9. Crestor
The company: AstraZeneca
Worldwide sales: $6.044 billion

For years there were two cholesterol-lowering drugs that dominated the market. First was Pfizer's ($PFE) Lipitor, followed by AstraZeneca's ($AZN) Crestor. Lipitor remained king of the hill until 2011 when it lost its exclusivity in the U.S. and its sales started dropping like an anchor through the water.

So did Crestor start to clean up now that it was the top branded statin on the market? Not exactly. What happened instead was that payers, patients and doctors figured that if there were generic versions of Lipitor to be had for cheap, why not just move patients to those? And that is what many have done. The effect cut 9% off worldwide Crestor sales last year.

Crestor might get a bump in sales from new cholesterol guidelines for prescribing statin drugs which say patients at the highest risk should take them. Because Crestor is a high-powered statin, it stands to win in this race. Still, it takes a while for these kinds of changes to filter through the healthcare system, and Crestor loses its U.S. patent protection in 2016.

Given the way this year is shaping up for AstraZeneca, it will take whatever it gets. Sales are expected to be off by a percentage in the low-to-mid single digits thanks to generics of its heartburn med Nexium hitting soon. As a result of past and future patent-cliff struggles, the company is in the middle of a cost-cutting program that includes more than 5,000 layoffs. But AZ's Phase III pipeline offers some hope for the future: It now includes 11 compounds, nearly twice as many as it did the previous year.

For more:
Special Report: The top 10 largest pharma layoffs of 2013 - AstraZeneca
With Teva's Symbicort copy nearing EU launch, AstraZeneca preps for battle
AstraZeneca steps up its global restructuring with 550 new job cuts
Generics pull AZ sales back again, but CEO promises a quicker bounce-back
AstraZeneca wins, Merck and AbbVie lose with new statin-use guidelines
Analysts skeptical as AstraZeneca sales, earnings sink

-- Eric Palmer (email | Twitter)


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