US spending on prescription drugs increased moderately in 2011 reflecting increased generic-drug incursion and lower spending on prescription drugs. Pfizer retained its number one position of the top company of US prescription drug sales, and the generic-drug company Teva Pharmaceutical moved into the top-five companies of US prescription drug sales.

Total healthcare system spending on medicines in the US reached $320 billion in 2011, up 3.7% in nominal terms or 0.5% on a real-per-capita basis, according to a recent report by the IMS Institute for Healthcare Informatics. Branded medicines spending grew 2.2% on a nominal basis and reflected the impact of $14.9 billion lower spending on products that lost their patent exclusivity. In 2011, spending for brands launched within the past two years was $12.2 billion, compared with $8.5 billion in the year-earlier period. Spending on generic drugs, which now account for 80% percent of dispensed prescriptions, increased $5.6 billion in 2011, according to IMS. Overall spending on medicines continued to be concentrated on traditional small-molecule oral pills dispensed through retail pharmacies, even as specialty drugs and biologics experienced higher growth.

Overall per-capita-use of medicines in the US declined slightly in 2011, as physician office visits and nonemergency-room hospital admissions dropped, and older Americans reduced their retail drug use, according to IMS. The number of office visits declined 4.7% while emergency-room admissions, which are relatively small in number, rose 7.4%. Retail prescription usage declined on average 1.1% in 2011 and fell by more than 3% in ten states, reflecting variations in demographics, epidemiology, clinical practice, and payer dynamics. Seniors age 65 and over reduced their use of prescription drugs by 3.1% last year, most notably in the antihypertensive class. Individuals age 19 to 25 increased their use of medicines by 2.0%, notably for attention deficit hyperactivity disorder treatments and antidepressants. This was the only age group that increased drug utilization in 2011.

Nearly one-third of total healthcare spending was concentrated in five therapy areas: oncology, asthma and chronic obstructive pulmonary disease, dyslipidemia, diabetes, and mental health, according to IMS. Each of these therapy areas grew faster than the overall market and exhibited a range of dynamics related to new treatment option usage and growing diagnosis of the related disease.

Product sales and company rankings
On a product basis, Pfizer’s anticholesterol drug Lipitor (atorvastatin) retained its position as the top-selling drug in the United States in 2011 with sales of $7.7 billion, according to data from IMS. Bristol-Myers Squibb’s and Sanofi’s antiplatelet drug Plavix (clopidogrel) was second with US sales of $6.8 billion. AstraZeneca’s Nexium (esomeprazol), a drug to treat gastroesophageal reflux disease, was third with US sales of $6.2 billion. Bristol-Myers Squibb’s Abilify (aripiprazole), an antipsychotic and antidepressant, came in fourth with US sales of $5.2 billion, and GlaxoSmithKine’s Advair Diskus (fluticasone and salmeterol), a drug to treat asthma, was fifth with US sales of $4.6 billion. Rounding out the 10 top-selling prescription drugs in the US were AstraZeneca’s antidepressant Seroquel (quetiapine), Merck & Co’s anti-asthma drug Singulair (montelukast), AstraZenenca’s anticholesterol drug Crestor (rosuvastatin), Eli Lilly’s antidepressant Cymbalta (duloxetine), and Abbott’s Humira (adalimumab), a drug to treat rheumatoid arthritis.

On a company basis, Pfizer retained its top position of US prescription drug sales in 2011, with sales of $25.1 billion followed by AstraZeneca with US sales of $19.9 billion, according to data from IMS. Merck & Co and Novartis closely followed with respective US sales of $19.3 billion and $19.2 billion. Teva Pharmaceutical took the fifth slot with US sales of $15.1 billion. Rounding out the top 10 companies of US prescription sales were Eli Lilly ($14.9 billion), Roche ($14.5 billion), GlaxoSmithKline ($14.2 billion), Amgen ($13.1 billion), and Johnson & Johnson ($12.1 billion). Sanofi, Abbott, Bristol-Myers Squibb, Boehringer Ingelheim, and Takeda, respectively, completed the top 15 companies of US prescription drug sales.