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The 25 Most Popular Drugs by U.S. Spending

Prescription medications for diabetes, weight loss, arthritis, blood clots topped the list in 2023

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The United States spent a total of more than $722 billion on prescription drugs in 2023, a new report finds. That’s a nearly 14 percent increase in spending from 2022 — the largest annual rise in the last 20 years — and researchers say that growth is only expected to continue in 2024.

According to a new study published April 24 in the American Journal of Health-System Pharmacy, semaglutide — known by brand names Ozempic, Rybelsus and Wegovy, and often prescribed for diabetes or weight management — topped the list of most popular drugs by overall U.S. spending in 2023. The U.S. spent nearly $38.6 billion on the medications, which can cost upward of $1,000 a month without insurance coverage.

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Given the soaring demand for these medications, which can help some people lose, on average, 15 percent of their body weight, lead study author Eric Tichy said he expected spending would be high. “But we didn't anticipate it would be quite as high as it was,” says Tichy, a pharmacist and Mayo Clinic division chair. It’s worth noting that a similar drug known for its weight loss benefits — tirzepatide, whose brand names include Mounjaro and Zepbound — also made the list of popular drugs by overall U.S. spending for 2023.

Former front-runner adalimumab (brand name Humira, plus several biosimilar competitors), which treats autoimmune disorders like rheumatoid arthritis, Crohn’s disease and psoriatic arthritis, came in second on the list of most popular drugs, with $35.3 billion in overall U.S. spending in 2023. And apixaban (Eliquis), prescribed to prevent strokes and blood clots in people who have a heart condition known as atrial fibrillation, was third, with roughly $22 billion in spending.

Why Rx spending is on the rise

The study’s authors note that the nearly 14 percent increase in spending seen between 2022 and 2023 was driven primarily by three factors:

1. More people taking prescription medications. One likely contributor to higher utilization, Tichy says, is expanded indications. This is when an already approved medication gets approved for another use.

This phenomenon could come into play again in 2024 with Wegovy, whose active ingredient is semaglutide, already the leader on the list of most popular drugs. The medication was approved for weight management in 2021, but that approval was expanded in March 2024 so that doctors can now prescribe it to reduce the risk of heart problems in people who are overweight and have cardiovascular disease. An April analysis from the health policy nonprofit KFF found that 3.6 million people with Medicare could be eligible for coverage of Wegovy with this new indication.

Another reason: Under the new prescription drug law passed in 2022, more people with Medicare are able to access and afford their prescription medications, Tichy says. For example, copays for insulin are now capped at $35, out-of-pocket expenditures for prescription drugs have a limit, and many vaccines are free. “Those are things that lower barriers to people getting medications,” Tichy says. 


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2. New products on the market. In 2023, the U.S. Food and Drug Administration approved 55 new drugs, 20 of which were deemed first-in-class medications, meaning they use a new and unique mechanism of action to treat a medical condition. High-profile approvals of 2023 include tirzepatide for weight management (Zepbound) and the Alzheimer’s treatment lecanemab (Leqembi), the study’s authors note. Several gene therapies for cancer and rare diseases were also approved — many of which come with a very high price tag.

3. Price changes. The study authors also report that 2023 saw a nearly 3 percent increase in all U.S. drug prices from 2022. The study authors note that Medicare’s ability under the new prescription drug law to negotiate drug prices with manufacturers is “expected to yield the most downward pressure on drug expenditures.” Medicare is currently negotiating prices for an initial batch of 10 drugs, and new drugs will be added to the program every year. The negotiated prices will start taking effect in 2026 for Medicare Part D drugs — prescriptions you typically pick up at the pharmacy — and 2028 for Medicare Part B drugs — medications that are often administered by a health care provider.

“That’s the big lever that would actually reduce expenses. So I think that is something we’re all keeping an eye out for,” Tichy says.  

The vast majority (82 percent) of Americans surveyed in a 2023 KFF poll say the cost of prescription drugs is unreasonable. People who take four or more prescription drugs are more likely to have trouble affording their medication, the poll found. 

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