The seemingly straightforward question, "What is the highest prescription?," is actually a complex one, as the answer depends on the metric being measured. A drug's 'highest' ranking can be based on the total number of prescriptions filled, its annual sales revenue, or the staggering cost of a single treatment. The top-ranked drug in one category is almost never the same as in another, reflecting the diverse landscape of modern pharmaceuticals. The most commonly prescribed medications are often inexpensive, well-established generics, while the highest-revenue and most expensive treatments are typically brand-name, specialty drugs for rare or complex conditions.
Highest volume prescriptions: The market leaders
When counting the sheer number of prescriptions dispensed, inexpensive and widely used generic drugs for chronic conditions consistently top the list. The prevalence of chronic diseases like high cholesterol, hypertension, and diabetes means that millions of people require these medications long-term.
- Atorvastatin (generic for Lipitor): A statin used to lower cholesterol, atorvastatin is a perennial leader in volume. In 2023, it was the most prescribed drug in the U.S., with over 115 million prescriptions. Its widespread use is driven by the high rate of cardiovascular disease and its generic availability, which makes it highly affordable.
- Metformin: The standard-of-care medication for type 2 diabetes, metformin regularly appears near the top of prescription volume lists. With millions of Americans living with diabetes, the demand for this affordable and effective drug is consistently high.
- Levothyroxine (generic for Synthroid): This synthetic thyroid hormone is used to treat hypothyroidism, a condition where the thyroid gland does not produce enough hormone. As hypothyroidism is a common chronic condition, levothyroxine is one of the most frequently prescribed drugs.
- Lisinopril: An ACE inhibitor used to treat high blood pressure, lisinopril is another top-tier volume leader. Given that nearly half of U.S. adults have hypertension, drugs like lisinopril are foundational treatments.
Highest revenue prescriptions: The biotech blockbusters
Unlike volume, revenue figures are dominated by high-cost, brand-name drugs, especially biologics and cancer therapies. These drugs, often protected by patents, command premium prices that generate billions in annual sales, despite being prescribed far less frequently than common generics.
- Keytruda (pembrolizumab): This immunotherapy drug for cancer treatments has become one of the world's best-selling drugs. In 2024, it was reported to be the top seller, with billions in revenue. Its high cost per treatment course, combined with its use in various types of cancer, drives its massive sales figures.
- Ozempic (semaglutide): Initially for type 2 diabetes, this drug has gained immense popularity for its weight-loss effects, leading to a massive increase in revenue. Its high price point contributes to its position as a top-selling drug.
- Eliquis (apixaban): This anticoagulant, used to prevent blood clots and stroke, generates billions in revenue. Its widespread use for cardiovascular protection, combined with a higher price than older alternatives, secures its spot on the list.
Highest price prescriptions: The gene therapy frontier
For a single-dose treatment, the highest price prescriptions are almost always gene therapies designed to treat ultra-rare genetic diseases. These therapies are often curative, but their development is incredibly complex and costly, resulting in price tags in the millions of dollars.
- Lenmeldy (atidarsagene autotemcel): Used to treat infants with a rare genetic disease called metachromatic leukodystrophy (MLD), Lenmeldy has been reported to cost $4.25 million for a single dose, making it one of the most expensive drugs ever.
- Hemgenix (etranacogene dezaparvovec-drlb): This gene therapy for hemophilia B has a reported price tag of $3.5 million per treatment.
- Elevidys (delandistrogene moxeparvovec-rokl): Another gene therapy, this one for Duchenne muscular dystrophy, carries a price of $3.2 million.
Comparing prescription metrics
To better understand the differences between these categories, consider the following comparison of exemplary drugs across metrics.
| Metric | Drug Example | Primary Use | Prescription Volume | Annual Sales Revenue | Individual Price (per treatment) |
|---|---|---|---|---|---|
| Highest Volume | Atorvastatin | High Cholesterol | >115 million/yr | Moderate (generic) | Low |
| Highest Revenue | Keytruda | Cancer Immunotherapy | Lower volume (specialty) | Billions of USD | High (tens of thousands) |
| Highest Price | Lenmeldy | Rare Genetic Disease | Extremely low (rare indication) | N/A (low volume) | Millions of USD |
The highest eye prescription
Separately, the term "highest prescription" is also used in optometry. A person's eye prescription is measured in diopters, and higher numbers (both positive and negative) indicate a stronger correction is needed. The highest eye prescription for glasses can reach extremes like -20.00 for severe nearsightedness (myopia) or +20.00 for severe farsightedness (hyperopia), though individual needs vary widely. These are significantly different from the types of prescriptions discussed in general pharmacology but represent a valid, literal interpretation of the question.
Conclusion: No single answer
The question of what is the highest prescription has no single answer because it depends on the context and criteria for ranking. The most prescribed medication by volume is typically a low-cost generic like atorvastatin, reflecting its widespread use for common chronic conditions. In contrast, the highest revenue prescriptions are high-priced, brand-name biologics and cancer therapies like Keytruda, while the most expensive individual treatments are ultra-expensive gene therapies like Lenmeldy for rare diseases. These different rankings highlight the varying roles medications play in modern healthcare, from routine, affordable maintenance to groundbreaking, multi-million-dollar cures. Understanding these distinctions is crucial for a complete picture of the pharmaceutical landscape.
For more information on prescription drug statistics, consult the resources of the U.S. Centers for Disease Control and Prevention (CDC) at https://www.cdc.gov/nchs/fastats/drug-use-therapeutic.htm.
