A study released earlier this month offers data that will likely crystallize the unease felt by patients seeking a break from the sky-high price of drugs. Between 2007 and 2018, the net cost of all brand-name prescription drugs sold in the U.S.—sticker price minus manufacturer discounts—rose more than three times as much as the inflation rate.
According to the study, published March 3 in JAMA by researchers at the Center for Pharmaceutical Policy and Prescribing (CP3) of the University of Pittsburgh’s Health Policy Institute, net prices increased by 60% or 4.5% per year, while list prices increased by 159% or 9.1% per year. Increases in manufacturer discounts offset 62% of list price increases.
The study does offer one bit of good news: Net prices began leveling off in 2015—the year both Hillary Clinton and Donald Trump began jawboning about high drug prices at the start of their 2016 presidential campaigns. Clinton proposed to carry out a $250 monthly cap on out-of-pocket prescription drug costs if elected, a prospect that sent the stock prices of drug developers tumbling for months.
“We’re seeing a lot of discussion that net prices have stabilized over the last few years, and that does appear to be the case,” the study’s senior author Walid Gellad, MD, MPH, associate professor of medicine and health policy at Pitt and director of the CP3, said in a statement.
“But the stabilization of net price comes on top of large increases over the last decade, many times faster than inflation, for products that have not changed over this time period,” added Gellad, who is also a physician and researcher with the VA Pittsburgh Healthcare System. “This net price is an average, with substantial variability across payers and drugs.”
2019 Top sellers
Below is GEN’s updated top 15 list of top-selling prescription drugs. The drug that topped last year’s A-List of 2018 top best sellers, AbbVie’s Humira (adalimumab), has led GEN’s yearly best-selling drug lists every year since the first list published in 2013, when it generated $10.66 billion—a leap of 80% over seven years, thanks to numerous new indications and annual price hikes. However, in 2019 Humira showed its first year-over-year sales decline, reflecting direct biosimilar competition in Europe and other countries that shrank the drug’s 2019 ex-U.S. sales by 31% from 2018.
Top-selling drugs are ranked based on sales or revenue reported for 2019 by biopharma companies in press announcements, annual reports, investor materials, and/or conference calls. Each drug is listed by name, sponsor(s), diseases indicated, 2019 sales, 2018 sales, and the percentage change between both years.
Eleven of last year’s 15 top-selling drugs registered year-over-year sales gains, with seven of the 11 racking up double-digit increases. The rest of the list saw sales declines from 2018, most often reflecting the launch of generic competitors or insurer discounts. The total aggregate value of the top 15 best-selling drugs was $131.69 billion, up 9.3% from $120.48 billion for the 15 drugs listed a year ago, mostly the same treatments. Among drugs ranked within the top 10, the year-over-year increase was 11.5%, to $101.15 billion last year from $90.73 billion in 2018.
Ranking #20 through #16 in 2019 were treatments that generated between $4.1 billion and approximately $4.8 billion—Eli Lilly’s Trulicity® (dulaglutide), Biogen’s Tecfidera® (dimethyl fumarate), Imbruvica (ibrutinib), Gilead’s Biktarvy® (bictegravir, emtricitabine & tenofovir alafenamide), and Remicade® (infliximab), marketed by Janssen Biotech (Johnson & Johnson) and Merck & Co.
Cancer continues to be the top disease category with eight of the 15 top sellers of last year having at least one oncology indication (up from seven in 2018), including three of the top five, followed by arthritis treatments with five.
Prevnar 13® / Prevenar 13® (Pneumococcal 13-valent Conjugate Vaccine [Diphtheria CRM197 Protein])
Janssen Biotech (Johnson & Johnson)
Rituxan® (also sold as MabThera; rituximab)
Roche (Genentech) and Biogen
Amgen and Pfizer
Bayer and Janssen Pharmaceuticals (Johnson & Johnson)
Bristol-Myers Squibb (BMS) and Ono Pharmaceutical
AbbVie and Johnson & Johnson
Bayer and Regeneron
Bristol-Myers Squibb 3
Merck & Co. 5
Bristol-Myers Squibb and Pfizer
1. 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. revenues generated by Biogen, since the company only discloses those revenues combined with revenues from Gazyva® (obinutuzumab), and does not break out each product separately. Biogen reported combined Rituxan-Gazyva revenues of $1.603 billion for 2019, and $1.502 billion for 2018.
2. Pfizer markets Enbrel outside the U.S. and Canada, where the treatment is marketed by Amgen. In reporting fourth-quarter and full year results for 2019, Pfizer said the decline in Enbrel sales reflected an 18% decrease operationally in international sales, “primarily reflecting continued biosimilar competition in most developed Europe markets.”
3. Revlimid was marketed by Celgene until Celgene was acquired by Bristol-Myers Squibb (BMS), in a deal completed November 20, 2019.
4. Net sales for 2019 is a pro forma figure disclosed by Bristol-Myers Squibb on February 6 during its quarterly conference call with analysts to discuss fourth-quarter and full-year 2019 results. (See Slide 6 of presentation). The 2019 figure for Revlimid includes $8.079 billion in net product sales disclosed by Celgene for the first three quarters of 2019, and $1.299 billion in product revenue figure for the fourth quarter furnished by BMS, which consists solely of product revenues from November 20, 2019 through December 31, 2019. Sales for the specific period from October 1, 2019 through November 19, 2019 have not been published. The 2018 sales figure was disclosed by Celgene.
5. On December 6, 2019, Merck entity MSD K.K. and Taiho Pharmaceutical, a subsidiary of Otsuka Holdings, announced that they agreed to terminate their co-promotion agreement for Keytruda at the end of December 2019. MSD agreed to continue manufacturing, distribution and promotion of Keytruda.
6. 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.