The diabetes medication landscape continues to evolve, driven by advancements in drug development, increasing prevalence of the condition and a growing demand for innovative therapies. Diabetes affects millions worldwide, and the pharmaceutical market is responding with treatments that not only improve glycemic control but also address cardiovascular and kidney-related complications, offering holistic management for patients.
In this blog, we take a closer look at the top 10 diabetes medications based on recent sales trends, exploring the factors behind their success, key clinical benefits and their broader impact on patient care. From blockbuster drugs like Ozempic to foundational treatments like insulin, these therapies showcase the diverse strategies used by pharma companies to meet the needs of a rapidly growing market.
Read on to examine the sales performance, unique attributes and clinical relevance of these leading diabetes medications, offering insights into the future of diabetes management and its role in improving patient outcomes globally.
Note: When it comes to companies that report in foreign currencies, the conversion to US dollars uses the average annual exchange rates reported by the US Federal Reserve.
1. Ozempic (Semaglutide)
Ozempic 2023 sales: 95.718 billion DKK ($13.892 billion USD)
Company/developer: Novo Nordisk
Date of first FDA approval: December 5, 2017
Indications Ozempic is FDA-approved for: Type 2 diabetes; lowering the risk of cardiovascular events, including heart attack, stroke or death, in individuals with diabetes and existing heart disease.
Price of Ozempic: The list price of Ozempic can vary based on the formulation prescribed by a healthcare provider: Ozempic 0.25 mg or 0.5 mg (1 x 1.5-mL pen): $968.52; Ozempic 1 mg (1 x 3-mL pen): $968.52; Ozempic 2 mg (1 x 3-mL pen): $968.52.
Why It Sold So Well: Ozempic has surged in popularity, solidifying its position as the world’s top-selling diabetes medication and is on track to become the best-selling drug globally. Year-over-year, Ozempic sales have skyrocketed by an impressive 66 percent in constant currency.
The demand for glucagon-like peptide-1 (GLP-1) receptor agonists continues to grow, fueled by widespread buzz, from Hollywood events like the Oscars to mentions on Saturday Night Live, with high-profile endorsements from celebrities such as Oprah.
While Ozempic is approved for managing type 2 diabetes, its notable weight loss side effect has turned it into a trendy weight loss solution. Since 2022, Novo Nordisk has faced ongoing challenges with drug shortages due to overwhelming demand and supply chain limitations. The company has also been dealing with imitations of its semaglutide-based products, including the obesity treatment Wegovy.
2. Jardiance (Empagliflozin)
Jardiance 2023 sales: $10.730 billion
Company/developer: Boehringer Ingelheim and Eli Lilly
Date of first FDA approval: August 1, 2014
Indications Jardiance is FDA-approved for: Type 2 diabetes, chronic heart failure, chronic kidney disease
List price of Jardiance: $611.10 for a one-month supply
Why it sold so well: Jardiance emerged as Boehringer Ingelheim’s top-performing product in 2023, contributing 28.8 percent to the company’s total net sales. Its revenue surged by 26.6 percent compared to 2022, reaching 5.832 billion euros ($6.143 billion USD).
For Eli Lilly, Jardiance ranked as the company’s fifth highest-selling product last year, generating $2.745 billion in sales. This marked a 33 percent growth from the $2.066 billion it achieved in 2022.
According to Boehringer Ingelheim’s 2023 annual report, the drug’s strong performance was attributed to sustained “strong momentum,” bolstered by regulatory approvals for chronic kidney disease in Europe and the US, as well as its use in treating pediatric type 2 diabetes. Eli Lilly also credited the robust sales growth to increased demand within the US, higher global volumes and favorable foreign exchange rates in markets outside the US.
3. Trulicity (Dulaglutide)
Trulicity 2023 sales: $7.132 billion
Company/developer: Eli Lilly
Date of first FDA approval: September 18, 2014
Indications Trulicity is FDA-approved for: As an adjunct to diet and exercise to improve blood sugar control in adults, as well as in children and adolescents aged 10 to 17 with type 2 diabetes that is not adequately managed through lifestyle changes alone. Additionally, it is indicated for reducing the risk of major adverse cardiovascular events (MACE) in adults with type 2 diabetes who have established heart disease.
Price of Trulicity: $977.42 per month
Why It Sold So Well: Trulicity, a GLP-1 receptor agonist, enhances glucose-dependent insulin secretion, playing a critical role in managing blood sugar levels in adults with type 2 diabetes, a condition affecting over 95 percent of diabetic patients. In 2021, an estimated 537 million adults were living with diabetes, a figure projected to climb to 783 million by 2045.
Trulicity received approval for reducing MACE in adults with type 2 diabetes who have either established cardiovascular disease or multiple risk factors. The approval for higher doses (3.0 mg and 4.5 mg) for the treatment of type 2 diabetes followed the AWARD-11 trial, which demonstrated significant improvements in glycosylated hemoglobin (HbA1c) levels and weight reduction. Furthermore, the AWARD-PEDS trial led to its approval for use in children and adolescents aged 10 to 17 with type 2 diabetes, addressing a critical need for this group, which often includes a high percentage of minority populations and experiences a more aggressive disease progression.
While Eli Lilly’s Q4 2023 report highlighted a 14 percent drop in global Trulicity revenue to $1.67 billion due to challenges in the US market, such as supply issues and competitive pricing, international sales remained robust, supported by increased volumes and favorable exchange rates. Overall, Trulicity’s total sales in 2023 reached $7.132 billion, with forecasts suggesting it could become the leading diabetes drug in 2024, surpassing competitors like Novo Nordisk’s Ozempic (semaglutide) and AstraZeneca’s Farxiga (dapagliflozin).
Despite competition from emerging therapies, such as Innovent Biologics’ mazdutide, and ongoing supply challenges, Trulicity’s established efficacy in cardiovascular risk reduction and the availability of higher doses continue to drive its strong market presence.
Eli Lilly’s total revenue surged by 28 percent to $9.35 billion in Q4 2023, fueled by strong performance from new product launches and existing drugs. The company is targeting revenue of $40.4 billion to $41.6 billion in 2024, positioning itself for sustained growth.
4. Insulin (Various Forms)
Insulin 2023 sales: $6.979 billion
First company/developer: Eli Lilly
Date of first FDA approval: Regular insulin or human insulin was approved in November 1982 (Eli Lilly and Company)
Indications insulin is FDA-approved for: Daily management of blood sugar levels in individuals with type 1 diabetes (juvenile diabetes mellitus); as a treatment option when oral medications are inadequate to manage blood sugar in type 2 diabetes; for controlling blood sugar in cases of maturity-onset diabetes of the young (MODY); to regulate blood glucose levels during pregnancy in individuals with gestational diabetes, as needed; as an essential part of treatment protocols for managing diabetic ketoacidosis.
Price of Insulin: Varies significantly by type and brand of insulin. For instance, Insulin Lispro Injection 100 units/mL is $25 a vial and Lantus injection is $92 per five-pack of KwikPens.
Why It Sold So Well: Insulin is a vital treatment for survival in type 1 diabetes and is crucial for managing blood sugar levels in many individuals with type 2 diabetes, making it a cornerstone of diabetes care.
Traditionally, insulin is administered through needles and syringes, insulin pens or pumps. Less commonly, it is delivered via inhalers, such as Afrezza by Mannkind, or insulin jet injectors. The FDA has also approved innovative solutions like the iLet Bionic Pancreas, an artificial pancreas system that uses advanced algorithms to automate insulin delivery.
The first genetically engineered human insulin, Humulin, was introduced in 1982. Today, modern insulin formulations, such as Humalog (insulin lispro, a rapid-acting insulin) and Lantus (insulin glargine, a long-acting insulin), provide improved glucose control and more convenient dosing options for patients.
In 2021, the FDA approved the first interchangeable biosimilar insulin, Semglee (insulin glargine-yfgn) from Mylan Pharmaceuticals. Clinically interchangeable with Lantus, Semglee is expected to significantly reduce the cost of insulin therapy, improving accessibility for patients.
The global insulin market is projected to grow from $19.69 billion in 2024 to $25.08 billion by 2032, driven by the rising prevalence of diabetes, increasingly sedentary lifestyles and advancements in insulin products.
However, high insulin prices in some markets have sparked public concern and legislative efforts to cap costs. Companies like Novo Nordisk have pledged to reduce the prices of their insulin products, including pre-filled pens, vials and pre-mixed formulations, by up to 75 percent. Meanwhile, emerging therapies like GLP-1 receptor agonists, such as Trulicity, are providing alternatives that challenge traditional insulin treatments.
Leading players in the global insulin market include Eli Lilly, Novo Nordisk and Sanofi, along with emerging competitors like Biocon and Boehringer Ingelheim. These companies are focusing on expanding into new markets, improving affordability and developing next-generation solutions for diabetes management.
5. Farxiga (Dapagliflozin)
Farxiga 2023 sales: $5.963 billion
Company/developer: AstraZeneca
Date of first FDA approval: January 13, 2014
Indications Farxiga is FDA-approved for: Reducing the risk of a sustained decline in kidney function (measured by estimated glomerular filtration rate or eGFR), end-stage kidney disease and cardiovascular or kidney-related death in adults with chronic kidney disease (CKD); lowering the risk of cardiovascular death and hospitalization in adults with heart failure with reduced ejection fraction; decreasing the likelihood of hospitalization due to heart failure in adults with type 2 diabetes who have established cardiovascular disease or multiple cardiovascular risk factors; enhancing blood sugar control in adults with type 2 diabetes, alongside diet and exercise, as part of a combination therapy approach.
List Price of Farxiga: $582.25 for a 30-day supply.
Why it sold so well: Farxiga is a novel sodium-glucose cotransporter-2 (SGLT2) inhibitor taken orally once daily. Research on the drug continues to expand, investigating its potential in prevention and organ protection, as studies increasingly highlight the interconnected functions of the heart, kidneys and pancreas.
Farxiga’s sales surged following its approval for treating heart failure and kidney disease. Over nearly a decade, it has demonstrated effectiveness both as a standalone treatment and as part of combination therapy, working alongside diet and exercise to improve blood sugar control in adults with type 2 diabetes.
6. Mounjaro (Tirzepatide)
Mounjaro 2023 sales: $5.163 billion
Company/developer: Eli Lilly
Date of first FDA approval: May 13, 2022
Indications Mounjaro is FDA-approved for: Mounjaro is used as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes.
List Price of Mounjaro: $1,069.08 per fill.
Why It Sold So Well: Tirzepatide, the first dual-acting glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptor agonist, is approved for the treatment of type 2 diabetes. It stands out by targeting the GIP receptor, complementing the effects of GLP-1 to improve insulin regulation and blood sugar control. In November 2023, the FDA also approved tirzepatide, branded as Zepbound, for chronic weight management in adults with obesity.
7. NovoRapid (Insulin Aspart)
NovoRapid 2023 sales: $4.177 billion
Company/developer: Novo Nordisk
Date of first FDA approval: September 7, 1999
Indications NovoRapid is FDA-approved for: NovoRapid, also known as NovoLog, is indicated for the treatment of diabetes mellitus in adults, adolescents and children aged one year and older. The primary function of the drug is to regulate glucose metabolism.
Price of NovoRapid: NovoRapid costs approximately $29.90 for a 10 mL vial.
Why it sold so well: NovoRapid produced results nearly identical to human insulin in two studies involving 1,954 patients with type 1 diabetes (a condition where the pancreas does not produce insulin) and in one study involving 182 patients with type 2 diabetes (a condition where the body cannot effectively use insulin). These studies compared NovoRapid to human insulin by measuring HbA1c levels, which indicate blood glucose control. After six months, NovoRapid reduced HbA1c levels by 0.12 percent and 0.15 percent more than human insulin.
8. Rybelsus (Semaglutide)
Rybelsus 2023 sales: $2.725 billion
Company/developer: Novo Nordisk
Date of first FDA approval: September 20, 2019
Indications Rybelsus is FDA-approved for: Rybelsus is a GLP-1 receptor agonist approved as an adjunct to diet and exercise for improving glycemic control in adults with type 2 diabetes mellitus.
Price of Rybelsus: The cost of Rybelsus 3 mg oral tablets is approximately $1,029 for a 30-tablet supply.
Why it sold so well: In placebo-controlled studies, Rybelsus, when used as a stand-alone therapy, significantly reduced blood sugar levels (hemoglobin A1c) compared to placebo, as measured by HbA1c tests, which track average blood sugar levels over time. After 26 weeks, 69 percent of patients taking 7 mg of Rybelsus once daily and 77 percent of those taking 14 mg once daily achieved HbA1c levels below 7 percent, compared to just 31 percent of patients on placebo.
Rybelsus experienced remarkable growth in 2022, with sales surging by 134 percent in Danish Krone (DKK) to DKK 11,299 million (about $1.6 billion USD). This strong momentum continued into 2023, with Rybelsus sales rising by 66 percent in DKK to DKK 18,750 million (around $2.7 billion USD).
9. Januvia (Sitagliptin)
Januvia 2023 sales: $2.189 billion
Company/developer: Merck
Date of first FDA approval: October 17, 2006
Indications Januvia is FDA-approved for: Januvia is a dipeptidyl peptidase-4 (DPP-4) inhibitor used as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.
Price of Januvia: The cost of Januvia (100 mg) oral tablet is approximately $613 for a supply of 30 tablets.
Why it sold so well: In 2023, Januvia achieved sales of $2,189 million. Its FDA approval was based on the combined results of two double-blind, placebo-controlled monotherapy studies and two double-blind, placebo-controlled combination therapy studies. Treatment with Januvia at a daily dose of 100 mg demonstrated significant improvements in HbA1c, fasting plasma glucose (FPG) and 2-hour postprandial plasma glucose (PPG) compared to placebo.
10. Trajenta (Linagliptin/Metformin)
Trajenta 2023 sales: $1.815 billion
Company/Developer: Boehringer Ingelheim
Date of first FDA approval: May 2, 2011
Indications Trajenta is FDA-approved for: Trajenta is a DPP-4 inhibitor used as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.
Price of Trajenta: The cost for Trajenta 5 mg oral tablet is about $562 for 30 tablets.
Why it sold so well: Sales of Trajenta have been stable since Boehringer acquired full rights from Lilly in 2019.
The efficacy of Trajenta has been demonstrated in clinical trials, showing statistically significant reductions in A1C both as monotherapy and as an add-on therapy. In a randomized, parallel-group Phase III study comparing linagliptin with placebo, Trajenta treatment resulted in a placebo-corrected reduction in HbA1c of -0.69 percent from baseline at 24 weeks (p < 0.0001). Patients receiving linagliptin were also more likely to achieve an HbA1c reduction of ≥0.5 percent at 24 weeks compared to those receiving placebo.
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