11. Remicade

Remicade's 2018 started off rough as Pfizer's biosimilar, Inflectra, and Merck's copy, Renflexis, started to gain some traction. (Johnson & Johnson)

11. Remicade
Johnson & Johnson
2018 U.S. sales: $3.7 billion
Used for: rheumatoid arthritis, psoriatic arthritis, ulcerative colitis, Crohn's disease, ankylosing spondylitis, plaque psoriasis

With 2017 sales that put it in the top five of all drugs in the U.S., Johnson & Johnson’s autoimmune blockbuster Remicade fell off a cliff in 2018. The culprits? Discounts that took a toll on net prices and a biosimilar that started to chip away at sales.

Remicade pulled in $3.7 billion in the U.S. last year, a depressing 19% decrease from the previous year. That's despite some aggressive work to keep Remicade patients on the original brand instead of switching to a biosimilar. Even with sales declining, though, Remicade was still J&J's single-best-selling immunology drug and the highest performer in the company's entire pharma portfolio. 

The year started off rough as Pfizer's biosimilar, Inflectra, and Merck's copy, Renflexis, started to gain some traction, and a U.S. appeals court upheld a patent decision in Pfizer's favor. Meanwhile, Pfizer was fighting in court against J&J's payer contracts, which tied Remicade discounts to agreements to avoid biosimilars. Pfizer had sued J&J over those “anticompetitive” deals. The contracts also drew federal regulators’ ire after former FDA chief Scott Gottlieb, M.D., called the exclusionary contract system “rigged” in March 2017.

But to keep market share on its side—in December, Bernstein analyst Ronny Gal quoted J&J's share of the Remicade pie at 93%—the company had to concede on Remicade’s price through 2018, racking up double-digit sales declines along the way.

Worse could be still to come. Remicade prices were down 10.7% year over year as of mid-December, Gal wrote, while Pfizer had sliced Inflectra's sticker by 24.2%. Prices for Merck’s Renflexis slipped by 18%. The decline was “gradual” at 3% to 7% per quarter, Gal said, but “you can absolutely see the strengthening trend.”

11. Remicade