The top-selling drugs in the U.S. in 2019

The 10 highest-selling drugs in the U.S. last year gave away more than $23 billion in rebates to insurance intermediaries, but still netted $50 billion in sales.

The big picture: The U.S. drug pricing system is filled with confusing numbers, and many entities profit off the flow of drugs, but pharmaceutical companies retain a vast majority of the proceeds.

By the numbers: Humira, the rheumatoid arthritis blockbuster made by AbbVie, continues to generate more revenue than any other drug, due to AbbVie extending U.S. patents and consequently retaining higher U.S. prices.

• After subtracting about $3 billion in discounts that went to drug distributors and other supply chain entities, Humira generated about $21.4 billion in "non-discounted invoice sales," according to a report from data analytics firm IQVIA.
• Another $6.5 billion in rebates went to pharmacy benefit managers, health insurers and employers, leading to $14.9 billion in net U.S. Humira sales for AbbVie.

Between the lines: Drugs that have more competitors usually offer higher insurance rebates than drugs with few or no competitors.

• Intravenous cancer drug Keytruda has few competitors and is used for several conditions, and therefore doesn’t have large rebates.
• Blood thinners Xarelto and Eliquis and diabetes drug Trulicity are battling several other drugs in their classes, and therefore offer rebates well over 50% of their list prices to get preferred slots on lists of covered drugs.

Editor’s note: This story and chart have been corrected to show there was roughly $50 billion (not $58 billion) in U.S. net sales. We had previously included international sales for Biktarvy, Enbrel, Januvia, Remicade and Stelara.