When it comes to pharma, the U.S. market poses a unique challenge for drugmakers: a lack of generic competition and biosimilars has boosted legacy drugs, but tight payer discounts are difficult to overcome. For another year, AbbVie's Humira has figured out that equation.
Using corporate financial statements and annual earnings transcripts, FiercePharma has put together its list of the top 20 drugs by 2018 U.S. sales. This year's list includes only single drugs rather than combination therapies. For instance, Merck's diabetes duo Januvia and Janumet, with sales reported together by the drugmaker, did not make the list despite sales that would have placed the combo on the top 20 list.
In general, the top of the list is a murderer's row of successful legacy drugs, including Humira, Celgene's Revlimid (No. 2), Amgen's Enbrel (No. 3) and Roche's Rituxan (No. 4). However, driven by successful launches and a mix of generic competition, tighter discounts and slow growth for legacy blockbusters, a few precocious challengers are quickly moving up the rankings.
Humira enjoyed another year at the top of the pack in U.S. sales, clearing more than double its nearest competitor with $13.68 billion. While Humira won't face any generic competition in the U.S. until 2023 after a series of patent settlements, the drug's first-ever sales drop in Europe in the first quarter due to generic launches could offer a vision of the drug's future in the coming years. In a distant second, Revlimid posted $6.47 billion on the year.
A few highlights on the list are Gilead's Genvoya (No. 12), the HIV treatment that the drugmaker called the most successful single-tablet launch in its history. The drug, which launched in 2016, scored $3.63 billion in 2018.
The single greatest success story on the list has been Keytruda's (No. 6) meteoric rise up the list with an 80% sales increase on the year to $4.2 billion. Keytruda, which is in a neck-and-neck battle with Bristol-Myers Squibb's Opdivo in immuno-oncology, has aggressively pursued new indications and has reaped the rewards for its pursuit.
On the other end of the spectrum, Johnson & Johnson's Remicade (No. 11) saw a 20% sales decrease on the year to $3.7 billion, driven by aggressive payer discounting and stolen market share from two biosimilar competitors. If sales continue to decline, it could knock J&J's inflammation blockbuster off of 2019's list.
Here's FiercePharma's list.