1. Johnson & Johnson

J&J topped more than $80 billion in sales last year. Its pharma unit turned in more than half of that figure. (Johnson & Johnson)

Johnson & Johnson
2018 revenue: $81.58 billion
2017 revenue: $76.45 billion
Headquarters: New Brunswick, New Jersey

Every year, Johnson & Johnson far and away tops the list of drugmakers ranked by total revenue. Every year, in recent memory at least, the company posts big gains for its prescription drug portfolio. Pharma, in fact, has been J&J’s growth engine through trouble for its medical devices business and a slowdown in consumer health.

Last year, for instance, J&J’s pharma business brought in $40.7 billion, an increase of almost $4.5 billion—or 12%—over 2017’s $36.26 billion.

J&J’s overall revenue came in at $81.58 billion, up a little more than $4 billion over the $76.45 billion the conglomerate brought in the previous year.

In other words, pharma accounted for the lion’s share of J&J’s absolute sales growth last year and just about half of its total sales. No doubt the company’s prescription drugs are valued at J&J.

One could argue, however, that J&J doesn’t belong in first place in this annual ranking. Roche reported CHF 56.8 billion in 2018 sales, 44 billion of that in its pharma division—more than J&J’s pharma business brought in. Novartis totted up $44.8 billion between its innovative medicines and generic-and-biosimilars group, Sandoz—also more than J&J’s pharma group.

But big drugmakers are messy. A big chunk of J&J’s consumer sales come from over-the-counter drugs, a segment that also contributes to GlaxoSmithKline, Pfizer, Bayer and Sanofi’s top lines. Animal health pitches in at Merck, Eli Lilly (for now) and Boehringer Ingelheim, among others. Roche boasts a diagnostics unit that produces some tests that work in tandem with drugs, but that’s far from all of its business. Novartis sells contact lenses through its soon-to-be-spun-off subsidiary Alcon. And so on.

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Suffice it to say that J&J has a big medical devices division that accounted for $26 billion of its sales last year, and a consumer unit that brought in $13.8 billion, about a third of that from over-the-counter drugs. But for years now, J&J’s pharma business has powered the conglomerate’s growth. And that pharma business has outclassed most of its Big Pharma peers growth-wise, too.

What’s fueling all of that? Its immunology franchise, for one. Psoriasis and psoriatic arthritis drug Stelara ginned up $5.2 billion last year, a 28% year-over-year sales hike, and psoriasis newcomer Tremfya brought in $544 million, up from just $63 million in 2017. And those newer drugs delivered at the same time aging stalwart Remicade stubbornly clung to market share to pitch in $13 billion despite biosimilar competition. J&J has been so aggressive about hanging on to Remicade sales in the face of biosims, in fact, that one of its putative rivals sued, alleging that its payer contracting violates antitrust rules.

Then there’s Actelion, the new purchase J&J brought into the fold in 2017. The company’s pulmonary hypertension drugs Opsumit, Tracleer and Uptravi together brought in almost $2.5 billion. J&J’s anticoagulant Xarelto put in about the same amount—flat compared with 2017, partly thanks to stepped-up competition from Pfizer and Bristol-Myers Squibb’s Eliquis—while SGLT2 diabetes drug Invokana pitched in less than $1 billion as safety worries eroded its blockbuster sales.

But J&J’s oncology business really revved up in 2018. Fast-growing blood cancer drugs Imbruvica and Darzalex together brought in $4.5 billion; Darzalex alone surpassed $2 billion just two years after its launch. Prostate cancer drug Zytiga boosted sales by 40% to $3.6 billion. Overall, cancer drugs brought in almost $10 billion for J&J.

RELATED: As competition heats up, U.S. prices for Remicade and biosims slip

This year could bring some big changes, though. Remicade biosimilars from Pfizer and Merck started taking a real toll on the drug in the fourth quarter of 2018, and the J&J drug could lose more ground in the first quarter thanks to formulary changes that took effect Jan. 1. Eliquis looks poised to continue grabbing share from Xarelto. And Zytiga faces an even bigger threat. Generic versions could theoretically arrive any day now, thanks to a series of court losses that left it vulnerable to earlier-than-expected copycats. In November, J&J lost its bid to stop knockoffs from launching before its appeal to the Federal Circuit could be heard. Several companies, including Mylan, rolled out their copycats, making a dent in Zytiga’s fourth-quarter sales. This year, unless J&J manages to win its appeal, Zytiga is set for a long downhill slide.

What can make up the difference? J&J rolled out a new prostate cancer drug, Erleada, last February, and analysts figure it can reach $1.3 billion in sales in a few years; the company posted data in January of this year that could put it in line for another approval. Just last month, the company nabbed FDA approval for Spravato, an inhaled remedy for severe depression based on the party drug ketamine, and some analysts see that drug hitting $3 billion in annual sales down the line.

One thing is certain: No matter what happens with those drugs, J&J will again appear at the top of this list in 2020. The only question will be how much of a role its pharma business plays in that victory.

1. Johnson & Johnson