In a world where health is paramount, the pharmaceutical industry stands as a formidable pillar, relentlessly pursuing scientific breakthroughs and life-saving innovations. With each passing year, pharmaceutical companies around the globe strive to deliver cutting-edge medicines, therapies and vaccines that impact the lives of millions.

In this in-depth article, we embark on a captivating journey to uncover the top 30 pharma and biotech companies that have been instrumental in shaping the future of medicine. We delve into the driving forces behind their successes and shed light on the groundbreaking research that has earned them a place among the elite in the pharmaceutical arena.

Whether you’re an industry enthusiast or simply intrigued by the remarkable strides made in modern medicine, this article promises to be an insightful and inspiring guide to the leading pharma and biotech companies at the forefront of innovation and human welfare.

Join us as we celebrate the accomplishments and resilience of the top 30 pharma and biotech companies, highlighting their unyielding dedication to shaping a healthier, more prosperous world for all.

Note: When it comes to companies that report in foreign currencies, the conversion to US dollars utilizes the average annual exchange rates reported by the US Federal Reserve. 

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RELATED: Top 10 Medical Device Companies in 2023: Statistics and Trends

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1) Pfizer

By: Nadia Stec, M.Sc.

2022 Revenue: Pfizer reported an annual revenue of $100.33 billion in 2022, a 23.43 percent increase from its 2021 revenue of $81.29 billion.

2022 Net Income: Pfizer’s net income for 2022 was $31.37 billion, a 42.74 percent increase from $21.98 billion in 2021.

2022 R&D Spend: Pfizer’s R&D expenses during 2022 were $11.43 billion, a 10.31 percent increase from the $10.36 billion that Pfizer spent on R&D in 2021.

Pfizer Inc. is a global pharmaceutical company, working across both developed and emerging markets. Most of the company’s revenue comes from the manufacture and sale of biopharmaceutical products. They are committed to capitalizing on growth opportunities primarily through the advancement of their own product pipeline and constantly improving their existing products, as well as through business development activities.

Their large revenue growth from 2021 to 2022 can be attributed to several significant business development activities in 2022, predominantly acquisitions. For example, in March 2022, Pfizer acquired Arena, a clinical-stage company developing therapies for various immune-inflammatory diseases. The acquisition of GBT, a biopharmaceutical company developing treatments to underserved patient communities, was completed in October 2022. At this time, Pfizer also acquired Biohaven, the company behind Nurtec ODT/Vydura (rimegepant), a therapy for acute and episodic migraines in adults.

In the last quarter of 2021, Pfizer underwent a change in their global structure and now manages their commercial operations through two segments: Biopharma, the innovative biopharmaceutical business, and PC1, their global contract development and manufacturing branch (and lead supplier of active pharmaceutical ingredients).

In the third quarter of 2022, the company underwent several more organizational changes to better leverage expertise in key areas. The changes included establishing a commercial structure within Biopharma, optimizing their R&D operations, prioritizing their internal portfolio and realigning enabling and platform functions across the company to support and optimize performance across the primary care, specialty care and oncology customer groups.

Pfizer’s Top 5 Best-Selling Drugs of 2022:

1) Comirnaty

Comirnaty is an mRNA-based vaccine indicated for the prevention of COVID-19. Pfizer’s total global revenue in 2022 from Comirnaty was $37.81 billion. Comirnaty was first Approved by the US Food and Drug Administration (FDA) in August 2021 for individuals over the age of 16.

2) Paxlovid (nirmatrelvir/ritonavir)

Paxlovid is a dual-packaged oral medication for the treatment of COVID-19. It contains the antiviral medications nirmatrelvir and ritonavir. It is indicated for people with positive SARS-CoV-2 tests who are at high risk for progressing to severe COVID-19. Pfizer’s total global revenue from Paxlovid was $18.93 billion in 2022. Paxlovid was first authorized under the FDA Emergency Use Authorization in December 2021; however, it has received FDA approval on May 25, 2023. Although initially provided at no cost since the US government purchased 20 million courses of Paxlovid priced at around $530 for a five-day course, Paxlovid is anticipated to reach the private market in the middle of 2023.

3) Eliquis (apixaban)

Eliquis is a factor Xa inhibitor (xaban) anticoagulant (blood thinner), indicated for reducing the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Pfizer’s total global revenue from Eliquis was $6.48 billion in 2022. Eliquis was first approved by the FDA in December 2012, and the average price of Eliquis without insurance is approximately $696 for a 30-day prescription of 60, 5 mg tablets.

4) Prevnar family

The Prevnar family of drugs are vaccinations indicated for the prevention of invasive disease caused by Streptococcus pneumoniae serotypes. Pfizer’s total global revenue from the Prevnar family of vaccines was $6.34 billion in 2022. Prevnar 13 (PCV13, a 13-valent conjugate vaccine for the prevention of disease caused by 13 S. pneumoniae serotypes) replaced the company’s first pneumococcal conjugate vaccine Prevnar (PCV7, approved by the FDA in February 2000) in a February 2010 FDA approval. The private sector cost of Prevnar 13 is approximately $226.43 for a pediatric dose. In addition, the FDA approved Pfizer’s pneumococcal 20-valent conjugate vaccine, Prevnar 20, for the first time in June 2021. The private sector price of Prevnar 20 is around $253.96 per dose.

5) Ibrance (palbociclib)

Ibrance is a chemotherapy drug indicated for hormone receptor positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer. It is a CDK 4/6 inhibitor that is taken in combination with other hormonal therapies to stop the growth of cancer and healthy cells. Pfizer’s total global revenue from Ibrance was $5.12 billion in 2022. Ibrance was first approved by the FDA in February 2016, and without insurance, the price of Ibrance is approximately $15,886 for a supply of 21 capsules.

2) Johnson & Johnson

By: Nadia Stec, M.Sc.

2022 Revenue: Johnson & Johnson’s annual revenue for 2022 was $94.94 billion, a 1.25 percent increase from its annual revenue of $93.78 billion in 2021.

2022 Net Income: Johnson & Johnson’s annual net income for 2022 was $17.94 billion, a 14.07 percent decrease from its annual net income of $20.88 billion in 2021.

2022 R&D Spend: In 2022, Johnson & Johnson spent $14.60 billion on R&D expenses, a 0.75 percent decrease from the $14.71 billion the pharma giant spent on R&D in 2021.

Johnson & Johnson (J&J), one of the world’s largest pharmaceutical companies, is routinely ranked first in finance reports, but this year falls behind Pfizer. The company is comprised of several units, and the largest is Johnson & Johnson’s pharma unit which generated $52.56 billion in 2022, a 1.71 percent growth from the $51.68 billion in pharmaceutical sales from 2021. Its other segments consist of medical devices and consumer healthcare, which generated $27.43 billion and $14.95 billion, respectively, in 2022.

The top drivers of Johnson & Johnson’s performance were their immunotherapy Stelara (ustekinumab), cancer drug Darzalex (daratumumab) and prostate cancer therapy Erleada (apalutamide), among several others that substantially contributed to earnings.

In contrast, several drugs experienced sale declines, such as Remicade (infliximab), an old immunology medication that continues to decline due to the rise of biosimilars since 2016. Johnson & Johnson’s annual 2022 revenue from Remicade was $2.34 billion, a 26.55 percent decline from the $3.19 billion the drug generated in 2021. Additionally, Imbruvica (ibrutinib), a blood cancer medication developed in partnership with AbbVie, also declined in sales in the past year. Johnson & Johnson’s total earnings from Imbruvica were $3.78 billion in 2022, a 13.39 percent decline since 2021 when Imbruvica generated $4.37 billion.

A novel challenge Johnson & Johnson will face in the coming year is that their top drug, Stelara, may enter a similar situation to Remicade, in that it will come head-to-head with emerging biosimilars. Stelara’s patents are expiring in September 2023, while a handful of biosimilar drugs are in late-stage development or seeking FDA approval.

Johnson & Johnson’s Top 5 Best-Selling Drugs of 2022:

1) Stelara (ustekinumab)

Stelara is an immunosuppressant biologic therapy that blocks the IL-12 and IL-23 proteins that play a role in plaque psoriasis and Crohn’s disease. The FDA approved the drug over a decade ago in September 2009. Johnson & Johnson’s total global earnings from Stelara were $9.72 billion in 2022, a 6.45 percent increase from the $9.13 billion the drug generated in 2021. The list price of Stelara was stated to be $25,497.12 every eight weeks for the 90 mg dose, according to the manufacturer.

2) Darzalex (daratumumab)

Darzalex is a targeted monoclonal antibody that slows or stops the progression of multiple myeloma (a blood cancer) by binding to the CD38 protein on multiple myeloma cells. The total global revenue from Darzalex was $7.98 billion in 2022, a 32.44 percent increase from $6.02 billion in 2021. The medication was approved by the FDA in November 2015, and the current cost of Darzalex (20 mg/mL) is approximately $714 for a 5 mL supply. Based on observed doses, the estimated total cost for a 52-week treatment with daratumumab can range from around $190,979.19 to $213,610.39.

3) Invega Sustenna/Xeplion and Invega Trinza/Trevicta (paliperidone palmitate)

Invega is a long-acting, injectable atypical antipsychotic used for the treatment of schizophrenia in adults. The medication rebalances dopamine and serotonin levels in the brain, improving patients’ thinking, mood and behaviour. The different variations of the drug can be taken either as an extended-release oral tablet or extended-release intramuscular suspension. The global revenue for Invega products was $4.14 billion in 2022, a 2.93 percent increase from $4.02 billion in 2021. Invega was first approved by the FDA in December 2006, and costs about $397 without insurance for a supply of 30 oral, extended release 1.5 mg tables.

4) Imbruvica (ibrutinib)

Imbruvica is approved for the following indications: Adults with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL); Adults with CLL/ SLL with 17p deletion; adults with Waldenström’s macroglobulinemia (WM); and adults and children one year of age and older with chronic graft versus host disease (cGVHD) after failure of one or more lines of systemic therapy. Johnson & Johnson’s 2022 global revenue from Imbruvica was $3.78 billion, a 13.39 percent decrease from $4.37 billion in 2021. Imbruvica was first approved by the FDA in November 2013 and the price of Imbruvica is around $484 per tablet (without insurance).

5) Tremfya (guselkumab)

Tremfya is a monoclonal antibody that blocks IL-23 and is used to treat adults with moderate to severe plaque psoriasis, and for adults with active psoriatic arthritis. Global revenue from Tremfya was $2.67 billion in 2022, a 25.43 percent increase from $2.13 billion in 2021. First FDA-approved in July 2017 for plaque psoriasis, the list price for a 30-day supply of Tremfya was stated to be $6,292, according to the manufacturer.

3) Sinopharm

By: Nadia Stec, M.Sc.

2022 Revenue: Sinopharm’s revenue was 552.15 billion CYN ($82.05 billion USD) in 2022, a 5.97 percent increase from 521.05 billion CYN ($80.77 billion) in 2021.

2022 Profit for the Year: Sinopharm’s profit for the year of 2022 was 14.35 billion CYN ($2.13 billion USD), a 9.80 percent increase from 13.06 billion CYN ($2.03 billion USD) in 2021.

From 2021 to 2022, the recurring outbreaks of the COVID-19 pandemic brought some challenges to Sinopharm’s business development; however, the company coordinated pandemic prevention and control, high quality development and business development, and saw an increase in revenue over the year.

Over the past year, the company promoted the innovation of new supply chain models and services to expand growth. Sinopharm formulated personalized marketing promotion programs to create drug marketing systems with the company’s characteristics.

By the end of 2022, strategic agreements were signed with several domestic and foreign pharmaceutical companies, including Novartis China, Santen Pharmaceutical, Pfizer and Boehringer. During 2022, sales of various pharmaceutical products (including four anti-tumor drugs from Novartis) increased by more than 40 percent.

During 2022, Sinopharm followed industry transformation trends, strengthened their distribution network capabilities and ensured growth of key regions and markets. They note improvements in revenue shares in regions including Guangdong, Guangxi, Central China, Yangtze River Delta and North China. Overall, due to their enhanced competitive advantage, the group is a leader in the pharmaceutical circulation market.

4) Roche

By: Nadia Stec, M.Sc.

2022 Revenue: Roche’s annual revenue in 2022 was 63.28 billion CHF ($66.26 billion USD), a 0.76 percent increase from 62.80 billion CHF ($68.68 billion USD) in 2021.

2022 Net Income: Roche’s net income was 13.53 billion CHF ($14.17 billion USD) in 2021, a 9.40 percent decrease from 14.94 billion CHF ($16.33 billion USD) in 2021.

2022 R&D Spend: In 2022, Roche spent 14.05 billion CHF ($14.72 billion USD) on R&D, a 2.52 percent increase from the 13.71 billion CHF ($14.99 billion USD) the company spent on R&D in 2021.

Roche experienced several setbacks in 2022, in their pipeline, against emerging biosimilars and a decline in their COVID-19 sales that resulted in just a 0.8 percent revenue increase over the past year. Notably, sales from their COVID-19 drug Actemra (tocilizumab) dropped significantly by 22 percent. The company expects to lose approximately 5 billion Swiss francs (around $5.2 billion USD) in revenue from COVID-related sales this year.

The emergence of biosimilars is new competition for Roche’s main cancer treatments (Rituzan [rituximab], Herceptin [trastuzumab] and Avastin [bevacizumab]), which resulted in a decrease in revenue by about 1.9 billion CHF (about $2.0 billion USD). Some drugs experienced continued growth in 2022: multiple sclerosis drug Ocrevus (ocrelizumab) had a 17 percent increase in sales, sales of hemophilia A therapy Hemlibra (emicizumab) increased by 27 percent and sales of cancer treatment Tecentriq (atezolizumab) increased by 14 percent. But all three drugs have new competitors. For example, Ocrevus will be challenged by Novartis’ Kesimpta (ofatumumab) and TG Therapeutics’ Briumvi (ublituximab). Both are anti-CD20 agents. Meanwhile, BioMarin’s gene therapy Roctavian is approved by the FDA for the treatment of hemophilia A.

Although Roche’s products are protected by patents, they would have to enter expensive litigation to enforce them and other intellectual property rights. Roche’s business, operations and financial condition could be adversely affected by a loss of market exclusivity for their major products due to competition from biosimilars and other non-comparable biologics. These medications are offered at much lower prices and can result in significant reduction in sales for Roche’s products.

In September 2022, Roche acquired Good Therapeutics for an upfront payment of $250 million, and has access to their PD-1-regulated IL-2 program. The company also continued the implementation of some global restructuring plans started in previous years, as well as initiating a portfolio prioritization program for their Pharmaceutical division.

Roche’s Top 5 Best-Selling Drugs of 2022:

1) Ocrevus (ocrelizumab)

Ocrevus is a monoclonal antibody administered intravenously, indicated for the treatment of relapsing or primary progressive multiple sclerosis in adults. The monoclonal antibody targets CD20, a protein found on the surface of B lymphocytes (B cells). Roche’s total global revenue from Ocrevus was 6.04 billion CHF ($6.32 billion USD) in 2022. First FDA-approved in March 2017, the list price of Ocrevus was about $75,102 annually, as reported by the manufacturer.

2) Perjeta (pertuzumab)

Perjeta is a monoclonal antibody approved for use in combination with chemotherapy (and Herceptin [trastuzumab]) to treat HER2+, locally advanced or early stage breast cancer prior to surgery, or after surgery in HER2+ breast cancer that has a higher likelihood of returning. The total revenue in 2022 from Perjeta was 4.09 billion CHF ($4.28 billion USD). Perjeta was first approved by the FDA in June 2012, and the list price of Perjeta is approximately $5,900 a month (or $71,000 annually). In combination with Herceptin (around $54,000 annually), the breast cancer treatment surpasses $100,000 per year.

3) Hemlibra (emicizumab)

Another monoclonal antibody in Roche’s roster, Hemlibra functions similarly to factor VIII, a protein that people with hemophilia A do not have in their blood. It can help maintain a blood clotting level of approximately 15 percent of that maintained by factor VIII. Hemlibra’s total global revenue was 3.82 billion CHF ($4.00 billion USD) in 2022. Approved by the FDA in November 2017, the mean annual list price of Hemlibra is around $450,000.

4) Tecentriq (atezolizumab)

Tecentriq is a monoclonal antibody that binds with the PD-L1 protein expressed by tumor cells and tumor-infiltrating immune cells. It is indicated for several cancers, including various lung cancers, liver cancer and melanoma. Tecentriq was first approved by the FDA in May 2016, and a monthly treatment of Tecentriq may cost around $14,540 depending on the dosage schedule. In 2022, Roche’s total revenue from Tecentriq was 3.72 billion CHF ($3.89 billion USD).

5) Actemra (tocilizumab)

Actemra is also a monoclonal antibody approved to treat adults with active rheumatoid arthritis or giant cell arteritis. Taken as an intravenous infusion or subcutaneous injection, this drug blocks the inflammatory IL-6, improving joint pain and swelling. Roche’s global revenue was from Actemra was 2.70 billion CHF ($2.83 billion USD) in 2022. Actemra was first approved by the FDA in January 2010, and the annual costs of Actemra, depending on the dosage, can range from around $8,000 to over $18,400 without insurance.

5) Merck & Co

By: Nadia Stec, M.Sc.

2022 Revenue: Merck’s annual revenue was $59.28 billion in 2022, a 21.72 percent increase from $48.70 billion in 2021.

2022 Net Income: Merck reported a net income of $14.52 billion in 2021, which was a 11.27 percent increase from Merck’s net income of $13.05 billion in 2021.

2022 R&D Spend: In 2022, Merck spent $13.55 billion on R&D, a 10.64 percent increase from the $12.25 billion Merck spent on R&D in 2021.

Although Merck did not develop a vaccine for COVID-19, 2022 was still a positive year for the company, which is reflected in the sustained revenue growth during the year. The annual worldwide sales were $59.3 billion, a 22 percent increase from 2021. This growth can be largely attributed to the temporary success of Lagevrio (molnupiravir), a new oral antiviral treatment from Merck. Lagevrio made up a large proportion of Merck’s revenue increase with $5.68 billion in sales in 2022 — though this year the company is expecting a decline to $1 billion. This is largely due to failed trials as a prophylaxis resulting in the European Committee for Medical Products (CHMP) recommending against the approval of Lagevrio.

Other drugs also contributed to Merck’s revenue growth. Keytruda and Gardasil/Gardasil 9 sales also grew 22 percent to $20.94 billion and $6.90 billion, respectively. The company credits Gardasil’s sales to high demand, especially in China, over the past year. Additional beneficial changes to the company’s pipeline also contributed to their growth, including the acquisition of Imago BioSciences in November 2022 for a total equity value of $1.35 billion and expanding their hematology portfolio, as well as agreements with Moderna and Kelun-Biotech, the latter with which they will be developing seven investigational preclinical antibody-drug conjugates for cancer treatment.

Merck is projecting their 2023 worldwide sales to amount to between $57.7 billion and $58.9 billion.

Merck’s Top 5 Best-Selling Drugs of 2022:

1) Keytruda (pembrolizumab)

Keytruda is a humanized antibody indicated for the treatment of a variety of cancers, including melanoma, head and neck cancer, lung cancer and cervical cancer, among others. This cancer immunotherapy blocks the PD-1 pathway, preventing cancer cells that express the PD-L1 protein from hiding, and helping the immune system find and fight the cancer cells. Keytruda was first FDA approved in September 2014, and the list price of Keytruda was about $10,897.12 per dose when given every three weeks, as reported by the manufacturer. Merck’s total global revenue from Keytruda was $20.94 billion in 2022.

2) Gardasil/Gardasil 9

The Gardasil non-infectious recombinant vaccines (prepared from the purified virus particles) are indicated for the prevention of cancer-causing infections due to the human papillomavirus (HPV). In 2022, Merck’s total revenue from Gardasil/Gardasil 9 was $6.90 billion. Gardasil was first approved by the FDA in June 2006, and the list price of individual doses of Gardasil 9 was reported to be $268.02, according to the manufacturer.

3) Lagevrio (molnupiravir)

Lagevrio is an investigational antiviral drug indicated for the treatment of currently-diagnosed mild or moderate COVID-19 infection in adults who are at risk of progressing to severe infection, hospitalization or death. Lagevrio is not approved by the FDA, but was granted Emergency Use Authorization for use during the COVID-19 pandemic. Lagevrio costs the US government about $700 for each course of treatment. Merck’s total global revenue from Lagevrio was $5.68 billion in 2022.

4) Januvia/Janumet (sitagliptin)

Januvia/Janumet is an anti-diabetic medication for the treatment of type 2 diabetes. It is a dipeptidyl peptidase-4 inhibitor that keeps insulin levels stable and reduces the amount of glucose produced by the body. Januvia was first approved by the FDA in October 2006. The cost of Januvia is around $664 for a 30-day supply (without insurance). Merck’s total revenue from Januvia/Janumet was $4.51 billion in 2022.

5) ProQuad/M-M-R II/Varivax

ProQuad, M-M-R II and Varivax are all measles, mumps, rubella and varicella vaccines indicated for different age groups. They are live, lyophilized (attenuated virus) preparations for subcutaneous injection. In total, these drugs generated $2.24 billion in 2022. ProQuad was first approved by the FDA in September 2005, whereas Varivax was approved by the FDA in March 1995. M-M-R II was approved even earlier, in 1978. The private sector costs/dose of pediatric versions of M-M-R II, ProQuad and Varivax are $89.87, $262.37 and $159.99, respectively.

6) AbbVie

By: Nadia Stec, M.Sc.

2022 Revenue: AbbVie’s annual revenue was $58.05 billion in 2022, a 3.30 percent increase from $56.20 billion in 2021.

2022 Net Income: In 2022, AbbVie had an annual net income of $11.84 billion, a 2.55 percent increase from $11.54 billion in 2021.

2022 R&D Spend: In 2022, AbbVie spent $6.51 billion on R&D, a 5.95 percent decrease from the $6.92 billion AbbVie spent on R&D in 2021.

AbbVie’s revenue in 2022 was not all that different from 2021 and saw an increase of about 3.3 percent over the year. One large contributor to the growth was their immunology portfolio, bringing in over $28.92 billion in 2022, an increase of 14.40 percent since 2021. The main sources of this revenue were sales from Humira (adalimumab), Skyrizi (risankizumab) and Rinvoq (upadacitinib).

Their hematologic oncology portfolio brought in $6.58 billion, a decrease of 9.01 percent since 2021, largely due to a decline in sales of Imbruvica (ibrutinib), a cancer treatment. AbbVie’s neuroscience portfolio saw a total profit of $6.53 billion, a 10.14 percent increase since 2021, predominantly due to Botox sales for therapeutic uses.

The company is looking at a loss of exclusivity for Humira after 20 years due to the release of Amjevita by Amgen, a biosimilar. At least seven more Humira biosimilars are expected to debut in the coming year, but AbbVie has a solid foundation that will allow them to absorb the loss.

AbbVie has also had some approvals made for their drugs, such as the European Commission approval of Skyrizi (risankizumab) and another FDA approval of Vraylar (cariprazine), which marks the fourth indication for Vraylar, this time as an adjunctive therapy to antidepressants for major depressive disorder.

Late in 2022, AbbVie partnered with HotSpot Therapeutics and announced an exclusive worldwide collaboration and option to license agreement for their interferon regulatory factor 5 (IRF5) inhibitor program for autoimmune disease treatment. This partnership will expand the company’s immunology pipeline. A similar collaboration with Anima Biotech will help discover and develop mRNA biology modulators for targets across immunology and oncology. AbbVie will have exclusive licencing rights to further develop and commercialize the new programs.

AbbVie’s Top 5 Best-Selling Drugs of 2022:

1) Humira (adalimumab)

Humira is a monoclonal antibody used to treat rheumatoid arthritis and psoriatic arthritis, as well as other immune conditions like Crohn’s and ulcerative colitis. Humira was first approved by the FDA 20 years ago in December 2002. The list price of a four-week supply of Humira was reported to be $6,922.62 in January 2023, according to the manufacturer. AbbVie’s total global revenue for Humira was $21.24 billion in 2022.

2) Botox Therapeutic/Cosmetic

Botox, or botulinum neurotoxin, is a neurotoxic protein produced by the Clostridium botulinum bacteria. It blocks the release of the neurotransmitter acetylcholine from neuron axons at neuromuscular junctions, causing a localized paralysis. When the purified version of the protein is injected into the facial muscles, it results in a refreshed appearance as wrinkles become less pronounced due to a lack of movement at the injection sites. Botox is also used as therapeutic treatments for neck spasms, excessive sweating, lazy eyes and migraines. Botox was first approved by the FDA in 1989 for blepharospasms and strabismus in adults. Botox brought in a total of $2.72 billion in therapeutics and $2.62 billion in aesthetics in 2022, for a total of $5.33 billion. The price of Botox varies based on the units required, but is generally around $10 to $15 per unit.

3) Skyrizi (risankizumab)

Skyrizi, a humanized monoclonal antibody, is the first specific IL-23 inhibitor indicated for the treatment of moderately to severely active Crohn’s disease in adults who have had inadequate response, lost response or were intolerant to conventional or biologic therapy. First FDA-approved in April 2019 for the treatment of plaque psoriasis, the list price of one dose of Skyrizi was reported to be $19,743.61 in January 2023, according to the manufacturer. Skyrizi brought in a total revenue of $5.17 billion in 2022.

4) Imbruvica (ibrutinib)

Imbruvica is a small molecule drug that inhibits B-cell growth and survival by binding to the Bryton’s tyrosine kinase protein. This binding inhibits B-cell receptor pathways, which are overly active in B-cell cancers. It is indicated for mantle cell lymphoma and CLL or SLL. AbbVie’s total global revenue from Imbruvica was $4.57 billion in 2022. Imbruvica was first approved by the FDA in November 2013 and the price of Imbruvica is around $484 per tablet regardless of its strength (without insurance).

5) Rinvoq (upadacitinib)

In 2022, the total global revenue for Rinvoq was $2.52 billion. It is a Janus kinase (JAK) inhibitor pill that blocks inflammatory signals that are present at higher levels in people with inflammatory conditions, such as rheumatoid arthritis. Rinvoq is indicated for this disease in people who have not reacted appropriately to tumor necrosis factors as a treatment. Rinvoq was first FDA-approved in August 2019, and the list price of Rinvoq for a 30-day supply of the pills was $6,124.96 in January 2023, according to the manufacturer.

7) Novartis

By: Nadia Stec, M.Sc.

2022 Revenue: Novartis’ annual revenue in 2022 was $50.55 billion, a 2.09 percent decrease from $51.63 billion in 2021.

2022 Net Income: In 2022, Novartis had an annual net income of $6.96 billion, a 71.04 percent decrease from its annual net income of $24.02 billion in 2021.

2022 R&D Spend: Novartis spent $10.00 billion on R&D in 2022, a 4.78 percent increase from the $9.54 billion the company spent on R&D in 2021.

In 2022, Novartis underwent several changes to its corporate structure. The company’s oncology and other therapeutic areas were merged into one unit, and the business was divided into US and international markets. These changes resulted in the dismissal of three C-level executives, as well as 8,000 employees, as the company aimed to transform into a leaner organization. The changes are expected to save Novartis about $1.5 billion in annual costs by 2024. Headquartered in Switzerland, the company is aiming to become one of the top five pharmaceutical companies in the United States by 2027 by taking a “US-first mindset.”

In terms of drugs, Novartis’ heart drug Entresto (sacubitril/valsartan) had increased sales, resulting in 31 percent growth in sales in the past year to $4.64 billion. The medication is now on track to surpass Cosentyx (secukinumab; an inflammatory disease therapy from Novartis) as the company’s best-selling product. In contrast, profit from Cosentyx increased by only 1 percent in the past year, to a total of $4.79 billion.

Other notably successful growth in pharmaceutical sales was seen in the company’s multiple sclerosis drug Kesimpta (ofatumumab), which doubled in sales to $1.09 billion in 2022. Kisqali (ribociclib), a CDK4/6 inhibitor, grew 31 percent in sales to $1.23 billion; however, there is large competition from Pfizer and Eli Lilly, and Kisqali lags behind its competitors.

Additional business operations include the FDA approval of a new radiotherapy called Pluvicto (lutetium Lu 177 vipivotide tetraxetan), which brought in $271 million in sales in 2022, though the company is struggling to keep up with demand after issues during manufacturing expansion. Developed in partnership with BeiGene, the PD-1 inhibitor tislelizumab is undergoing prolonged FDA review due to delays during the COVID-19 pandemic and encountered some regulatory setbacks.

Novartis’ Top 5 Best-Selling Drugs of 2022:

1) Cosentyx (secukinumab)

Cosentyx is a human IgG1k monoclonal antibody that binds to IL-17A, indicated for the treatment of psoriasis, ankylosing spondylitis and psoriatic arthritis. Like many interleukins, IL-17A causes inflammation, particularly in the skin and joints. Cosentyx was first approved by the FDA in January 2015, and the list price of Cosentyx was reported to be $6,924.26 a month for either 150 mg or 300 mg dose strength packages, and $3,462.13 for the 75 mg dose strength package in January 2023, according to the manufacturer. Total global revenue from Cosentyx was $4.79 billion in 2022.

2) Entresto (sacubitril/valsartan)

A combination drug, Entresto consists of neprilysin inhibitor sacubitril and angiotensin receptor blocker valsartan. Essentially, they are both antihypertensive drugs that reduce a patient’s blood pressure. It is used to treat adults with chronic heart failure to reduce their risk of death and hospitalization. Novartis’ total revenue from Entresto was $4.64 billion in 2022. Entresto was first FDA-approved in July 2015, and the list price of Entresto was reported to be $667.97 a month, according to the manufacturer.

3) Promacta/Revolade

Promacta (Revolade outside of the US) is a thrombopoietin (TPO) receptor agonist. The TPO receptor agonist regulates blood platelet production by binding to and activating TPO receptors on megakaryocyte cells and inducing signalling cascades that increase platelet production. Promacta/Revolade is indicated for both adults and children over one year of age with persistent or chronic thrombocytopenia, aplastic anemia and hepatitis C-associated thrombocytopenia. Promacta was first approved by the FDA in November 2008. Novartis’ total revenue from Promacta/Revolade was $2.09 billion in 2022. The list price of Promacta per month was reported to be $6,035.45, $10,921.67 and $16,382.51 for the 25 mg, 50 mg and 75 mg tablet doses, respectively, according to the manufacturer.

4) Gilenya (fingolimod)

Gilenya is a sphingosine-1-phosphate receptor modulator. It works by containing lymphocytes within the lymph nodes, preventing them from entering the central nervous system via the blood-brain barrier and causing an autoimmune reaction that destroys myelin on neurons. This drug is indicated for the treatment of relapsing multiple sclerosis and relapse-remitting disease and was approved for this purpose in September 2010 by the FDA. Novartis’ total revenue from Gilenya in 2022 was $2.01 billion, and the annual list price of Gilenya is about $95,594.

5) Tasigna (nilotinib)

Tasigna brought in Novartis a total revenue of $1.92 billion in 2022. It belongs to a class of medications known as tyrosine kinase inhibitors, which attack the growth of cancer cells while preserving normal cells. Tasigna was first approved by the FDA in October 2007 for chronic myelogenous leukemia with the Philadelphia chromosome. Novartis made $1.92 billion from worldwide sales of Tasigna in 2022. For a supply of 28 capsules, the price of Tasigna is about $4,895 (without insurance).

8) Bristol Myers Squibb

By: Nadia Stec, M.Sc.

2022 Revenue: In 2022, Bristol Myers Squibb had an annual revenue of $46.16 billion, a 0.49 percent decrease from $46.39 billion in 2021.

2022 Net Income: Bristol Myers Squib had a net income of $6.33 billion in 2022, a 9.54 percent decrease from $6.99 billion in 2021.

2022 R&D Spend: In 2022, Bristol Myers Squib spent $9.51 billion on R&D, a 6.73 percent decrease from the $10.20 billion that the company spent on R&D in 2021.

Bristol Myers Squib (BMS) saw pharmaceutical sales drop from 2021 to 2022, with the slow decline occurring every quarter since the beginning of 2021. This can largely be attributed to a loss of exclusivity for their multiple myeloma drug Revlimid (lenalidomide). Revlimid sales peaked in 2021 at $12.82 billion and dropped 22.17 percent to $9.98 billion this past year. BMS is foreshadowing a further decline in the upcoming years.

Over the next year, BMS expects a 2 percent increase in growth if supported by large sales by star products like Eliquis (apixaban) and Opdivo (nivolumab), which are patent protected until 2026 and 2028, respectively. Additionally, three new products were approved in 2022 and are expected to have strong sales. The products are Opdualag (nivolumab/relatlimab) for melanoma, Camzyos (mavacamten) for obstructive hypertrophic cardiomyopathy and Sotyktu (deucravacitinib) for plaque psoriasis. In total, BMS predicts that the three drugs will bring in about $12 billion by 2025.

Several other novel medications from BMS are also growing quickly. For example, Reblozyl (luspatercept), an anemia drug, increased in sales by 30 percent to $717 million in 2022. Onureg (azacitidine), a leukemia therapy, also saw large growth of 70 percent to $124 million in 2022, and the multiple sclerosis drug Zeposia (ozanimod) generated $250 million in 2022, an 87 percent increase.

2022 was the first year on market for cell-based gene therapies Abecma (Idecabtagene vicleucel) and Breyanzi (lisocabtagene maraleucel), which generated $388 million and $182 million, respectively.

Bristol Myers Squibb’s Top 5 Best-Selling Drugs of 2022:

1) Eliquis (apixaban)

Eliquis is an anticoagulation medication used to reduce the risk of stroke or blood clots in people with atrial fibrillation. It is often prescribed to patients who are at risk of forming clots in their legs and lungs after hip or knee replacement surgery. The anticoagulant was first approved by the FDA in December 2012. In 2022, the total global revenue for Eliquis was $11.79 billion, and the list price for a 30-day supply of Eliquis was reported to be $561, according to the manufacturer.

2) Revlimid (lenalidomide)

Revlimid is an immune-modulating treatment, indicated for the treatment of multiple myeloma in combination with several other therapies. It works by supporting the function of the immune system to fight against cancer cells. This drug was first approved by the FDA in December 2005. Revlimid brought in a total revenue of $9.98 billion in 2022, and a supply of 28 capsules of Revlimid 2.5 mg can cost around $24,576 (without insurance).

3) Opdivo (nivolumab)

In 2022, Opdivo’s total global revenue sat at $8.25 billion. Opdivo is an IgG4 monoclonal antibody that blocks the PD-1 pathway as a checkpoint inhibitor, so that T cells are not blocked from attacking cancer cells. It is primarily indicated for the treatment of advanced stage non-small cell lung cancer that is metastatic, as well as advanced melanoma and kidney cancer. Opdivo was first approved by the FDA in December 2014. The list price of treatment with Opdivo 240 mg every two weeks was reported to be $7,194 per infusion and the list price of treatment with Opdivo 480 mg every four weeks was reported to be $14,389 per infusion, according to the manufacturer.

4) Pomalyst/Imnovid (pomalidomide)

Pomalyst, like Revlimid, is also an immunomodulatory agent, but more potent. It binds to a protein on multiple myeloma cancer cells called cereblon, resulting in the cell’s death. Pomalyst is also indicated for multiple myeloma. First FDA-approved in February 2013, total global revenue from Pomalyst in 2022 was $3.50 billion. A yearly supply of Pomalyst may cost around $147,302 (without insurance).

5) Orencia (abatacept)

Indicated for adult rheumatoid arthritis, Orencia is a fusion protein created from the fusion of IgG1 to extracellular domain of CTLA-4. It works by acting as an analog for CTLA-4, which prevents antigen-presenting cells from delivering a stimulatory signal and activating T cells, and thus reducing immune reactions. Orencia was first approved by the FDA in December 2005, and the list price of Orencia administered as an IV was reported to be $4,043 per infusion and the list price for self-injected Orencia was reported to be $5,373 per month, according to the manufacturer. Total revenue from Orencia was $3.46 billion in 2022.

9) Sanofi

By: Nadia Stec, M.Sc.

2022 Revenue: In 2022, Sanofi’s annual revenue was €43.00 billion ($45.21 billion USD), a 13.87 percent increase from €37.76 billion ($44.63 billion USD) in 2021.

2022 Net Income: Sanofi’s annual net income in 2022 was €8.37 billion ($8.80 billion USD), a 34.52 percent increase from €6.22 billion ($7.36 billion USD) in 2021.

2022 R&D Spend: In 2022, Sanofi spent €6.71 billion ($7.05 billion USD) on R&D, a 17.81 percent increase from the €5.69 billion ($6.73 billion USD) Sanofi spent on R&D in 2021.

In 2022, Sanofi implemented a “Play to Win” strategy, which entailed big decisions and action to support the competitive margins required for the company to succeed. Their annual report outlines four major priorities: focus on growth, lead with innovation, accelerate efficiency and reinvent how they work.

Sanofi’s global sales in 2022 were a total of €43 billion — a 7 percent growth from the last year, largely due to the key growth driver Dupixent (dupilumab), as well as their vaccine sales. Dupixent alone generated €8.29 billion ($8.72 billion USD) in sales in 2022, a 43.8 percent increase from 2021. Dupixent has been approved for new indications in the past few years, such as for the treatment of prurigo nodularis, eosinophilic esophagitis and asthma, which have contributed to sales. It is expected that Dupixent sales will reach €10 billion by 2023.

In terms of other significant operations, Sanofi launched collaborations with several partners in 2022. With Blackstone Life Sciences, up to €300 million (around $315 million USD) will be invested to accelerate pivotal studies and clinical development programs for formulating the subcutaneous delivery of the anti-CD38 antibody Sarclisa (isatuximab) for the treatment of multiple myeloma. In partnership with Seagen, Sanofi will design, develop and commercialize ADCs for three cancer targets using Sanofi’s proprietary monoclonal antibody technology and Seagen’s proprietary ADC technology.

Some business losses include the pause of patient enrollment in a Phase III tolebrutinib trial by the FDA due to some potential side effects from the treatment, as well as the cessation of the global clinical development program of amcenestrant for breast cancer in August 2022.

Sanofi’s Top 5 Best-Selling Drugs of 2022:

1) Dupixent (dupilumab)

Dupixent is a monoclonal antibody that blocks IL-4 and IL-13, key causes of allergic diseases. Blocking these interleukins reduces the inflammatory response in the body. It is indicated for eczema, severe asthma, eosinophilic esophagitis and prurigo nodularis. Dupixent was first approved by the FDA in March 2017. The list price of Dupixent was reported to be $3,587.92 per carton, according