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The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda have Exploded Healthcare Costs in the United States
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Introduction
If you’ve learned anything at all from reading this website you should already know that, contrary to popular belief, most prescription medications sold in the U.S. aren’t really very expensive. In fact, roughly 87% of prescriptions filled in the U.S. in the last two years were for generic medications and most generic prescription drugs cost pharmacies only a few pennies a pill.
That said, you should also know that when prescription medications are expensive, they’re really expensive, especially in the U.S. Even so, since fewer people each year are getting these really expensive medications, how do the pharmaceutical companies continue to earn such huge profits?
In this section, I intend to answer that question by profiling the 50 medications that earned pharmaceutical companies their highest revenues in 2018 — the 50 biggest money makers for big pharma.
Overview
The 50 medications profiled here are marketed in the U.S. by 16 different pharmaceutical companies and earned each of these companies a lot of money in 2018.
How much money?
$220 billion in worldwide sales and $136 billion from sales in the U.S. alone! And that’s what the pharmaceutical companies earned after paying all of their rebates and chargebacks.
For perspective, that’s half the total revenue these companies earned from all of the medications they sold last year and 60% of all the money these pharmaceutical companies earned from sales in the U.S. In fact, $136 billion is roughly 30% of the total amount all pharmaceutical companies in the world earned from all of the products they sold in the U.S. last year. That’s a lot of money for selling just 50 drugs.
What’s more, most of these medications were used to treat relatively few people since most of them treat relatively uncommon diseases like cancer, multiple sclerosis, HIV or severe rheumatic diseases.
There are exceptions, of course. A few of these medications were widely prescribed and two of them are vaccines meant to be given to nearly everyone. Still, most of the medications profiled here were used to make a lot of money by treating relatively few people.
So a few medications earned a lot of money while being used to treat only a few people. How? Simply by charging insanely high prices for medications that people will need either to survive or to avoid a severe disability. Basically, the pharmaceutical companies are saying, “Your money or your life!” to these people.
In the table below I list each of the 50 medications, explain what they’re used for, how much each one costs (either the lowest retail price for a month’s supply or, for some chemotherapies, the retail price or what Medicare pays for an infusion of the medication) and how much the pharmaceutical company that markets each medication earned both in the U.S. and in total from its sale.
The Medications
| Medication | Pharmaceutical Company |
Total Sales | U.S. Sales | Lowest Retail Price1 |
Indication |
| 1. Humira (Adalimumab) |
AbbVie | $19.9 billion | $13.7 billion | $5,243 for 80 mg | Rheumatic Diseases and Inflammatory Bowel Disease |
| 2. Eliquis (Apixaban) |
Bristol-Myers Squibb/Pfizer2 |
$9.87 billion | $5.61 billion | $458 for 60 pills | Anticoagulant (Blood Thinner) for Heart Arrhythmias |
| 3. Revlimid (Lenalidomide) |
Celgene | $9.69 billion | $6.47 billion | $15,300 for 21 capsules |
Multiple Myeloma |
| 4. Keytruda (Pembrolizumab) |
Merck | $7.17 billion | $4.15 billion | $6,656 for 150 mg | Cancer Chemotherapy |
| 5. Enbrel (Etanercept) |
Amgen/Pfizer2 | $7.13 billion | $4.81 billion | $5,130 for 200 mg | Rheumatic Diseases |
| 6. Herceptin (Trastuzumab) |
Roche | $6.84 billion | $2.85 billion | $1,458 for 140 mg | Breast Cancer Chemotherapy |
| 7. Eylea (Aflibercept) |
Regeneron | $6.75 billion | $4.08 billion | $1,935 for 2 mg | Wet Macular Degeneration |
| 8. Opdivo (Nivolumab) |
Bristol-Myers Squibb |
$6.74 billion | $4.24 billion | $8,086 for 100 mg | Cancer Chemotherapy |
| 9. Avastin (Bevacizumab) |
Roche | $6.71 billion | $2.85 billion | $7,925 for 1 gm | Cancer Chemotherapy |
| 10. Rituxin (Rituximab) |
Roche | $6.62 billion | $4.20 billion | $6,439 for 700 mg | Rheumatic Diseases and Cancer Chemotherapy |
| 11. Xarelto (Rivaroxaban) |
Johnson & Johnson/Bayer2 |
$6.16 billion | $2.48 billion | $452 for 30 pills | Anticoagulant (Blood Thinner) for Heart Arrhythmias |
| 12. Januvia/Janumet (Sitagliptin) |
Merck | $5.91 billion | $2.68 billion | $465 for 30 pills | Diabetes |
| 13. Tivicay (Dolutegravir) |
GlaxoSmithKline | $5.88 billion | $3.76 billion | $1,769 for 30 pills | HIV |
| 14. Prevnar 13 | Pfizer | $5.80 billion | $3.36 billion | $195 per dose | Pneumonia Vaccine |
| 15. Remicade (Infliximab) |
Johnson & Johnson |
$5.33 billion | $3.66 billion | $5,789 for 500 mg | Rheumatic Diseases |
| 16. Stelara (Ustekinumab) |
Johnson & Johnson |
$5.16 billion | $3.47 billion | $21,793 for 90 mg | Psoriasis and Crohn’s Disease |
| 17. Genvoya (Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Alafenamide) |
Gilead Sciences | $4.62 billion | $3.59 billion | $2,925 for 30 pills | HIV |
| 18. Lyrica (Pregabalin) |
Pfizer | $4.62 billion | $3.59 billion | $460 for 60 capsules |
Chronic Nerve Pain |
| 19. Neulasta (Pegfilgrastim) |
Amgen | $4.48 billion | $3.87 billion | $6,177 for 6 mg | Low White Blood Cell Count |
| 20. Tecfidera (Dimethyl Fumarate) |
Biogen | $4.27 billion | $3.25 billion | $7,907 for 60 capsules |
Multiple Sclerosis |
| 21. Lantus (insulin glargine) |
Sanofi | $4.21 billion | $1.91 billion | $200 for 1000 units | Diabetes |
| 22. Ibrance (Palbociclib) |
Pfizer | $4.12 billion | $2.92 billion | $11,746 for 21 capsules |
Breast Cancer Chemotherapy |
| 23. Imbruvica (Ibrutinib) |
AbbVie | $3.59 billion | $2.97 billion | $13,094 for 90 capsules |
Leukemia and Lymphoma |
| 24. Juluca (Dolutegravir, Rilpivirine) |
GlaxoSmithKline | $3.52 billion | $2.22 billion | $2,748 for 30 pills | HIV |
| 25. Mavyret (glecaprevir, pibrentasvir) |
AbbVie | $3.44 billion | $1.61 billion | $13,076 for 84 pills | Hepatitis C |
| 26. Gilenya (Fingolimod) |
Novartis | $3.34 billion | $1.77 billion | $8,137 for 30 pills | Multiple Sclerosis |
| 27. Advair (Fluticasone, Salmeterol) |
GlaxoSmithKline | $3.22 billion | $1.46 billion | $400 for 1 inhaler3 | Asthma |
| 28. Trulicity (Dulaglutide) |
Eli Lilly | $3.20 billion | $2.52 billion | $657 for 6 mg | Diabetes |
| 29. Gardasil | Merck | $3.15 billion | $1.87 billion | $170 per dose | HPV Vaccine |
| 30. Humalog (Insulin Lispro) |
Eli Lilly | $3.00 billion | $1.79 billion | $178 for 1,000 units | Diabetes |
| 31. Truvada (Emtricitabine, Tenofovir) |
Gilead Sciences | $3.00 billion | $2.61 billion | $1,667 for 30 pills | HIV Prevention |
| 32. Invega Sustenna (Paliperidone Palmitate) |
Johnson & Johnson |
$2.93 billion | $1.79 billion | $1,773 for 156 mg | Psychosis |
| 33. Cosentyx (Secukinumab) |
Novartis | $2.84 billion | $1.67 billion | $5,136 for 300 mg | Psoriasis |
| 34. Perjeta (Pertuzumab) |
Roche | $2.72 billion | $1.30 billion | $4,971 for 420 mg | Breast Cancer Chemotherapy |
| 35. Orencia (Abatacept) |
Bristol-Myers Squibb |
$2.71 billion | $1.88 billion | $4,338 for 500 mg | Rheumatic Diseases |
| 36. Symbicort (Budesonide Formoterol) |
AstraZeneca | $2.56 billion | $0.86 billion | $331 for 1 inhaler | Asthma and COPD |
| 37. Avonex/Plegrity (Interferon Beta-1a) |
Biogen | $2.36 billion | $1.67 billion | $7,015 for 1 month | Multiple Sclerosis |
| 38. Ocrevus (Ocrelizumab) |
Roche | $2.31 billion | $2.04 billion | $34,406 for 600 mg | Multiple Sclerosis |
| 39. Prolia (Denosumab) |
Amgen | $2.29 billion | $1.50 billion | $1,215 for 60 mg | Osteoporosis |
| 40. Triumeq (Dolutegravir, Abacavir, and Lamivudine) |
GlaxoSmithKline | $2.18 billion | $1.39 billion | $2,932 for 30 pills | HIV |
| 41. Alimta (Pemetrexed) |
Eli Lilly | $2.13 billion | $1.13 billion | $4,790 for 700 mg | Cancer Chemotherapy |
| 42. Actemra (Tocilizumab) |
Roche | $2.12 billion | $0.84 billion | $4,333 for 800 mg | Rheumatic Diseases |
| 43. Simponi (Golimumab) |
Johnson & Johnson |
$2.08 billion | $1.05 billion | $4,769 for 50 mg | Rheumatic Diseases and Inflammatory Bowel Disease |
| 44. Pomalyst (Pomalidomide) |
Celgene | $2.04 billion | $1.39 billion | $17,415 for 21 capsules |
Multiple Myeloma |
| 45. Darzalex (Daratumumab) |
Johnson & Johnson |
$2.03 billion | $1.20 billion | $5,765 for 1,100 mg | Multiple Myeloma |
| 46. Sprycel (Dasatinib) |
Bristol-Myers Squibb |
$2.00 billion | $1.09 billion | $13,854 for 30 pills | Leukemia |
| 47. Epclusa (Sofosbuvir, velpatasvir) |
Gilead Sciences | $1.97 billion | $0.93 billion | $24,679 for 30 pills3 | Hepatitis C |
| 48. Prezista (Darunavir Ethanolate) |
Johnson & Johnson |
$1.96 billion | $1.17 billion | $1,681 for 30 pills | HIV |
| 49. Aubagio (Teriflunomide) |
Sanofi | $1.94 billion | $1.37 billion | $6,904 for 28 pills | Multiple Sclerosis |
| 50. Aranesp (Darbepoetin Alfa) |
Amgen | $1.88 billion | $0.94 billion | $3,073 for 400 mcg | Anemia |
| Totals | $220 billion | $136 billion |
1 The retail price given is the lowest price for a standard one month supply on GoodRx.com or, in the case of some of the chemotherapies and the vaccines, the cost of a single treatment. Six of the medications are chemotherapy treatment that aren’t sold in retail pharmacies. For these medications, Medicare’s reimbursement for a standard chemotherapy dose is given.
2 Bristol-Myers Squibb and Pfizer market Eliquis jointly. Enbrel is marketed by Amgen in the U.S. and Canada and Pfizer in all other countries. Xarelto is marketed by Bayer outside of the U.S.
3 Advair and Epclusa are now available as generic medications for about one third of the listed brand name price.