Pharmaceuticals are big business, and some drugs dominate the industry with billions in revenue each year. These medicines not only improve health outcomes but also shape the strategies of pharmaceutical companies worldwide. Below, we break down the top-selling drugs, their market performance, and the key lessons companies and investors can take from their success.
1. Humira (adalimumab) – $21.2 billion in global sales (2022)
Humira, an anti-inflammatory biologic, has held the title of the best-selling drug for years. Used to treat conditions like rheumatoid arthritis, Crohn’s disease, and psoriasis, its continued dominance highlights the power of biologic treatments.
Key Takeaway: Even though biosimilars are entering the market, Humira’s sales remain strong due to brand loyalty, strong marketing, and physician trust. If you’re investing in pharmaceuticals, keep an eye on how well companies defend their patents and navigate biosimilar competition.
2. Keytruda (pembrolizumab) – $20.9 billion in global sales (2022)
Keytruda is an immunotherapy drug used in various cancers, including lung cancer. It works by blocking PD-1, helping the immune system fight cancer cells more effectively.
Key Takeaway: Immunotherapy is changing the cancer treatment landscape. Pharmaceutical companies that innovate in this space—especially with combination therapies—can capture a growing market share.
3. Comirnaty (Pfizer-BioNTech COVID-19 vaccine) – $37.8 billion in global sales (2022)
Pfizer’s COVID-19 vaccine became the highest-selling drug of 2022. It played a critical role in the pandemic response, benefiting from rapid development, global demand, and government contracts.
Key Takeaway: Speed to market and strategic partnerships can drive incredible revenue. Companies that focus on vaccine research and preparedness for future pandemics will likely see strong returns.
4. Spikevax (Moderna COVID-19 vaccine) – $18.4 billion in global sales (2022)
Moderna’s mRNA vaccine also generated massive revenue, showing the power of mRNA technology. The success of Spikevax has positioned Moderna as a major player in the biotech industry.
Key Takeaway: mRNA technology has long-term potential beyond COVID-19. Companies exploring mRNA-based treatments for cancer, flu, and other diseases could be the next big winners.
5. Eliquis (apixaban) – $11.8 billion in global sales (2022)
Eliquis is a widely used blood thinner that prevents strokes in patients with atrial fibrillation. It has outperformed competitors like Xarelto due to better safety and effectiveness data.
Key Takeaway: Investing in drugs with clear clinical advantages over competitors ensures long-term dominance. Companies that prioritize head-to-head trials to demonstrate superiority can command the market.
6. Opdivo (nivolumab) – $8.2 billion in global sales (2022)
Opdivo is another immunotherapy that targets PD-1. It has shown effectiveness in multiple cancers, including melanoma and lung cancer.
Key Takeaway: Expanding indications is key to long-term revenue. The more a drug can be approved for additional conditions, the longer it can stay profitable.
7. Jardiance (empagliflozin) – $7.0 billion in global sales (2022)
Jardiance is a diabetes drug that also reduces heart failure risk. This dual benefit has helped it grow significantly in sales.
Key Takeaway: Multi-use medications have a strategic advantage. Pharmaceutical companies that can demonstrate additional benefits beyond the primary use can increase sales potential.
8. Stelara (ustekinumab) – $9.7 billion in global sales (2022)
Stelara is an immunosuppressive drug used for psoriasis and Crohn’s disease. It has remained competitive despite newer biologics entering the market.
Key Takeaway: Strong clinical data and long-term safety records keep biologics relevant even as newer competitors emerge.
9. Revlimid (lenalidomide) – $9.5 billion in global sales (2022)
Revlimid, a treatment for multiple myeloma, has been a blockbuster for years. However, generic versions are starting to eat into its revenue.
Key Takeaway: The patent cliff is a challenge for every major drug. Companies need a strategy to extend patent protection, such as developing new formulations or combination therapies.
10. Ozempic (semaglutide) – $8.5 billion in global sales (2022)
Ozempic, a diabetes drug, has exploded in popularity thanks to its weight loss benefits. Demand has exceeded supply in many markets.
Key Takeaway: Drugs with secondary lifestyle benefits, such as weight loss, can drive unexpected surges in demand. Companies should explore new applications for existing medications.
11. Dupixent (dupilumab) – $8.7 billion in global sales (2022)
Dupixent treats eczema, asthma, and sinus conditions. Its broad range of uses has made it a top-selling biologic.
Key Takeaway: Expanding a drug’s indications can significantly increase revenue. Regulatory approval in multiple conditions is a proven growth strategy.
12. Trulicity (dulaglutide) – $7.4 billion in global sales (2022)
Eli Lilly’s Trulicity (dulaglutide) has become a dominant force in the diabetes market, generating $7.4 billion in global sales in 2022.
As a GLP-1 receptor agonist, it has not only captured a significant share of the type 2 diabetes market but is also riding the wave of increased demand for weight management treatments.
But as competition heats up and market dynamics shift, businesses looking to capitalize on this space must think strategically.
Whether you’re an investor, biotech startup, or pharmaceutical company, understanding Trulicity’s success, challenges, and future trajectory is key to staying ahead.
13. Imbruvica (ibrutinib) – $5.3 billion in global sales (2022)
Imbruvica (ibrutinib) has been a cornerstone therapy in hematologic cancers since its launch. Co-developed by AbbVie and Johnson & Johnson, it has been a market leader in treating chronic lymphocytic leukemia (CLL), mantle cell lymphoma (MCL), and Waldenström’s macroglobulinemia (WM).
Generating $5.3 billion in global sales in 2022, Imbruvica has enjoyed a long reign as the gold standard BTK inhibitor. But rising competition, pricing pressures, and an approaching patent cliff are reshaping its future.
For biotech firms, pharma companies, and investors, understanding these dynamics is crucial to navigating opportunities and threats in the hematology market.
14. Ibrance (palbociclib) – $5.1 billion in global sales (2022)
Ibrance (palbociclib) has been a game-changer in oncology, particularly for the treatment of HR-positive, HER2-negative breast cancer.
With $5.1 billion in global revenue in 2022, Pfizer’s blockbuster drug continues to dominate the CDK4/6 inhibitor space, but businesses need to look beyond just the numbers.
The pharmaceutical landscape is shifting rapidly—competitor drugs, evolving treatment standards, and the patent cliff are all key factors that will shape Ibrance’s future market performance.
Here’s a strategic breakdown of where Ibrance stands today and what businesses—whether investors, biotech firms, or pharmaceutical companies—can learn from its success.
15. Xarelto (rivaroxaban) – $6.4 billion in global sales (2022)
Xarelto (rivaroxaban), developed by Bayer and Johnson & Johnson, has been a top-selling oral anticoagulant (blood thinner) for years. Generating $6.4 billion in global sales in 2022, it remains a leader in preventing stroke, deep vein thrombosis (DVT), and pulmonary embolism (PE).
However, the blood thinner market is evolving, with new competitors, upcoming patent expirations, and pricing pressures reshaping the industry.
For pharmaceutical companies, biotech startups, and investors, understanding these changes is critical to navigating future opportunities in the anticoagulant market.
16. Enbrel (etanercept) – $3.7 billion in global sales (2022)
Enbrel (etanercept), a TNF inhibitor developed by Amgen and Pfizer, has been a cornerstone treatment for autoimmune diseases such as rheumatoid arthritis (RA), psoriatic arthritis, and plaque psoriasis.
Generating $3.7 billion in global sales in 2022, Enbrel has enjoyed strong market penetration for over two decades.
However, as biosimilars flood the market, pricing pressures increase, and new biologics enter the space, Enbrel’s long-standing dominance is being put to the test.
For pharmaceutical companies, biosimilar manufacturers, and biotech investors, understanding Enbrel’s evolving landscape is critical to identifying new opportunities and emerging risks in the autoimmune drug market.
17. Ocrevus (ocrelizumab) – $6.5 billion in global sales (2022)
Ocrevus (ocrelizumab), developed by Roche, has been a game-changing therapy for multiple sclerosis (MS) since its approval in 2017.
Generating $6.5 billion in global sales in 2022, it remains one of the top-selling MS treatments, with a strong presence in both relapsing-remitting MS (RRMS) and primary progressive MS (PPMS).
However, the MS treatment landscape is evolving, with new competitors, pricing pressures, and patent expirations shaping Ocrevus’s future.
For pharmaceutical companies, biotech firms, and investors, understanding these shifts is critical to spotting opportunities and mitigating risks in the MS market.
18. Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide) – $10.4 billion in global sales (2022)
Biktarvy, developed by Gilead Sciences, has emerged as the gold standard in HIV treatment, generating $10.4 billion in global sales in 2022.
As a single-tablet regimen (STR) for HIV-1, Biktarvy offers a highly effective, well-tolerated, and convenient once-daily treatment, making it the most prescribed HIV therapy worldwide.
However, as competition intensifies, pricing pressures mount, and generic threats loom, Biktarvy’s future dominance is not guaranteed.
For pharmaceutical companies, biotech firms, and investors, understanding these market forces is critical to identifying new opportunities and potential risks in the HIV treatment landscape.
19. Tecentriq (atezolizumab) – $3.4 billion in global sales (2022)
Tecentriq (atezolizumab), developed by Roche/Genentech, has established itself as a leading immune checkpoint inhibitor, generating $3.4 billion in global sales in 2022.
As a PD-L1 inhibitor, Tecentriq has been a valuable treatment option for non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC), triple-negative breast cancer (TNBC), and bladder cancer.
However, the immuno-oncology (IO) space is evolving rapidly, with rising competition, shifting treatment paradigms, and market access challenges shaping the future of Tecentriq.
For pharmaceutical executives, biotech innovators, and investors, understanding these changes is key to navigating opportunities and risks in the oncology market.
20. Shingrix (herpes zoster vaccine) – $3.7 billion in global sales (2022)
Shingrix, developed by GlaxoSmithKline (GSK), has revolutionized the herpes zoster (shingles) vaccine market, generating $3.7 billion in global sales in 2022.
As the gold-standard shingles vaccine, Shingrix has set new benchmarks in efficacy, durability, and global adoption, far surpassing its predecessor Zostavax (Merck’s live-attenuated vaccine).
However, rising demand, supply constraints, competition from next-gen vaccines, and emerging global markets will define Shingrix’s next phase of growth.
For pharmaceutical companies, biotech firms, and investors, understanding these dynamics is critical to identifying opportunities in the rapidly expanding vaccine market.
21. Evusheld (tixagevimab/cilgavimab, COVID-19 treatment) – $2.5 billion in global sales (2022)
Evusheld, developed by AstraZeneca, quickly became a critical COVID-19 prevention and treatment option for immunocompromised individuals, generating $2.5 billion in global sales in 2022.
Unlike traditional vaccines or antivirals, Evusheld is a long-acting monoclonal antibody (LAAB) therapy designed to prevent COVID-19 infection in high-risk populations, including cancer patients, organ transplant recipients, and those with weakened immune systems.
However, emerging variants, evolving treatment guidelines, and declining pandemic-driven demand have reshaped Evusheld’s role in the COVID-19 treatment landscape.
For pharmaceutical companies, biotech innovators, and investors, understanding these shifts is crucial to identifying future opportunities in monoclonal antibody therapies and pandemic preparedness strategies.
22. Paxlovid (nirmatrelvir/ritonavir, COVID-19 treatment) – $18.9 billion in global sales (2022)
Paxlovid, developed by Pfizer, became the top-selling COVID-19 treatment in 2022, generating an astonishing $18.9 billion in global sales.
As an oral antiviral therapy, Paxlovid offered a critical tool for reducing hospitalizations and deaths in high-risk COVID-19 patients, particularly during the Omicron surge.
However, as COVID-19 transitions from a global emergency to an endemic virus, the demand for Paxlovid is declining, raising critical questions about its long-term commercial viability.
For pharmaceutical companies, biotech innovators, and investors, understanding Paxlovid’s trajectory and the evolving antiviral market is essential for identifying future opportunities in infectious disease therapeutics.
Paxlovid’s success wasn’t just about timing—it was about efficacy, accessibility, and a strategic government-driven rollout.
Key Factors Behind Paxlovid’s Blockbuster Sales
✅ Highly Effective in Preventing Severe COVID-19 – Clinical trials showed Paxlovid reduced hospitalizations and deaths by nearly 90% in high-risk individuals when taken within five days of symptom onset.
✅ Convenience of Oral Administration – Unlike monoclonal antibodies (such as Evusheld) or IV antivirals (Veklury/remdesivir), Paxlovid could be taken at home, making it far easier to distribute and administer.
✅ Massive Government Procurement Deals – Governments around the world pre-purchased millions of doses, driving record-breaking sales in 2022.
✅ Emergency Use Authorization (EUA) Led to Rapid Adoption – Regulatory agencies fast-tracked Paxlovid’s approval, ensuring quick market penetration during pandemic peaks.
✅ Preferred Treatment Over Alternatives – Paxlovid outperformed competitors like Lagevrio (molnupiravir, Merck), which had lower efficacy, and monoclonal antibodies, which lost effectiveness as the virus mutated.
✅ Broad Insurance Coverage and Free Access – Many governments subsidized Paxlovid entirely, ensuring widespread prescriptions with little to no cost for patients.
✅ High Trust from Health Organizations – Endorsements from WHO, CDC, and FDA cemented Paxlovid as the gold standard for COVID-19 outpatient treatment.
✅ Strong Use in Immunocompromised and Elderly Populations – Paxlovid became the go-to treatment for those at highest risk of severe COVID-19, ensuring steady demand even as general case numbers declined.
Pfizer is actively exploring ways to keep Paxlovid relevant, even as COVID-19 demand declines.
Pfizer’s Strategy to Sustain Paxlovid Sales
🔹 Targeting Immunocompromised & Elderly Populations – Pfizer is working to secure long-term recommendations for Paxlovid use in cancer patients, transplant recipients, and the elderly, who remain vulnerable.
🔹 Developing a Next-Gen Antiviral for Respiratory Viruses – Pfizer is investing in new research to develop a broad-spectrum antiviral that could work against COVID-19, influenza, and RSV, making it a multi-use therapy.
🔹 Pursuing Full FDA Approval – While Paxlovid was launched under Emergency Use Authorization (EUA), Pfizer is working toward full regulatory approval, which could help expand its usage in routine medical care.
🔹 Addressing Paxlovid Rebound – New studies are exploring how to refine dosing strategies to reduce the risk of viral rebound, making the treatment more appealing to doctors and patients.
🔹 Expanding into Emerging Markets – While Western nations have stockpiles, many developing countries still lack access. Pfizer is working on global distribution deals to expand Paxlovid’s reach.
✅ Business Takeaway:
For pharma executives, the post-pandemic antiviral market will shift toward broader-use therapies. Single-virus antivirals are risky long-term bets—companies must invest in adaptable treatments that can address multiple viral threats.
23. Tagrisso (osimertinib) – $5.9 billion in global sales (2022)
Tagrisso is a leading lung cancer treatment that targets specific genetic mutations. Its effectiveness in extending survival has made it the standard of care in many cases.
Key Takeaway: Precision medicine is the future of oncology. Drugs that target specific mutations in cancer patients will continue to dominate, making genetic testing and personalized treatment strategies more critical than ever.
24. Skyrizi (risankizumab-rzaa) – $5.2 billion in global sales (2022)
Skyrizi (risankizumab-rzaa), developed by AbbVie and Boehringer Ingelheim, has emerged as a major player in the immunology market, generating $5.2 billion in global sales in 2022.
As a selective IL-23 inhibitor, Skyrizi has rapidly gained traction for the treatment of moderate-to-severe plaque psoriasis (PsO), psoriatic arthritis (PsA), and Crohn’s disease (CD).
With expanding indications, strong clinical data, and a growing patient base, Skyrizi is on track to become one of the top-selling immunology drugs of the decade.
However, increasing competition, pricing pressures, and shifting treatment preferences present both challenges and opportunities for pharmaceutical companies, biotech firms, and investors looking to capitalize on the evolving immunology landscape.
25. Veklury (remdesivir, COVID-19 treatment) – $3.9 billion in global sales (2022)
Veklury (remdesivir), developed by Gilead Sciences, became one of the first FDA-approved treatments for COVID-19, generating $3.9 billion in global sales in 2022.
As a broad-spectrum antiviral originally developed for Ebola, remdesivir found its place as a go-to treatment for hospitalized COVID-19 patients, especially in the early waves of the pandemic.
However, with declining COVID-19 hospitalizations, increasing competition, and evolving treatment guidelines, Veklury faces an uncertain future.
For pharmaceutical companies, biotech firms, and investors, understanding how Gilead navigates the post-pandemic landscape is critical in forecasting the future of antiviral and pandemic-related drug markets.
26. Cosentyx (secukinumab) – $4.9 billion in global sales (2022)
Cosentyx (secukinumab), developed by Novartis, has been a dominant force in the IL-17 inhibitor market, generating $4.9 billion in global sales in 2022.
As a leading biologic for autoimmune diseases, Cosentyx is widely used for treating psoriasis, psoriatic arthritis (PsA), ankylosing spondylitis (AS), and non-radiographic axial spondyloarthritis (nr-axSpA).
Despite its strong performance, competition from newer biologics, biosimilars, and market access challenges are reshaping the future of Cosentyx.
For pharmaceutical companies, biotech innovators, and investors, understanding these shifts is essential to staying ahead in the high-growth immunology market.
27. Zolgensma (onasemnogene abeparvovec-xioi, gene therapy for SMA) – $1.4 billion in global sales (2022)
Zolgensma, developed by Novartis, is a groundbreaking gene therapy for spinal muscular atrophy (SMA) and one of the most expensive drugs ever brought to market, with a one-time treatment cost of over $2.1 million per patient.
Despite its high price, global sales reached $1.4 billion in 2022, solidifying its status as a pioneer in gene therapy and a critical treatment for SMA patients.
However, competition, reimbursement challenges, and the future of gene therapy pricing models are reshaping Zolgensma’s trajectory.
For pharmaceutical companies, biotech innovators, and investors, understanding these dynamics is crucial to navigating opportunities and challenges in the rapidly evolving gene therapy space.
28. Darzalex (daratumumab) – $8.0 billion in global sales (2022)
Darzalex, a multiple myeloma treatment, has transformed cancer care with its high efficacy.
Key Takeaway: Cancer drugs that significantly improve survival rates will always have strong demand. Pharmaceutical companies must invest in combination therapies to improve outcomes further.
29. Xgeva/Prolia (denosumab) – $5.4 billion in global sales (2022)
Xgeva and Prolia, both versions of denosumab, treat osteoporosis and bone-related conditions. Their steady sales reflect the growing need for bone health treatments as the global population ages.
Key Takeaway: The aging population will drive demand for osteoporosis and bone health drugs. Investing in musculoskeletal treatments is a smart long-term strategy.
30. Lexiscan (regadenoson, cardiac imaging agent) – $700 million in global sales (2022)
Lexiscan is a widely used stress agent for cardiac imaging. While it doesn’t generate as much revenue as other blockbuster drugs, it remains a critical diagnostic tool.
Key Takeaway: Diagnostic agents and imaging contrast drugs are often overlooked but provide steady revenue streams. Companies should explore this niche market for reliable growth.
wrapping it up
The pharmaceutical industry is a high-stakes, high-reward business where innovation, strategic positioning, and market demand determine success.
The top-selling drugs in 2022 have shown clear trends: biologics are dominating, immunotherapies are reshaping cancer treatment, and drugs with multiple indications are maximizing revenue potential.
