, falling to #199 from #165 in 2022
- Possible explanations for fewer sacubitril/valsartan prescriptions could include cost compared to ACE inhibitors or ARBs (average out-of-pocket cost of sacubitril/valsartan is $55 per prescription and total cost of $1,158 per prescription), shifting emphasis of SGLT2 inhibitors for heart failure, or prior authorization/formulary friction
Sacubitril/Valsartan Total Prescriptions and Patients Per Year (2018-2023)
Rebounding Popularity of Adalimumab
- Adalimumab (Humira® and biosimilars), a TNF-alpha inhibitors for autoimmune conditions, has rebounded to #144 (from #241) after a decline in popularity from 2020-2022
- A substantial number of adalimumab biosimilars entered the market in 2023 (Amjevita®, Cyltezo®, Yusimry®, Hadlima®, Hyrimoz®, Hulio®, Abrilada®, Idacio®, Yuflyma®), which likely contributed to the increase in prescriptions
- Despite the new biosimilars, the total cost per prescription fill (including copays and third-party reimbursement) has remained the same since 2020 — about $5,200 per prescription; however, out-of-pocket cost decreased from $255/fill in 2022 to $103/fill in 2023
Adalimumab Total Prescriptions and Patients Per Year (2014-2023)
Adalimumab Total Cost Per Prescription Fill (2014-2023)
New or Reappearing Agents to DrugStats in 2023
Some agents entered or re-entered the Top 300 Drug list after not being captured in the prior MEPS cycle. Because MEPS is a survey of about 300,000 prescription events in the US, year-to-year capture of lower frequency medications can vary.
- Carbamazepine (Carbatrol®, Tegretol®), a classic antiseizure medication, is now ranked #185 after an absence from 2021-2022
- Evolocumab (Repatha®), an injectable PCSK9 inhibitor for dyslipidemia, was ranked in 2020, was absent, and has reappeared in 2023 at rank #188
- Emtricitabine; tenofovir (Truvada®, Descovy®), a combination nucleoside reverse transcriptase inhibitor (NRTI) for HIV, has its first DrugStats appearance in 2023 (rank #205). Although the medication has been on the market since 2004 (Truvada®) and 2015 (Descovy®), the increase in prescriptions is likely in part due to expansion of PrEP (pre-exposure prophylaxis for HIV) programs and marketing
- Rimegepant (Nurtec®), an oral CGRP receptor antagonist or “gepant” for acute and preventive migraine therapy, has not historically been ranked but is now #206 likely due to increased prescriber familiarity and adoption of this newer drug class
More to Explore
DrugStats includes about 2.5 billion prescriptions across about 400 unique compounds with multiple years of US prescribing patterns. Explore the full database for free, including data regarding drug class and drug cost trends, on the ClinCalc DrugStats site.
DrugSpell Dictionary Updates
In coordination with the 2023 DrugStats update, the ClinCalc DrugSpell dictionary is also updated. This dictionary file 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. For more information, see the ClinCalc DrugSpell Dictionary File.
