In the fast-evolving pharmaceutical landscape, tracking the top-selling drugs offers valuable insights into trends, healthcare priorities and the dynamics of the global market. As we approach the end of 2023, a retrospective look at the statistics from 2022 reveals the top 20 drugs dominating retail sales. This list not only highlights the drugs that have achieved significant commercial success but also reflects the prevailing health challenges and the pharmaceutical industry’s response to them. From life-saving cancer medications to treatments for chronic conditions, these top-selling drugs underscore the industry’s focus areas and innovation trajectories. In this article, we will explore the factors contributing to the success of the top 20 drugs in 2023 by retail sales from the prior year.
1. Comirnaty (COVID-19 Vaccine, mRNA)
Sales in 2022: $37.81 billion
Company: Pfizer
Disease it is FDA-approved to treat: Comirnaty is an active immunization to prevent COVID-19 caused by SARS-CoV-2 in individuals 12 years of age and older.
Cost: The price of Comirnaty is $110 to $130 per dose.
Why it did so well: The COVID-19 pandemic was one of the major drivers for Comirnaty sales in the US in 2022 as it remained the vaccine of choice throughout the pandemic. The rise of the Omicron variant fuelled the sale of the vaccine. Additionally, it was sold in bulk through government contracts thus pushing sales to make Comirnaty the top-selling drug in 2022.
2. Humira (adalimumab)
Sales in 2022: $21.24 billion
Company: AbbVie
Diseases it is FDA-approved to treat: Rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, plaque psoriasis.
Cost: The price of Humira is approximately $3,400 to $3,700 per dose (40mg/0.4 mL).
Why it did so well: Humira had monopolized the pharmaceutical market as a treatment for rheumatoid arthritis and certain other autoimmune conditions, such as spondylitis, psoriasis and Crohn’s disease, for almost 20 years. With no competition in the market and impressive performance, Humira reported approximately $21.2 billion in sales in 2022. With several biosimilars lined up to be launched in the US market, the monopoly is now over but their effect on Humira sales is yet to be determined.
3. Keytruda (pembrolizumab)
Sales in 2022: $20.94 billion
Company: Merck
Diseases it is FDA-approved to treat: Breast cancer, melanoma, non-small cell lung cancer, head and neck squamous cell cancer, urothelial carcinoma, microsatellite instability-high or a mismatch repair deficient solid tumor, colon or rectal cancer, esophageal or certain gastroesophageal junction carcinomas, cervical cancer, renal cell carcinoma, endometrial carcinoma, cutaneous squamous cell carcinoma.
Cost: The list price for each indicated dose of Keytruda when given every three weeks is $10,897.12. The list price for each indicated dose of Keytruda when given every six weeks is $21,794.24.
Why it did so well: Keytruda is a programmed death receptor-1 (PD-1) immune checkpoint inhibitor which means it enables the body’s own immune system to work better against cancer. One of the key factors in its success is its versatility as it is getting approvals for different types of cancers, especially at advanced stages where other medicines are no longer working. Keytruda’s large pool of positive data across various cancer types has made it the checkpoint inhibitor partner of choice for potential combinations.
4. Paxlovid (ritonavir/nirmatrelvir)
Sales in 2022: $18.93 billion
Company: Pfizer
Diseases it is FDA-approved to treat: COVID-19
Cost: The price of Paxlovid oral tablet is around $10 for a supply of 30 tablets.
Why it did so well: Paxlovid, an oral antiviral pill was approved by the FDA for the treatment of mild-to-moderate COVID-19 in adults at high risk for severe disease. The EPIC-HR clinical study that showed reduced risk of hospitalization or death with Paxlovid use prompted the National Institutes of Health (NIH) to prioritize it over other COVID-19 treatments. Studies outside of the laboratory have since confirmed Paxlovid’s effectiveness among people who have been vaccinated. It’s cheaper than many other COVID-19 drugs, and, perhaps most reassuring, it is expected to work against the Omicron variant.
5. Spikevax (COVID-19 vaccine, mRNA)
Sales in 2022: $18.44 billion
Company: Moderna
Diseases it is FDA-approved to treat: COVID-19
Cost: The private sector price of Spikevax is around $128 per dose.
Why it did so well: As is the case with COVID-19 vaccines and immunization drugs, the stellar sales performance of Moderna’s Spikevax was largely driven by the pandemic and the rise of variants such as Omicron. It was one of the earliest available vaccines for COVID-19 and global government contracts remained the top source of sales. The company has projected lower sales for 2023 due to a decline in demand globally.
6. Eliquis (apixaban)
Sales in 2022: $11.79 billion
Companies: Pfizer & Bristol Myers Squibb
Diseases it is FDA-approved to treat: Eliquis is an anticoagulant indicated to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation.
Cost: The price of Eliquis (oral tablet, 5 mg) is around $600 for a supply of 60 tablets.
Why it did so well: Eliquis has quickly become the drug of choice for anticoagulants backed by its superior performance to its alternatives. It has outpaced warfarin itself in US in terms of total prescriptions. There are lower side effects in comparison to its rivals, and this has strengthened its position in the market and boosted sales.
7. Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide)
Sales in 2022: $10.39 billion
Company: Gilead Sciences, Inc.
Diseases it is FDA-approved to treat: HIV-1 infection
Cost: The cost for Biktarvy oral tablet (50 mg-200 mg-25 mg) is around $4,006 for a supply of 30 tablets.
Why it did so well: Biktarvy is a complete HIV-1 treatment that combines three powerful medicines to form the smallest three-drug, integrase strand transfer inhibitor (INSTI)-based single-tablet regimen (STR) available, offering simple once-daily dosing with or without food, with a limited drug interaction potential and a high barrier to resistance. It is one of the most successful HIV therapies worldwide and is the most prescribed HIV treatment for both new and switch patients in the US.
8. Revlimid (lenalidomide)
Sales in 2022: $9.98 billion
Company: Bristol Myers Squibb
Diseases it is FDA-approved to treat: Multiple myeloma, smoldering myeloma and myelodysplastic syndromes.
Cost: The price of Revlimid (oral capsule, 2.5 mg) is around $24,576 for a supply of 28 capsules.
Why it did so well: Revlimid is among one of the best-selling medicines for blood cancer treatment. It has proven effectiveness against multiple myeloma with a more than 70 percent response rate. Generics are threatening to cut into Revlimid’s revenue with a decrease of 22 percent in worldwide revenues in 2022 compared to the prior year.
9. Stelara (ustekinumab)
Sales in 2022: $9.72 billion
Company: Janssen Pharmaceuticals
Diseases it is FDA-approved to treat: Crohn’s disease, ulcerative colitis, plaque psoriasis and psoriatic arthritis.
Cost: The list price of Stelara is $25,497.12 every eight weeks for the 90 mg dose as of March 2022.
Why it did so well: Stelara was the first biologic selective inhibitor of IL-12 and IL-23 pathways. At present it is protected by patent, and it has also gained new approvals strengthening its portfolio. Other competitors are driving prices down for Stelara, but the sales can be boosted by increasing the volume to cover up for the lower price and the company led strong marketing campaigns for the drug.
10. Eylea (aflibercept)
Sales in 2022: $9.64 billion
Company: Regeneron Pharmaceuticals
Diseases it is FDA-approved to treat: Neovascular (wet) age-related macular degeneration (AMD)
Cost: The price of Eylea intravitreal solution (40 mg/mL) is around $1,958 for a supply of 0.05 milliliters.
Why it did so well: Dubbed as ‘the King’ in the ophthalmology field, Eylea has a strong position in the market with its consistent performance. There are several biosimilars launched in the market that could prove to be fierce competitors in the near future.
11. Opdivo (nivolumab)
Sales in 2022: $9.30 billion
Company: Bristol Myers Squibb
Diseases it is FDA-approved to treat: Opdivo (nivolumab) is a PD-1 blocking antibody for the treatment of melanoma, non-small cell lung cancer, malignant pleural mesothelioma, renal cell carcinoma, classical Hodgkin lymphoma, squamous cell carcinoma of the head and neck, urothelial carcinoma, MSI-H or dMMR metastatic colorectal cancer, hepatocellular carcinoma, esophageal cancer, gastric cancer and gastroesophageal junction cancer.
Cost: The price of Opdivo intravenous solution (10 mg/mL) is around $1,297 for a supply of 4 milliliters.
Why it did so well: Opdivo has shown promising clinical efficacy in the treatment of advanced non-small cell lung cancer. In advanced squamous non-small cell lung cancer, Opdivo resulted in tumor shrinkage in 20 percent of patients, compared to 9 percent with chemotherapy (docetaxel). The median progression-free survival was 3.5 months with Opdivo and 2.8 months with chemotherapy. In advanced non-squamous non-small cell lung cancer, Opdivo achieved tumor shrinkage in 19 percent of patients, compared to 12 percent with docetaxel. The median progression-free survival was 2.3 months with Opdivo and 4.2 months with chemotherapy.
12. Dupixent (dupilumab)
Sales in 2022: $9.10 billion
Company: Regeneron and Sanofi
Diseases it is FDA-approved to treat: Dupixent is an IL-4 receptor alpha antagonist indicated for the treatment of adult patients with moderate-to-severe atopic dermatitis whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable. Dupixent can be used with or without topical corticosteroids.
Cost: The list price of Dupixent is $3,587.92 per carton.
Why it did so well: In 2022, Sanofi announced that Dupixent’s revenue increased by 42 percent to 2.4 billion euros in the quarter ending on December 31. This exceeded the consensus of 2.37 billion euros. Sanofi has projected that Dupixent could generate sales of up to 13 billion euros in its peak year, as the company aims to expand its usage for various inflammatory conditions.
13. Ozempic (semaglutide)
Sales in 2022: $8.71 billion
Company: Novo Nordisk
Diseases it is FDA-approved to treat: Ozempic is a glucagon-like peptide 1 (GLP-1) receptor agonist indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.
Cost: The price of Ozempic subcutaneous solution, available in a 1.5 milliliter supply with a concentration of 2 mg/1.5 mL (0.25 mg or 0.5 mg dose), is approximately $912 per dose.
Why it did so well: As of May 2023, both Ozempic and Wegovy have become highly sought after and gained significant popularity on social media platforms. This surge in demand is primarily due to people celebrating their potential for weight loss. However, it’s important to note that both medications are currently listed on the FDA’s Drug Shortages list due to a global shortage of semaglutide, their active ingredient. While unintended weight loss is listed as a side effect of Ozempic, some individuals on social media platforms are promoting this side effect as a desirable benefit for weight loss. This trend has led to increased demand for this medication from individuals who do not have a medical need but seek it solely for weight loss purposes.
14. Jardiance (empagliflozin)
Sales in 2022: $8.39 billion
Company: Boehringer Ingelheim and Eli Lilly & Co.
Diseases it is FDA-approved to treat: Jardiance is a SGLT2 inhibitor intended for the treatment of type 2 diabetes and to reduce the risk of cardiovascular death in adult patients with type 2 diabetes mellitus and established cardiovascular disease.
Cost: The list price for a one-month supply of Jardiance is $570.48.
Why it did so well: In 2021, Boehringer Ingelheim witnessed a significant increase in Jardiance sales, reaching 3.9 billion euros ($4.3 billion), a 29 percent rise from the previous year. This growth can be attributed to Boehringer Ingelheim’s efforts to target a broader range of diabetes and heart failure patients. Looking ahead, Jardiance holds substantial potential for further expansion. Jardiance already had a sizable market as an SGLT2 inhibitor, but its endorsement for heart failure has unlocked substantial potential. Boehringer Ingelheim recently estimated that by 2030, the US alone could have 8 million cases of heart failure, further highlighting the immense opportunities for Jardiance.
15. Imbruvica (ibrutinib)
Sales in 2022: $8.35 billion
Company: Pharmacyclics LLC, an AbbVie company and Janssen Biotech, Inc, which is wholly owned by Johnson & Johnson.
Diseases it is FDA-approved to treat: Imbruvica is indicated for the treatment of adult patients with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) with 17p deletion.
Cost: Imbruvica costs $597 per capsule/tablet.
Why it did so well: In 2021, AbbVie announced sales of Imbruvica amounting to $5.4 billion, representing a modest 1.8 percent growth compared to its performance in 2020. Last year, Janssen reported worldwide Imbruvica sales of $4.37 billion, reflecting a 5.8 percent increase. These figures highlight the continued commercial success of Imbruvica for both AbbVie and Johnson & Johnson, demonstrating steady growth in sales.
16. Darzalex (daratumumab)
Sales in 2022: $7.98 billion
Company: Janssen Biotech, Inc., a Janssen Pharmaceutical Company of Johnson & Johnson
Diseases it is FDA-approved to treat: Darzalex is a CD38 monoclonal antibody cancer medicine used to treat multiple myeloma.
Cost: The price of Darzalex intravenous solution (20 mg/mL) is around $714 for a supply of 5 milliliters.
Why it did so well: The worldwide net trade sales of Darzalex were $2.26 billion in the first quarter of 2023. As the pioneering CD38-directed cytolytic antibody approved for multiple myeloma treatment, Darzalex has proven its effectiveness in reducing tumor burden. In a particular trial, 29 percent of patients experienced a partial or complete reduction in their tumor burden, with an average duration of 7.4 months. In another trial, 36 percent of patients witnessed a partial or complete reduction in tumor burden. These results highlight Darzalex’s potential in providing meaningful responses and positive outcomes for patients with multiple myeloma.
17. Trikafta (elexacaftor/tezacaftor/ivacaftor)
Sales in 2022: $7.69 billion
Company: Vertex Pharmaceuticals
Diseases it is FDA-approved to treat: Trikafta is a combination of ivacaftor, a cystic fibrosis transmembrane conductance regulator (CFTR) potentiator, tezacaftor and elexacaftor indicated for the treatment of cystic fibrosis in patients aged two years and older who have at least one F508del mutation in the CFTR gene or a mutation in the CFTR gene that is responsive based on in vitro data.
Cost: The price of Trikafta is roughly $326,000 per patient per year.
Why it did so well: Trikafta has received approval for use in around 90 percent of patients with cystic fibrosis, offering a much-needed therapeutic option for many individuals who previously had no approved treatments available. As a result of this approval, approximately 2,250 children will become eligible for Trikafta, with over 900 gaining access to a CFTR modulator for the first time. Clinical trials have shown meaningful improvements in patients, and the drug has demonstrated both safety and tolerability in individuals with cystic fibrosis. In 2022, Trikafta achieved sales of $7.69 billion, representing an annual increase of 35 percent. These figures highlight the positive impact of Trikafta on patients and its growing recognition in the treatment of cystic fibrosis.
18. Trulicity (dulaglutide)
Sales in 2022: $7.44 billion
Company: Eli Lilly & Co.
Diseases it is FDA-approved to treat: Trulicity is a GLP-1 receptor agonist indicated for use in adults with type 2 diabetes mellitus. It is prescribed as an adjunct to diet and exercise to improve glycemic control. Additionally, it is approved to reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes mellitus who have either established cardiovascular disease or multiple cardiovascular risk factors.
Cost: The list price of Trulicity is $930.88 per month.
Why it did so well: In the US, Trulicity revenue increased by 5 percent to reach $1.53 billion in the fourth quarter of 2022. However, it is important to note that Trulicity is currently listed on the FDA’s Drug Shortages list due to a global supply issue. The shortage is closely associated with a shortage of another diabetes medication, Ozempic.
19. Xarelto (rivaroxaban)
Sales in 2022: $7.22 billion
Company: Janssen Pharmaceuticals
Diseases it is FDA-approved to treat: Xarelto is a factor Xa inhibitor indicated to reduce the risk of stroke and systemic embolism in nonvalvular atrial fibrillation; for treatment of deep vein thrombosis (DVT); for treatment of pulmonary embolism (PE); for reduction in the risk of recurrence of DVT or PE; for the prophylaxis of DVT, which may lead to PE in patients undergoing knee or hip replacement surgery; for prophylaxis of venous thromboembolism (VTE) in acutely ill medical patients; to reduce the risk of major cardiovascular events in patients with coronary artery disease (CAD); to reduce the risk of major thrombotic vascular events in patients with peripheral artery disease (PAD), including patients after recent lower extremity revascularization due to symptomatic PAD; for treatment of VTE and reduction in the risk of recurrent VTE in pediatric patients from birth to less than 18 years; for thromboprophylaxis in pediatric patients two years and older.
Cost: The price of Xarelto (oral tablet, 20 mg) is around $581 for a supply of 30 tablets.
Why it did so well: The high sales of Xarelto in 2022 can be attributed to its effective mechanism of action across multiple indications, its broad global market presence and particularly strong performance in the European market.
20. Gardasil (HPV quadrivalent vaccine)
Sales in 2022: $6.90 billion
Company: Merck & Co.
Diseases it is FDA-approved to treat: Gardasil is a vaccine indicated in people nine through 26 years of age for the prevention of certain types of cancer caused by human papillomavirus (HPV) infection.
Cost: The list price for each indicated dose of Gardasil 9 is approximately $286.78.
Why it did so well: Clinical data has demonstrated the effectiveness of the HPV vaccine in preventing HPV infections. For instance, studies have shown a 56 percent reduction in HPV infections among females aged 14 to 19, four years after vaccination. Furthermore, within 12 years of the vaccine’s introduction, the HPV vaccine has been associated with an 88 percent decrease in HPV infections among females aged 14 to 19 and an 81 percent decrease among females aged 20 to 24 in the US.
The HPV vaccine market size is expected to exceed $13 billion by 2032, with a projected compound annual growth rate (CAGR) of 12 percent from 2023 to 2032. The emergence of various HPV strains has emphasized the importance of HPV vaccines as a primary preventative measure against infection. The increasing level of public awareness regarding the risks associated with HPV has played a significant role in driving the demand for vaccination. This growing demand is expected to contribute to the market expansion of HPV vaccines in the coming years.
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