Pfizer, Forest and Lilly dominate top 10 ranking of psych meds

Psychiatric meds have been growth superstars for more than a decade, generating billions for their makers as the U.S. became Prozac Nation, antipsychotics also became antidepressants, and ADHD a byword. But generics have flooded the playing field, and save a few select on-patent meds, today's top-selling psych meds, dollarwise, are lowercase copycats, not capital-letter brands.

According to a recent ranking by PsychCentral, based on data from the IMS Institute for Healthcare Informatics, the field's biggest gains since 2005 were charted by generic antidepressants and ADHD meds. Standby anxiety meds still rank among the top 10 best-selling drugs for psychiatric difficulties, with tens of millions of scripts each year. But some branded psych meds rake in hundreds of millions of dollars, despite the generic competition.

For instance, Xanax--once Pfizer's ($PFE) brand-name anxiety pill, now sold by multiple generics makers as alprazolam--has kept the top slot by dispensed prescriptions for years. Last year, the antianxiety pill racked up almost 48.5 million prescriptions in the U.S., a number little changed since 2011. Pfizer's branded version still accounted for $276 million in 2013 sales.

Meanwhile, antidepressants account for second, third and fourth place by script numbers last year. Pfizer's Zoloft, and its copycat forms, accounted for 41.4 million scripts last year, an 11% increase over 2011. For Pfizer, the brand managed to bring in $469 million in sales, more than many of its newer drugs.

It's a different story for Effexor XR, an antidepressant Pfizer acquired along with Wyeth in 2009--a more typical generics story. Scripts rose by more than one-quarter last year to 15.8 million, as copycat versions hit the market. But Pfizer's sales of the drug plummeted to $440 million last year from $678 million in 2011--and more than $2.5 billion in its heyday.

Other top-selling antidepressants delivered similar results, with big script numbers but low branded sales. Forest Laboratories' ($FRX) Celexa and its generics racked up 39.4 million scripts, a major leap since Forest's patent expired in 2003 and copies rolled onto the market. That put Celexa in third place overall. And Eli Lilly's ($LLY) mighty Prozac grew by 15% since 2011 to 28.3 million scripts, the vast majority of them generics, putting it in fourth place for last year. 

Meanwhile, Forest's newer antidepressant, Lexapro, and its copycats slid down the ranking to 7th place, scriptwise, despite 5% growth over 2011 and almost 25 million prescriptions. That gives Forest the distinction of having one drug and its successor in the top 10, though Pfizer and Lilly each have two antidepressants in the group. Indeed, the sole still-on-patent drug in the top 10 was Lilly's Cymbalta, with 18.5 million scripts; the drug lost exclusivity in December, so 2014 script numbers may well take a leap.

Atypical antipsychotics such as AstraZeneca's ($AZN) Seroquel and Bristol-Myers Squibb's ($BMY) Abilify didn't hit the top 10, but they did make PsychCentral's top 25 list, with 14 million and 8 million prescriptions, respectively. These drugs are "modestly" increasing their patient share by targeting individuals who do not respond to first-line treatment, a 2012 study by Decision Resources concluded.

- read the report from PsychCentral