What are the top 3 drugs used worldwide? A look at global pharmaceutical leaders

In 2024, the global pharmaceutical market saw the top 50 best-selling drugs generate over $116 billion in revenue. Answering the question, 'What are the top 3 drugs used worldwide?', requires clarity, as the most widely used medicines by volume (often cheap generics) differ significantly from the most profitable ones by sales revenue. Based on 2024 revenue, the pharmaceutical market's top three blockbuster drugs are Merck's Keytruda, Novo Nordisk's Ozempic, and Bristol Myers Squibb/Pfizer's Eliquis.

Quick Summary

An analysis of 2024 global sales data reveals the top three prescription drugs by revenue are Keytruda, Ozempic, and Eliquis. These blockbuster medications treat cancer, diabetes, and cardiovascular conditions. Their market positions are influenced by efficacy, patient demand, and patent life cycles.

Key Points

• Top 3 by Revenue, Not Volume: The top three drugs by global sales revenue in 2024 were Keytruda, Ozempic, and Eliquis, not necessarily the most widely consumed medications by volume.

• Keytruda's Oncology Dominance: Merck's Keytruda, a cancer immunotherapy, held the top sales position for 2024, demonstrating the high market value of innovative cancer treatments.

• Ozempic's Metabolic Breakthrough: Novo Nordisk's Ozempic is a GLP-1 agonist used for type 2 diabetes, and its immense popularity, partly due to weight-loss benefits, propelled it to the #2 spot.

• Eliquis's Cardiovascular Role: Jointly developed by BMS and Pfizer, Eliquis is a leading anticoagulant that prevents blood clots and strokes, ranking as the third best-selling drug.

• Patent Expirations Threaten Market Share: Both Keytruda and Eliquis face upcoming patent expirations, which will expose them to generic and biosimilar competition and could significantly reshape future sales rankings.

• High-Cost vs. High-Volume: High-revenue blockbusters differ significantly from high-volume, low-cost medications like common generics or OTC pain relievers, which are far more frequently used by the general population.

• Market Dynamism: The pharmaceutical market is in a state of constant flux, with factors like patent expiration, new technologies, and shifts in public health priorities continuously redefining the top-selling drug landscape.

The term “top drugs” is open to interpretation, encompassing different metrics such as prescription volume, revenue, or patient population. This article will focus on the top three best-selling prescription medications globally in 2024, as revenue figures provide a clear, standardized metric for market dominance, reflecting the impact and demand for high-cost, innovative therapies. The rankings below are based on sales data from 2024, showcasing the dynamic nature of the pharmaceutical landscape.

1: Keytruda (Pembrolizumab)

Merck's cancer immunotherapy, Keytruda, secured the top spot for the second year in a row in 2024, generating nearly $29.5 billion in sales. This makes it the world's best-selling drug, a testament to its success as a cornerstone therapy in oncology.

Therapeutic Impact and Mechanism

Keytruda is a PD-1 (programmed cell death protein 1) inhibitor that helps the immune system fight cancer. It is approved for a wide range of cancers, including non-small cell lung cancer, melanoma, renal cell carcinoma, and endometrial carcinoma. Keytruda's patents are expected to expire around 2028, potentially leading to biosimilar competition.

2: Ozempic (Semaglutide)

Novo Nordisk's Ozempic, used for type 2 diabetes, was the second best-selling drug with approximately $17 billion in sales in 2024. Its popularity has been boosted by its weight-loss effects, driving interest in the GLP-1 agonist class.

Therapeutic Impact and Mechanism

Ozempic is a GLP-1 receptor agonist that helps lower blood sugar and can reduce cardiovascular risk in type 2 diabetes patients. It also aids in weight loss. The success of GLP-1 medications like Ozempic highlights a major trend in addressing metabolic health issues.

3: Eliquis (Apixaban)

Developed by Bristol Myers Squibb and Pfizer, the anticoagulant Eliquis ranked third with $13.3 billion in sales in 2024. It is widely used to prevent blood clots.

Therapeutic Impact and Mechanism

Eliquis is a Factor Xa inhibitor, a blood thinner used to prevent conditions like stroke in patients with AFib, deep vein thrombosis, and pulmonary embolism. It is considered a safer alternative to older anticoagulants. Eliquis's patents are set to expire around 2026, which may lead to generic competition.

Comparison of Top 3 Best-Selling Prescription Drugs (2024)

Feature	Keytruda (Pembrolizumab)	Ozempic (Semaglutide)	Eliquis (Apixaban)
Manufacturer(s)	Merck & Co.	Novo Nordisk	Bristol Myers Squibb/Pfizer
Primary Therapeutic Area	Oncology (Cancer)	Endocrinology (Type 2 Diabetes, Weight Loss)	Cardiovascular Health (Anticoagulant)
Mechanism of Action	PD-1 Inhibitor	GLP-1 Receptor Agonist	Factor Xa Inhibitor
2024 Global Sales	~$29.5 Billion	~$17 Billion	~$13.3 Billion
Key Market Driver	Broad range of cancer indications	Dual efficacy in diabetes and weight loss	Prevention of stroke and blood clots
Upcoming Challenge	Patent expiry and biosimilar competition around 2028	Potential price negotiation impact under the Inflation Reduction Act	Patent expiry and generic competition around 2026

The Broader Context: Beyond Best-Sellers

Focusing solely on revenue provides a specific view of the market. Other metrics offer a different perspective on drug usage.

Commonly Consumed Medicines by Volume

Medicines used in high volumes include over-the-counter pain relievers like acetaminophen and ibuprofen, as well as generic prescription drugs for common conditions such as high cholesterol (statins) and high blood pressure (e.g., lisinopril). These are used by vast numbers of people but have lower price points compared to the top-selling blockbuster drugs. Separately, substances like cannabis, alcohol, and nicotine are widely used globally, but are tracked differently than pharmaceutical sales.

Conclusion: A Shifting Pharmaceutical Market

The top three best-selling drugs of 2024—Keytruda, Ozempic, and Eliquis—reflect significant advancements and market demand in oncology, metabolic disorders, and cardiovascular health. These high-revenue drugs are driven by innovative research and address major health challenges globally. However, impending patent expirations for Keytruda and Eliquis signal potential shifts in market share due to upcoming generic and biosimilar competition. The substantial growth in the GLP-1 market, exemplified by Ozempic, highlights the increasing focus on widespread health issues like obesity and diabetes. While these blockbuster drugs are major financial drivers for the pharmaceutical industry, they are distinct from the high-volume, lower-cost medications and other substances most frequently consumed worldwide. For more detailed insights into global medicine usage, the IQVIA Institute's reports are a valuable resource.

Frequently Asked Questions

Why are the top-selling drugs not the most commonly used ones?

Top-selling drugs are ranked by revenue, reflecting their high price and market size, especially for complex or rare diseases. The most commonly used drugs by volume, such as generics for common conditions like pain or high blood pressure, are often much cheaper, so they don't top the sales charts despite being used more frequently.

What is Keytruda used for?

Keytruda is a cancer immunotherapy primarily used to treat a wide range of cancers, including non-small cell lung cancer, melanoma, and head and neck cancer. It works by activating the body's own immune system to fight cancer cells.

How does Ozempic work?

Ozempic is a GLP-1 receptor agonist that mimics a hormone to help lower blood sugar levels in patients with type 2 diabetes. It also has appetite-suppressing effects that contribute to weight loss.

What is the primary function of Eliquis?

Eliquis is an anticoagulant, or blood thinner, used to prevent the formation of dangerous blood clots. It is commonly prescribed to reduce the risk of stroke in patients with atrial fibrillation and for treating deep vein thrombosis and pulmonary embolism.

What is a 'blockbuster' drug?

A blockbuster drug is a pharmaceutical product that generates over $1 billion in annual sales. These drugs are typically innovative, patented therapies that command a large market share for specific, often chronic or severe, medical conditions.

What happens when a drug's patent expires?

When a drug's patent expires, other companies can manufacture and sell generic or biosimilar versions. This typically leads to a significant decrease in the original drug's sales as competition drives down prices.

What is a biosimilar?

A biosimilar is a biological product that is highly similar to an already FDA-approved biological product (the 'reference product') and has no clinically meaningful differences in terms of safety, purity, and potency. They are a form of generic competition for biologics like Keytruda.

How do illicit drug use statistics compare to prescription drug sales?

Statistics on illicit drug use, such as cannabis use figures reported by the UN, relate to user volume and are typically tracked separately from pharmaceutical sales. The two metrics measure very different markets and purposes, with blockbuster drug sales reflecting high-cost therapeutic innovation rather than general consumption rates.