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Data: IQVIA, company financial documents; Note: Data has been corrected for Biktarvy, Enbrel, Januvia, Remicade and Stelara (more info below). Chart: Andrew Witherspoon/Axios

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.

Go deeper

Voters approve marijuana legalization in 4 states

An election worker sorts submitted ballots. Photo: Nathan Howard/Getty Images

Voters approved legalizing recreational marijuana use in several states, and Oregon decriminalized the possession of street drugs.

The big picture: New Jersey, Arizona, Montana and South Dakota will join the 11 states and D.C. that have already legalized cannabis for adult recreational use.

Updated 8 mins ago - World

Ukraine crisis: Blinken to visit Kyiv, then meet Russian foreign minister

Photo: Russian Foreign Ministry/Handout/Anadolu Agency via Getty Images

Secretary of State Antony Blinken will meet with Russian Foreign Minister Sergey Lavrov in Geneva on Friday, following a trip to Kyiv to reinforce U.S. support for Ukraine in the face of a possible Russian invasion, according to a senior U.S. official.

Why it matters: The meeting with Lavrov suggests a diplomatic resolution to the crisis may still be on the table, despite the collapse of security talks between Russia and the West last week.

Updated 43 mins ago - Politics & Policy

Omicron dashboard

Illustration: Brendan Lynch/Axios

  1. Health: Transplants rebound from COVID lull — CDC director says COVID-19 messaging should have been clearer — Concerns grow over CDC's isolation guidelines.
  2. Vaccines: Kids' COVID vaccination rates are particularly low in rural America — America's vaccination drive runs out of gas.
  3. Politics: Joint Chiefs chair Gen. Mark Milley tests positive for COVID-19 — Vivek Murthy calls SCOTUS vaccine mandate block "a setback for public health."
  4. States: America struggles to keep schools open — Youngkin ends mandates for masks in schools and COVID vaccinations for state workers.
  5. World: Greece imposes vaccine mandate for people 60 and older — French parliament passes COVID vaccine passport legislation.
  6. Variant tracker