Investors looking for stocks that can put up big gains know that pharmaceutical sales can make it happen. Two out of three of the world's top-selling drugs weren't even available in 2020.
Last year, in the U.S. alone, prescription drug sales reached $577 billion, and that was 7.7% more than a year earlier. A substantial majority of new drug launches underperform their prelaunch expectations -- but every once in a while, blockbusters blow past even the loftiest predictions.
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These five drugs rose to the top in terms of global sales last year. Let's check in on their progress to see if they can stay there.
1. Comirnaty: $59.1 billion
If you don't recognize its official brand name, don't worry: Most of us still call it the Pfizer (PFE 1.19%) vaccine. Comirnaty was developed by a pre-commercial biotechnology company headquartered in Germany called BioNTech (BNTX 2.14%). Unprecedented demand drove sales of the COVID-19 vaccine up to an amazing $59.1 billion in 2021.
As you may already suspect, in 2022 Comirnaty is unlikely to get anywhere near the high-water mark it set last year. First-quarter sales came in at $13.2 billion, and the company expects further deceleration from there.
In May, Pfizer told investors it expected around $32 billion in Comirnaty sales for the entire year. Recent authorization from the U.S. Food and Drug Administration (FDA) of a booster shot for children aged 5 to 11 could keep sales of Comirnaty from sinking too far.
2. Humira: $20.7 billion
Humira, an anti-inflammatory drug from AbbVie (ABBV -0.03%) had been in the top spot for years. First approved to treat rheumatoid arthritis in 2002, this top-selling biologic crossed the $20 billion line for the first time in 2021. But Comirnaty's meteoric rise still pushed it down to the No. 2 position on the bestseller list.
Humira began getting biosimilar competition throughout Europe in late 2018. Now, 84% of worldwide Humira revenue comes from the U.S. market. AbbVie hasn't provided forward guidance for Humira sales in 2022, but we can probably expect one more year of price increases in the U.S. market. In 2023, though, Humira sales could finally start falling in the U.S.
Next year, Americans will finally be able to order multiple biosimilar versions of Humira. In July 2023, Boehringer Ingelheim will launch one called Cytelzo, and its effects on Humira sales could be swift and severe. The FDA has approved this as an "interchangeable" biosimilar; that allows your healthcare benefits manager to instruct your pharmacist to give you Cytelzo even if your physician ordered Humira. Biosimilars that aren't considered interchangeable have had a limited impact in the U.S., partly because physicians must prescribe them by name.
3. Spikevax: $17.7 billion
The second-best COVID vaccine by sales was the third-best-selling drug of 2021. Spikevax also happens to be Moderna's (MRNA 0.66%) only approved product.
Sales of Spikevax hit a whopping $17.7 billion last year. This pales in comparison to Comirnaty, but it's nothing to sneeze at. It took Humira over a decade to pass $17 billion in annual sales, while Moderna's first vaccine passed this mark during its rookie season.
Unlike Pfizer and BioNTech, Moderna expects sales of its vaccine to rise in 2022. In the first quarter, Spikevax reached an annualized run rate of $24.4 billion. The company also had advance purchase agreements for 2022 totaling $21 billion when it reported first-quarter earnings in May.
4. Keytruda: $17.2 billion
Keytruda is a cancer immunotherapy from Merck (MRK 0.53%). Instead of attacking cancer directly, it keeps tumor cells from inhibiting the immune system cells which are trying to attack them.
There are several other drugs that work along the same lines as Keytruda, including Opdivo from Bristol Myers Squibb (BMY 2.45%). None come close to Keytruda in terms of sales, though. Merck's drug racked up $17.2 billion in sales last year, making it the world's top cancer drug by a wide margin.
We can expect to see Merck at the top of this list again next year. First-quarter sales of Keytruda bounded 23% higher year over year to an annualized $19.6 billion. The recent approval of Keytruda in the EU, as a long-term preventative treatment following breast cancer surgery, will help it continue rising at a breakneck pace.
5. Eliquis: $16.7 billion
Eliquis is an oral blood thinner marketed in partnership by Pfizer and Bristol Myers Squibb. Blood clots form for many reasons, and they can be extremely dangerous when they break free and jam up the blood vessels that your heart, lungs, and brain rely on.
The old standard treatments are effective, but clinical trial evidence says Eliquis does a measurably better job. This is why worldwide sales of Eliquis bounded 20% higher in 2021, to reach $10.7 billion for Bristol Myers Squibb and $6 billion for Pfizer.
In 2020, Bristol Myers Squibb and Pfizer were able to extend Eliquis' key "composition of matter" patent out to 2026. More than likely, though, patents regarding the drug's formulation will stave off generic competition in the U.S. until 2031.
