For American patients aching for relief from the sky-high price of drugs, the news has been decidedly mixed recently.
“It’s unacceptable that Americans pay vastly more than people in other countries for the exact same drugs, often made in the exact same place. This is wrong, this is unfair, and together we will stop it—and we’ll stop it fast,” President Donald Trump vowed in his State of the Union address on February 5.
Six days later, Sanofi and Regeneron Pharmaceuticals announced the second list-price reduction in as many years for their cholesterol-reducing drug Praluent® (alirocumab). That list price was cut to $5,850 for both the 75 mg and 150 mg doses, effective in March—matching the lower price set by Amgen in October 2018 for its rival cholesterol-fighter Repatha (evolocumab), and 60% below Praluent’s original $14,000 list price after approval in 2015.
On February 19, however, the U.S. Supreme Court declined to review a decision by the 4th U.S. Circuit Court of Appeals in Richmond, VA, striking down H.B. 631, a 2017 Maryland law designed to prevent price gouging by generic drugmakers. The law set fines of $10,000 per violation for “unconscionable” increases in prices of an “essential” off-patent or generic drug.
The appellate court sided against Attorney General Brian Frosh (D), and with a trade group of generic drugmakers. The Association for Accessible Medicines argued that by imposing state rules over interstate commerce, the measure violated the commerce clause of the U.S. Constitution (Article I, Section 8, Clause 3). The Association also argued the law would effectively drive drugmakers away from marketing generics, thus potentially raising prices.
Worldwide spending on medicines reached $1.2 trillion in 2018 and will exceed $1.5 trillion by 2023, according to “The Global Use of Medicine in 2019 and Outlook to 2023,” a study released in January by the IQVIA Institute for Human Data Science. U.S. spending is expected to grow from $485 billion last year to between $625 billion and $655 billion by 2023.
Over the next five years, according to IQVIA Institute, the five-year compound annual growth rate (CAGR) in the U.S. is projected between 4% and 7%, from 7.2% between 2014 to 2018. Worldwide, CAGR is projected at 3%–6%, down from 6.3%.
Below is GEN’s updated top 15 list of top-selling prescription drugs. The drug that topped the list of 2017 best-sellers also led GEN’s first list of best-selling drugs in 2013, when it generated $10.659 billion—an 87% jump over five years.
Top-selling drugs are ranked based on sales or revenue reported for 2018 by bio/pharma companies in press announcements, annual reports, investor materials, and/or conference calls. Each drug is listed by name, sponsor(s), diseases indicated, 2018 sales, 2017 sales, and the percentage change between both years.
Ten of last year’s 15 top-selling drugs registered year-over-year sales gains, with six of the 10 racking up double-digit increases. The rest of the list saw sales declines from 2017, most often reflecting the launch of generic competitors or insurer discounts.
Ranking #20 through #16 are treatments that generated between $4 billion and approximately $4.7 billion last year—Sanofi’s Lantus® (insulin glargine), Pfizer’s Ibrance®(palbociclib), Biogen’s Tecfidera® (dimethyl fumarate), Gilead Sciences’ Genvoya®(elvitegravir, cobicistat, emtricitabine, tenofovir alafenamide); and Amgen/Kyowa Hakko Kirin’s Neulasta® / Peglasta® (pegfilgrastim), which cracked last year’s Top 15.
This year as last, cancer continues to be the top disease category with 6 of the 15 top sellers, including 3 of the top 5, while arthritis grew to 5 (from 4 last year) as Janssen Biotech (Johnson & Johnson)’s Stelara® (ustekinumab) made the list. Also new this year is Merck & Co.’s Keytruda® (pembrolizumab), which placed within the top 5.
#15. Lyrica® (pregabaliln)
2018 Sales: $4.970 billion 1
2017 Sales: $5.065 billion 1
% Change: –1.9%
#14. Stelara (ustekinumab)
Janssen Biotech (Johnson & Johnson)
2018 Sales: $5.156 billion
2017 Sales: $4.011 billion
% Change: 28.5%
#13. Prevnar 13® / Prevenar 13® (Pneumococcal 13-valent Conjugate Vaccine [Diphtheria CRM197 Protein]
2018 Sales: $5.802 billion
2017 Sales: $5.601 billion
% Change: 3.6%
#12. Remicade® (infliximab)
Johnson & Johnson and Merck & Co.
2018 Sales: $5.908 billion ($5.326 billion J&J + $0.582 billion Merck)
2017 Sales: $7.152 billion ($6.315 billion J&J + $0.837 billion Merck)
% Change: –17.4%
#11. Eylea® (aflibercept)
Bayer and Regeneron Pharmaceuticals
2018 Sales: $6.551 billion ($2.474 billion [€2.185 billion] Bayer + $4.077 billion Regeneron)
2017 Sales: $5.830 billion ($2.128 billion [€1.880 billion] Bayer + $3.702 billion Regeneron)
% Change: 12.4%
#10. Xarelto® (rivaroxaban)
Bayer and Johnson & Johnson
2018 Sales: $6.589 billion ($4.112 billion [€3.631 billion] Bayer + $2.477 billion J&J)
2017 Sales: $6.234 billion ($3.734 billion [€3.298 billion] Bayer + $2.500 billion J&J)
% Change: 5.8%
#9. Rituxan® (also sold as MabThera; rituximab)
Roche (Genentech) and Biogen 2
2018 Sales: $6.750 billion [CHF 6.752 billion] 2
2017 Sales: $7.298 billion [CHF 7.300 billion] 2
% Change: –7.5%
#8. Avastin® (bevacizumab)
2018 Sales: $6.847 billion (CHF 6.849 billion)
2017 Sales: $6.686 billion (CHF 6.688 billion)
% Change: 2.4%
#7. Herceptin® (trastuzumab)
2018 Sales: $6.981 billion (CHF 6.982 billion)
2017 Sales: $7.013 billion (CHF 7.014 billion)
% Change: –0.5%
#6. Enbrel® (etanercept)
Amgen and Pfizer
2018 Sales: $7.126 billion ($5.014 billion Amgen + $2.112 billion Pfizer) 3
2017 Sales: $7.885 billion ($5.433 billion Amgen + $2.452 billion Pfizer) 3
% Change: –9.6%
#5. Keytruda® (pembrolizumab)
Merck & Co.
2018 Sales: $7.171 billion
2017 Sales: $3.809 billion
% Change: 88.3%
#4. Opdivo® (nivolumed)
Bristol-Myers Squibb and Ono Pharmaceutical
2018 Sales: $7.570 billion ($6.735 billion BMS + $835 million [¥92.5 billion] Ono)
2017 Sales: $5.763 billion ($4.948 billion BMS + $815 million [¥90.2 billion] Ono)
% Change: 31.4%
#3. Revlimid (lenalidomide)
2018 Sales: $9.685 billion
2017 Sales: $8.187 billion
% Change: 18.3%
#2. Eliquis® (apixaban)
Bristol-Myers Squibb and Pfizer
2018 Sales: $9.872 billion ($6.438 billion BMS + $3.434 billion Pfizer) 4
2017 Sales: $7.395 billion ($4.872 billion BMS + $2.523 billion Pfizer) 4
% Change: 33.5%
#1. Humira® (adalimumab)
2018 Sales: $19.936 billion
2017 Sales: $18.427 billion
% Change: 8.2%
1. Pfizer lists separately the Lyrica revenues generated in all of Europe, Russia, Turkey, Israel, and Central Asia countries ($347 million in 2018, $553 million in 2017). Those revenues are listed by Pfizer’s “Essential Health” operating segment, while its “Innovative Health” segment records Lyrica revenues generated elsewhere in the world, including the U.S. ($4.622 billion in 2018, $4.511 billion in 2017).
2. Biogen receives a share of U.S. pre-tax profits on sales of Rituxan, which is marketed by Genentech (Roche). Sales figures do not include U.S. pre-tax profits generated by Biogen, since the company only discloses those profits combined with profits from Gazyva® (obinutuzumab), and does not break out each product separately. Biogen reported combined Rituxan-Gazyva pre-tax profits of $1.432 billion for 2018, and $1.316 billion for 2017.
3. Pfizer markets Enbrel outside the U.S. and Canada, where the treatment is marketed by Amgen.
4. Pfizer figures for Eliquis consist of “alliance revenues” reflecting products co-developed with partner companies, as well as direct sales in some regions of the world.
A Product Manager with expertise in pharma marketing and sales operations