Atorvastatin, a cholesterol-lowering medication, is the most prescribed drug in America with over 115 million prescriptions filled in 2023. That figure puts it roughly 30 million prescriptions ahead of the second-place drug, metformin, which treats type 2 diabetes. The rest of the top 10 is dominated by medications for blood pressure, thyroid conditions, and other chronic diseases that require daily, long-term use.
The Top 10 Most Prescribed Drugs
The full list, ranked by total prescriptions filled in 2023:
- Atorvastatin (cholesterol): 115.3 million prescriptions
- Metformin (type 2 diabetes): 85.7 million
- Levothyroxine (underactive thyroid): 80.9 million
- Lisinopril (high blood pressure): 76.1 million
- Amlodipine (high blood pressure): 68.7 million
- Metoprolol (high blood pressure, heart rate): 59.5 million
- Albuterol (asthma, breathing issues): 59.5 million
- Losartan (high blood pressure): 56.2 million
- Gabapentin (nerve pain, seizures): 46.0 million
- Omeprazole (acid reflux): 45.3 million
Seven of the ten are for cardiovascular conditions or closely related risk factors like cholesterol and diabetes. That pattern holds across the broader landscape too. Of the top 200 most prescribed drugs in the country, cardiovascular medications, nervous system drugs, and hormonal or endocrine treatments account for roughly 70% of the list.
Why Atorvastatin Tops the List
Atorvastatin belongs to a class of drugs called statins, which lower LDL (“bad”) cholesterol and reduce the risk of heart attack and stroke. Heart disease is the leading cause of death in the United States, and tens of millions of Americans have cholesterol levels high enough to warrant treatment. Because high cholesterol rarely causes symptoms on its own, people who start a statin typically stay on it indefinitely, refilling the prescription multiple times a year. That combination of a massive eligible population and lifelong use is what pushes atorvastatin’s numbers so far ahead.
The drug also went generic years ago, making it inexpensive and easy for insurers to cover. Nearly all of those 115 million prescriptions are filled as generics rather than brand-name versions. That affordability helps keep patients on the medication long term, which further inflates the annual prescription count.
Chronic Disease Drives Prescription Volume
The entire top 10 list reflects the same dynamic. These aren’t drugs people take for a week and stop. Metformin manages blood sugar every day. Levothyroxine replaces a hormone your thyroid can’t produce on its own. Blood pressure medications like lisinopril, amlodipine, metoprolol, and losartan are taken daily for years or decades. Each patient generates multiple prescription fills per year, which is why chronic disease medications dominate the rankings.
Albuterol is the one exception to the “daily use” pattern. It’s a rescue inhaler used as needed for asthma or other breathing difficulties, but asthma is common enough (affecting roughly 25 million Americans) that it still cracks the top 10.
Age Is the Biggest Factor
Prescription use climbs sharply with age. About 36% of adults between 21 and 39 take at least one prescription medication. By ages 60 to 74, that number jumps to over 74%. The gap is even more dramatic for people on multiple drugs: 27% of adults in that older group take five or more medications, compared to just 3% of younger adults. Since the conditions treated by the top 10 drugs (high cholesterol, high blood pressure, diabetes, thyroid disorders) become more common with age, older adults account for a disproportionate share of these prescriptions.
Most Prescriptions vs. Most Expensive
The drugs that generate the most prescriptions are not the drugs that cost the healthcare system the most money. Nearly every medication in the top 10 is available as a cheap generic. Generics account for about 90% of all prescriptions dispensed in the United States, keeping costs low for high-volume drugs.
Spending is concentrated in the opposite direction. In Medicare’s prescription drug program, the top 1% of drugs by spending accounted for just 5.1% of all prescriptions filled but 41.1% of total spending in 2021. Specialty drugs, which treat conditions like cancer, autoimmune diseases, and rare genetic disorders, made up only 6.2% of prescriptions but 71.1% of total spending that same year. The ten single most expensive drugs represented just 0.3% of covered medications but consumed 22% of total program spending.
That gap has been widening. The share of spending concentrated in the most expensive 1% of drugs grew from 31.4% in 2012 to 41.1% in 2021, even as those drugs’ share of total prescription volume dropped. In other words, a small number of increasingly costly specialty medications are driving healthcare spending, while the drugs most Americans actually take remain relatively affordable.
GLP-1 Drugs Are Reshaping the Rankings
The biggest shift in prescribing right now involves GLP-1 drugs, a class of medications originally developed for type 2 diabetes that have become widely prescribed for weight loss. These drugs have driven a sharp acceleration in drug spending for both Medicare and employer-sponsored insurance, with employers seeing spending growth of 12.9% in 2023, largely due to GLP-1 use. While GLP-1 medications haven’t yet cracked the top 10 by raw prescription count, their rapid adoption means they could reshape these rankings in the coming years, particularly if prices drop and access expands.