President Joe Biden and former President Donald Trump have seemingly found one issue they can agree on: Drug costs are too high. Each is crediting himself with price-busting policy successes that should be considered in their respective presidential runs this year.
Biden has touted his signing of the Inflation Reduction Act, legislation that lets Medicare set prices for some small-molecule drugs 9 years after FDA approval, versus 13 years for biologics. The law has drawn criticism—and litigation—from several biopharma giants. They contend that the law hinders drug development. Georgetown University Law Center’s O’Neill Institute for National and Global Health Law tracks 14 lawsuits seeking to overturn the measure—two each by AstraZeneca, Bristol Myers Squibb, and Janssen Pharmaceuticals (Johnson & Johnson); and one each by Astellas Pharma, Boehringer Ingelheim, Merck & Co., Novartis, and Novo Nordisk.
Trump points to his 2020 signing of executive orders that directed federally qualified health centers to pass along insulin and epinephrine discounts to low-income Americans; allowed importation of prescription drugs from Canada and other countries where prices for identical drugs were lower; barred discount-reducing agreements between drug manufacturers and pharmacy benefit manages; and ensured that the United States paid the lowest price available among economically advanced countries for Medicare Part B drugs.
A year after Deloitte pegged the average cost of developing a new drug at approximately $2.3 billion among the top 20 global biopharma companies it studied, there’s no reason to think it will fall significantly—and thus no reason to expect a drip in drug prices soon.
Below is GEN’s updated A-List of top 10 best-selling prescription drugs based on 2023 sales. This year marks the first time in the 11 years that GEN has compiled such rankings that AbbVie’s Humira (adalimumab) didn’t finish on top. Humira led GEN’s yearly best-selling drug lists since the first list published in 2013, when the drug generated $10.66 billion. That translates to $14.346 billion in today’s dollars, which means Humira’s sales grew only 0.4% over the past decade when inflation is accounted for.
Humira showed its first year-over-year sales decline in 2019, reflecting direct biosimilar competition in Europe and other countries that shrank the drug’s 2019 sales beyond the United States by 31% from 2018. Last year, Humira saw its first biosimilar competition in the United States, starting with Amgen’s Amjevita (adalimumab-atto), which generated $626 million in 2023 product sales.
Top-selling drugs are ranked based on sales or revenue reported for 2023 by biopharma companies in press announcements, annual reports, investor materials, and/or conference calls. Each drug is listed by name, sponsor(s), 2023 sales, 2022 sales, and the percentage change between both years.
Seven of last year’s 10 top-selling drugs registered year-over-year sales gains, with 5 of the 7 racking up double-digit increases. The rest of the list saw declines in sales from 2023, typically reflecting the launch of generic or biosimilar competitors, plus insurer discounts.
The total aggregate value of the top 10 best-selling drugs last year was $145.495 billion, down 27% from $198.073 billion in 2022, when two COVID-19 vaccines and one antiviral drug to treat the virus contributed to a sales spike that accounted for nearly half (47%) of total sales. Only one of the COVID-19 vaccines generated enough in sales to make last year’s top 10. However, the 2023 top 10 generated 44% more in sales than the $101.15 billion racked up in 2019 for the top 10 drugs listed by GEN in March 2020, as the pandemic wreaked havoc on the world.
Ranking number 11 through number 15 in 2023 were treatments that generated between $7.1 billion and $9.7 billion in revenues:
- Darzalex/Darzalex Faspro (daratumumab) from Janssen Biotech (Johnson & Johnson).
- Trikafta/Kaftrio (elexacaftor/tezacaftor/ivacaftor and ivacaftor) from Vertex Pharmaceuticals.
- Gardasil/Gardasil 9 (Human Papillomavirus Quadrivalent (Types 6, 11, 16, and 18) Vaccine, Recombinant/Human Papillomavirus 9-valent Vaccine, Recombinant) from Merck & Co.
- AbbVie’s Skyrizi (risankizumab‐rzaa) from AbbVie.
- Trulicity (dulaglutide) from Eli Lilly and Company.
| 1 | Keytruda (pembrolizumab) |
Merck & Co.2023 Sales: $25.011 billion 2022 Sales: $20.937 billion % Change: 19.5% |
| 2 | Eliquis (apixaban) |
Bristol Myers Squibb and Pfizer2023 Sales: $18.953 billion ($12.206 billion BMS + $6.747 billion Pfizer) 2022 Sales: $18.269 billion ($11.789 billion BMS + $6.480 billion Pfizer) % Change: 3.7% |
| 3 | Comirnaty (COVID-19 vaccine mRNA) |
Pfizer and BioNTech2023 Sales: $15.379 billion ($11.220 billion Pfizer + $4.159 billion [€3.819 billion] BioNTech) 2022 Sales: $56.660 billion ($37.806 billion Pfizer + $18.854 billion [€17.311 billion] BioNTech) % Change: -72.9% |
| 4 | Humira (adalimumab) |
AbbVie2023 Sales: $14.404 billion 2022 Sales: $21.237 billion % Change: -32.2% |
| 5 | Ozempic (semaglutide) |
Sponsor(s): Novo Nordisk2023 Sales: $13.929 billion (DKK 95.718 billion) 2022 Sales: $8.695 billion (DKK 59.75 billion) % Change: 60.2% |
| 6 | Eylea/Eylea HD (aflibercept)1 |
Regeneron Pharmaceuticals and Bayer2023 Sales: $12.875 billion ($9.381 billion Regeneron + $3.494 billion [€3.231 billion] Bayer) 2022 Sales: $13.121 billion ($9.647 billion Regeneron + $3.474 billion [€3.213 billion] Bayer) % Change: -1.9% |
| 7 | Biktarvy (bictegravir, emtricitabine, and tenofovir alafenamide) |
Gilead Sciences2023 Sales: $11.850 billion 2022 Sales: $10.390 billion % Change: 14.1% |
| 8 | Dupixent (dupilumab)2 |
Sanofi and Regeneron Pharmaceuticals2023 Sales: $11.669 billion [€10.715 billion] 2022 Sales: $9.031 billion [€8,293 billion] % Change: 29.2% |
| 9 | Stelara (ustekinumab) |
Janssen Biotech (Johnson & Johnson)2023 Sales: $10.858 billion 2022 Sales: $9.723 billion % Change: 11.7% |
| 10 | Opdivo (nivolumab)3 |
Bristol Myers Squibb and Ono Pharmaceutical2023 Sales: $10.567 billion ($9.009 billion sales BMS + ¥ 148.1 billion [$942.7 million] sales Ono + ¥ 96.7 billion [$615.5 million] royalties Ono) 2022 Sales: $10.368 billion ($8.962 billion sales BMS + ¥ 136.4 billion [$868.0 million] sales Ono + ¥ 84.6 billion [$538.3 million] royalties Ono) % Change: 1.9% |
References
1. Includes sales of Eylea® HD, which won FDA approval in August 2023, and Eylea. In 2023, Eylea HD generated $165.8 million in U.S. sales.
2. Sanofi records global net product sales of Dupixent, with each company recording its half-share of profits on global sales of the drug.
3. Figure includes product revenue for both companies and royalty revenue disclosed by Ono.
