BEST SELLING DRUGS

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Humira (adalimumab, AbbVie) again topped the list for most spending by invoice among branded drugs in the United States, as it has each of the last 5 years, according to the latest report from QuintilesIMS Institute, which tracks drug spending and prescriptions annually.

Spending on the drug, prescribed for inflammatory conditions, has tripled from $4.5 billion in 2012 to $13.6 billion in 2016.

Levothyroxine, for hypothyroidism, was the most commonly prescribed drug, as it has been for each of the 5 years, with 123 million prescriptions in 2016.

The total number of all prescriptions dispensed in 2016 hit 4.4 billion, up 1.9% from 2015, on par with increases seen in earlier years.

"Notably," the authors say, "chronic prescriptions with 3-month duration have increased dramatically in the last 2 years, and prescriptions grew by 3.3% when adjusting for prescription size."

Use of pain medications, both narcotic and nonnarcotic, was down 1% as restrictions on prescribing and distributing have become more common, according to the report.

Following are the lists of the top 10 drugs in invoice spending and prescriptions.

Table 1. Top 10 Branded Medicines by Sales^a

Rank	Medicine	2012 ($ in Billions)	2016 ($ in Billions)
	Total US market	317.8	450.0
1	Humira (adalimumab, AbbVie)	4.5	13.6
2	Harvoni (ledipasvir sofosbuvir, Gilead)	0.0	10.0
3	Enbrel (etanercept, Amgen)	4.2	7.4
4	Lantus Solostar (insulin glargine injection, Sanofi)	2.3	5.7
5	Remicade (infliximab, Janssen Biotech)	3.8	5.3
6	Januvia (sitagliptin, Merck)	2.6	4.8
7	Advair Diskus (fluticasone/salmeterol, GlaxoSmithKline)	4.6	4.7
8	Lyrica (pregabalin, Pfizer)	1.9	4.4
9	Crestor (rosuvastatin, AstraZeneca)	4.8	4.2
10	Neulasta (pegfilgrastim, Amgen)‎	3.4	4.2
aSales spending is based on QuintilesIMS National Sales Perspectives and is not adjusted for estimates of off-invoice discounts and rebates.

Table 2. Top 10 Medicines by Prescriptions^a

Rank	Medicine	2012 (No. of Prescriptions in Millions)	2016 (No. of Prescriptions in Millions)
	Total US market	4154	4453
1	Levothyroxine	112	123
2	Lisinopril	99	110
3	Atorvastatin	55	106
4	Acetaminophen/hydrocodone	136	90
5	Metoprolol	82	88
6	Amlodipine	69	87
7	Metformin	68	87
8	Omeprazole	67	76
9	Albuterol	61	70
10	Gabapentin	39	64
aIncludes prescriptions and insulins dispensed through chain and independent pharmacies, food store pharmacies, mail services, and long-term care facilities. Over-the-counter medications were excluded.

In the report, authors Murray Aitken, executive director, and Michael Kleinrock, research director, QuintilesIMS Institute, write that invoice spending on medications — the amount paid to distributors by pharmacy or hospital customers — in 2016 grew more slowly than in the previous year.

Spending adjusted for net prices grew by 4.8% in 2016, slowing significantly from 8.9% in 2015.

The report says that was largely due to smaller price increases for protected branded products, fewer new products, and lower spending on hepatitis C treatments in 2016.

The report estimates that 226,000 new patients were treated with hepatitis C medicines in 2016, down by 23,000 from the year before. The drugs are potentially curing 13% to 22% of the 3 to 5 million infected patients in the United States, the authors write.

The report predicts spending will continue to moderate in the next 5 years.

"The outlook for medicine spending through 2021 is for mid-single digit growth driven by further clusters of innovative treatments, offset by a rising impact from brands facing generic or biosimilar competition," the authors write.