Defining 'Most' in the Pharmaceutical Market
Pinpointing the top-selling drug in the USA is a complex task because sales can be measured in two distinct ways: by the total revenue generated and by the total number of prescriptions filled. These two metrics often highlight different types of drugs, revealing the underlying economics and health priorities of the American healthcare system. High-cost, specialized biologic drugs frequently top the revenue charts, while inexpensive, high-volume generic medications dominate prescription counts. A comprehensive understanding requires examining both perspectives.
Top-Selling Drugs by Revenue
Measuring drug sales by revenue typically highlights innovative, expensive, often biologic, medications. These therapies address complex diseases like cancer or autoimmune disorders and often have limited competition due to patent protection. As of 2024, the landscape of top revenue-generators includes several well-known and costly treatments.
Keytruda (Pembrolizumab)
Keytruda, a biologic cancer immunotherapy from Merck, is a consistent leader in global sales and performs strongly in the U.S. market. Its high revenue, which reached approximately $29.5 billion globally in 2024, stems from its high cost and widespread use for treating various cancers. The drug works by blocking the PD-1 protein, allowing the immune system to more effectively fight cancer cells.
Ozempic and Wegovy (Semaglutide)
Semaglutide, marketed as Ozempic for type 2 diabetes and Wegovy for weight loss, is another revenue powerhouse from Novo Nordisk. This GLP-1 agonist has seen explosive growth in sales, reaching an estimated $18.7 billion globally in 2024, propelled by high demand for both diabetes management and obesity treatment. The popularity and high cost of these medications have driven significant revenue for the manufacturer.
Eliquis (Apixaban)
The anticoagulant Eliquis, co-marketed by Bristol Myers Squibb and Pfizer, consistently generates massive sales. With global sales exceeding $20 billion in 2024, this blood thinner is widely used to prevent and treat dangerous blood clots, highlighting the large patient population requiring ongoing cardiovascular care.
Other high-revenue drugs
- Dupixent (Dupilumab): An immunology drug for atopic dermatitis, asthma, and other conditions.
- Biktarvy (Bictegravir/emtricitabine/tenofovir alafenamide): A cornerstone HIV treatment from Gilead Sciences.
- Skyrizi (Risankizumab-rzaa): An immunology drug from AbbVie used for conditions like psoriasis.
Top-Selling Drugs by Prescription Volume
In contrast to the revenue leaders, the most frequently prescribed medications are often generic, lower-cost drugs that manage common, chronic conditions affecting a large portion of the population. These drugs are the bedrock of everyday medication use. According to 2023 data, these are some of the most prescribed drugs by count.
Atorvastatin (Lipitor)
The generic version of Lipitor, atorvastatin, consistently ranks as one of the most prescribed drugs in the United States. Prescribed to millions to lower cholesterol, this statin plays a critical role in preventing cardiovascular disease. Its high volume is a direct reflection of the widespread prevalence of high cholesterol among American adults.
Metformin
Used to treat type 2 diabetes, metformin is another high-volume prescription drug. With millions of patients relying on this medication to manage their blood sugar, its frequent prescription underscores the high rate of diabetes in the U.S. population.
Levothyroxine (Synthroid)
As a synthetic thyroid hormone, levothyroxine is the most prescribed drug for hypothyroidism. Millions require this medication daily for life, which accounts for its consistently high ranking in prescription volume.
Comparison of Top Drugs by Revenue vs. Volume
| Metric | Typical Drug Profile | Examples | Therapeutic Areas | Price Point |
|---|---|---|---|---|
| Revenue | Branded, often biologic, and high-cost | Keytruda, Ozempic, Eliquis, Dupixent | Oncology, autoimmune, diabetes, cardiovascular | High; billions in annual sales |
| Prescription Volume | Generic, small-molecule, and low-cost | Atorvastatin, Metformin, Levothyroxine | High cholesterol, diabetes, thyroid disorders | Low; high volume driven by low per-unit cost |
Explaining the Disparity
The stark contrast between the lists of top revenue and top prescription volume drugs is a key feature of the modern pharmaceutical industry. It highlights the bifurcation of the market into two distinct segments. The first includes innovative, often very expensive, biologic therapies for diseases like cancer, which command high prices and generate immense revenue despite serving a smaller patient pool. The second consists of older, generic drugs that treat common chronic conditions. These medications have a low cost per unit but are prescribed to millions of people, leading to high volume but lower overall revenue compared to their high-priced counterparts.
Conclusion
When considering "What drug sells the most in the USA?", the answer depends entirely on the metric of success. If measured by total revenue, the top spot is held by high-cost, specialized drugs like Keytruda or other cutting-edge biologics, which address complex diseases. If measured by the number of prescriptions filled, the leader is almost always a low-cost, widely-used generic like atorvastatin, which manages prevalent chronic conditions. The divergence of these two lists offers valuable insight into the American healthcare market, revealing the high cost of modern innovation and the pervasive need for affordable maintenance medications.
For more detailed prescription data, resources like ClinCalc.com offer extensive statistics and analysis.
How does the USA compare to the rest of the world for drug sales?
The US market is often characterized by higher drug prices compared to many other developed nations, meaning that the highest-revenue drugs in the US often correspond to some of the highest globally. However, prescription volume can vary depending on different healthcare systems and disease prevalence worldwide.
Why is the top drug by revenue different from the top drug by volume?
The disparity exists because revenue is calculated by price multiplied by volume. High-cost, patented brand-name drugs, often biologics for complex conditions, generate immense revenue even with lower patient counts. Conversely, high-volume generic drugs, like those for cholesterol or high blood pressure, have very low per-unit costs, resulting in high prescription numbers but lower total revenue.
