The Top-Selling Drugs in America

Health Insurance

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Prescription drugs are a vital part of American health, helping millions every year with their health conditions. About half of all Americans take a prescription drug regularly, and about 1 in 5 U.S. adults takes three or more regular prescription drugs, according to the Centers for Disease Control and Prevention.

But these medications are also a vital part of our economy, for better or worse. Collectively, we spent nearly $374 billion on prescriptions in 2014, according to the latest report by IMS Health Informatics, a company that tracks health care spending. That amount is about equal to Walmart’s profits in 2008 or the entire gross domestic product of Austria in 2009.

We’ve already shared with you the most widely prescribed drugs, but none of those makes the most money. So which drugs were the top earners in 2014?

  1. Sovaldi, $7.9 billion
  2. Abilify, $7.8 billion
  3. Humira, $7.2 billion
  4. Nexium, $5.9 billion
  5. Crestor, $5.8 billion

Uses for the top-selling drugs

The top-selling drugs treat different ailments, and all are brand-name drugs, meaning there were no generic options for them in 2014. That may be why they top the list in sales; generic drugs are typically much cheaper than branded drugs. Here’s what the top-selling prescriptions are used for.

  • Sovaldi was first approved for most types of hepatitis C in 2013 and quickly skyrocketed to the top earnings spot in 2014. There are six genotypes of hepatitis C, and Sovaldi can cure four of them in one or two treatment courses; the other two genotypes account for about 3% of hepatitis C patients. Manufacturer Gilead boasts an 84% to 96% cure rate of hepatitis C, depending on which genotype is being treated, leading many to call Sovaldi a miracle drug.
  • Abilify is a medication for depression, bipolar disorder, and schizophrenia. Officially classified as an antipsychotic, Abilify also treats irritability associated with autism. In April 2015, the first generic for Abilify, aripiprazole, became commercially available.
  • Humira is a biologic drug, which means it’s synthesized from animal tissues or cells instead of from chemicals. It’s indicated for eight conditions, including Crohn’s disease, plaque psoriasis and several types of arthritis.
  • Nexium is approved to treat frequent acid reflux, stomach ulcers, damaged esophagus and gastroesophageal reflux disorder (GERD). In January 2015, the Food and Drug Administration approved the first generic Nexium drug, esomeprazole, so it may not make this list next year.
  • Crestor is the only statin on our list, approved to treat high cholesterol and triglyceride levels. It also may reduce the risk of heart attack and stroke in some high-risk patients.

Cost of the top-selling drugs

These five drugs aren’t among the most widely prescribed, so their high prices explain why they made so much money for their manufacturers last year. Drug prices also vary depending on which pharmacy and dose you use, your health insurance policy and how much you purchase at once, among other factors.

Here are some cash price estimates for one month of common doses of each of the five drugs based on GoodRx searches in San Francisco. For comparison, we’ve also included the prices of the two generics that are now available for the same doses and time frame. Keep in mind that your price will depend on on your insurance formulary, or list of approved medications for coverage, and out-of-pocket costs outlined in your policy.

  • Sovaldi: $30,700 – $31,900
  • Abilify: $921 – $954
    • Generic Abilify, aripiprazole: $371-$682
  • Humira: $3,305 – $3,408
  • Nexium: $252 – $273
    • Generic Nexium, esomeprazole: $103 – $199
  • Crestor: $219 – $225

Bear in mind that the first drug, Sovaldi, is not intended for chronic use, but rather only for three to six months in one lifetime. Sovaldi costs about $84,000 for an average 12-week course of treatment, and some patients require two courses, for a whopping price tag of $168,000. Humira also has a caveat:  It requires a larger dose to start before going to maintenance dosage, which will cost more. Only maintenance doses are quoted above.

Saving on the drugs

All this price variation can be a big problem if you’re using one of these drugs. If you’re paying cash for your medications, consider looking into coupons on a site like RxRevu or the manufacturer’s website, which also may have longer-term discount programs. The price ranges are based on different pharmacies, so where you choose to fill your script can make a difference of hundreds or thousands of dollars.

You can also save on your medications by going through an online pharmacy. By allowing you to purchase a larger supply, online pharmacies can offer substantial discounts. If you need more help, you can check out the U.S. Department of Health and Human Service’s listing of prescription assistance programs.

Lastly, if you take a drug such as Abilify or Nexium for which a generic is available, talk to your doctor about switching to the less expensive option. Generics are required to be just as safe and effective as branded drugs, and they must meet the same quality standards. According to the FDA, generics cost about 80%  to 85% less, on average, than their pricey brand-name counterparts.

Don’t be afraid to ask your doctor questions about any cost issues. It is always OK to ask about generics, or any other cost-saving options you might find.Whether it’s for drugs, medical procedures, or finding the right doctor, doing your homework and shopping around is a great way to start saving money.

Lacie Glover is a staff writer at NerdWallet, a personal finance website. Email: [email protected]. Twitter: @LacieWrites.