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Big pharma stands to make hundreds of billions of dollars from a handful of medical conditions.

• No. 7: Viral hepatitis - $45 billion and $55 billion will be spent globally on drugs that treat viral hepatitis by 2022...around 257 million have chronic hepatitis B virus infection and 71 million people have chronic hepatitis C virus infection.
• No. 6: Respiratory diseases - treating respiratory diseases are expected to generate between $53 billion and $56 billion in sales by 2020. The most common respiratory diseases include asthma, allergies, and chronic obstructive pulmonary disease.
• No. 5: Autoimmune diseases - Autoimmune disease medications could make big pharma companies between $55 billion and $65 billion by 2020
• No. 4: Cardiovascular diseases - cardiovascular disease drugs will rack up sales between $73 billion and $76 billion by 2020...Cardiovascular drugs include treatments for hypertension, heart disease, and cholesterol.
• No. 3: Pain - Pain medications are projected to be the third-biggest moneymaker by 2020, with sales of $82 billion to $85 billion...drugs includes treatments for musculoskeletal pain, arthritis, anesthesia, analgesics (both narcotic and non-narcotic), and migraine.
• No. 2: Diabetes - diabetes drugs are expected to be near the top in spending, with projected global sales between $107 billion and $113 billion by 2020
• No. 1: Cancer - The top medical condition that will likely line big pharma's pockets by 2020 is cancer…sales of cancer drugs will be between $100 billion and $120 billion

Prescription drug spending has skyrocketed over the past few years, with many Americans struggling to access proper treatment. Lawmakers have attempted to address this issue, but it is likely that the trend of escalating drug spending will continue as costly specialty drugs dominate the market...All of the drugs that had the highest sales in 2016 are for specialty conditions, including autoimmune disorders and hepatitis C virus; however, the emergence of biosimilars may threaten their revenue into the future...

• 5. Infliximab (Remicade) - Johnson & Johnson and Merck report a 10.6% decrease in revenue from 2015, with infliximab generating nearly $7.83 billion in 2016...
• 4. Rituximab (Rituxan) - Partners Roche and Biogen reported total revenue of $8.58 billion for rituximab in 2016, which is a 2.7% increase from 2015. The drug is approved to treat non-Hodgkin’s lymphoma, chronic lymphocytic leukemia, rheumatoid arthritis, and granulomatosis with polyangiitis...
• 3. Etanercept (Enbrel) - This autoimmune disease drug treats rheumatoid arthritis, plaque psoriasis, and psoriatic arthritis. Amgen and Pfizer reported $8.87 billion in total sales for etanercept in 2016.
• 2. Ledipasvir/sofosbuvir (Harvoni) - When this drug hit the shelves, many patients with HCV and healthcare providers experienced sticker shock. The high cost of the curative drug and the prevalence of HCV have driven the $9.08 billion sales for the drug, according to the article.
• 1. Adalimumab (Humira) - In 2016, adalimumab grossed $16.08 billion in sales, which is a 14.7% increase in revenue for AbbVie, according to the article. The drug is approved to treat several autoimmune conditions, including rheumatoid arthritis, ulcerative colitis, and psoriasis.

Drug and device makers collectively made nearly $8.2 billion in payments to physicians and teaching hospitals in the U.S. last year, according to data made public by the Centers for Medicare and Medicaid Services last week...Payments for research made up more than half of the total, which also includes money given to doctors and hospitals for expenses like travel, gifts, speaking fees and meals. The $8.2 billion recorded last year was a notch higher than 2015's total and $320 million more than 2014's figure...Among the ranks of big pharma...Roche spent the most — a princely $586 million in payments. Novartis and Pfizer were close behind with more than $475 million each, although both made more research-related payments than Roche did...The data gives a snapshot of the enormous sums of money paid by the drug and device industries to doctors and hospitals. Most of the money goes towards research, payments for things like enrolling patients into new clinical studies or study implementation. Research payments can also include direct compensation to doctors…CMS began tracking payments in 2013 as part of changes to federal law through the Affordable Care Act, with 2016 marking the third full year of the program...

If you have been a part of the biopharmaceutical industry, you’ve heard these criticisms hundreds of times:

1. The industry hides negative data.
2. Clinical studies paid for by pharma companies usually yield positive results.
3. Doctors paid by pharma companies are beholden to them and will skew data in the company’s favor.
4. Companies prefer "me-too" drug programs because they lack innovation.

Critics commonly use these arguments as they promote damning views of an industry that is supposed to be doing important and valued drug R&D... two recent publications in the New England Journal of Medicine show the fallacy of these claims...Despite the exciting early clinical results, Pfizer announced on November 1, 2016 that it was ending its bococizumab program... This was a devastating result...and undoubtedly cost close to a billion dollars. Unfortunately, it is not uncommon for a large clinical trial to fail...two extensive publications appeared in the NEJM comprehensively explaining the bococizumab study designs and results. So much for hiding negative data...Publishing negative studies like this was not all that common in the past, as many publications only focused on breakthrough research. As can be seen in this example, a lot can be learned from negative studies.

Quest Analysis of 3.4 million tests shows evidence of dangerous drug combinations...A majority of test results from patients taking prescription medications show signs of drug misuse—including potentially dangerous drug combinations...The Quest Diagnostics Health Trends study is based on analysis of the company's de-identified laboratory data, believed to be one of the largest nationally representative datasets of objective laboratory information of patients prescribed opioids and other commonly abused medications. Physicians order laboratory services to aid their ability to monitor patients for signs of prescription or illicit drug misuse or abuse...(The report, "Prescription Drug Misuse in America: Diagnostic Insights in the Growing Drug Epidemic")

• evidence of misuse has declined in recent years, 52% of test results showed evidence of potential misuse in 2016, suggesting a majority of patients took their prescribed drugs in ways that were inconsistent with their physician's instruction...
• disturbing patterns of concurrent drug use. Among more than 33,000 specimens tested for opioids, benzodiazepines, and alcohol in 2016, more than 20% were positive for both opioids and benzodiazepines, more than 10% were positive for both opioids and alcohol, and 3% were positive for all three...
• 19% of specimens positive for heroin in 2016 were also positive for nonprescribed fentanyl...
• drug misuse rates were high among most age groups and both genders. However, adolescents (10 to 17 years of age) showed a striking improvement, with the rate dropping from 70% to 29% between 2011 and 2016...
• Misuse rates were higher for men and women of reproductive age (58%) than in the general study population (52%)

CVS Health...put out its standard control formulary for 2018, days after competitor Express Scripts announced its own drug coverage list for next year...Last year, CVS made biosimilars preferable over their reference product on its formulary, while this year the PBM expects to expand value-based deals to add further benefit for its customers...last year...it opted to include the highly touted, but still very new class of biosimilar products over longer-used reference products...This year, CVS Health looks set to change the game once again with an outcomes-based management program that will specifically target drugs for breast cancer, non-small cell lung cancer, obesity and chronic obstructive pulmonary disease...In each of these cases, manufacturers will have to cover costs over a pre-specified threshold if patients don't reach certain outcomes...Outcomes-based strategies have long been talked about as a means to control drug pricing. But there have only been a handful of such agreements put into practice and usually with specific drugmakers for specific products...CVS Health will remove 17 drugs from the 2018 formulary list across 10 drug classes...

Two of the world’s top drug companies and a local pharma are in the hot seat in South Africa as competition officials launched a probe into "excessive pricing" on lifesaving cancer meds...South Africa’s competition commissioner Tembinkosi Bonakele announced...that his agency would probe pricing on cancer drugs from Roche, Pfizer and Aspen Pharmacare, according to the Competition Commission of South Africa’s official Twitter account...Roche is under investigation for breast cancer drug pricing, according to the commission, while Pfizer’s lung cancer drug pricing is included in the inquiry...Aspen said the probe is for "suspected abuse of dominance" in the cancer drug market...In announcing the probe, the South African commissioner pointed to patents as a driver of high drug prices…Under South African law, the Department of Health "establishes a universal fixed price" for pharma products...Commissioner Bonakele said the probe will "look at patents and how they get abused,"..."A perpetual monopoly aided by patents is unlawful,"…

The Food and Drug Administration...accused the drugmaker Pfizer of failing to properly investigate reports of malfunctioning EpiPens, including incidents when patients died or became severely ill after the device failed to work. Pfizer manufactures the EpiPen, which treats allergic reactions, for the drugmaker Mylan...In a warning letter...the agency said Meridian Medical Technologies, which is a unit of Pfizer, did not adequately look into problems with a crucial component of the EpiPen — the mechanism on the device that insures that it fires and delivers the proper dose of epinephrine, which stops an allergic reaction... the company failed to conduct a proper investigation even though it received numerous complaints about problems with activating the device. "Our own data show that you received hundreds of complaints that your EpiPen products failed to operate during life-threatening emergencies, including some situations in which patients subsequently died...

A $1.2 million allocation from the attorney general’s office to the University of Nevada, Reno Medical School should soon begin producing more pediatric doctors for the state...The funding from a settlement between the attorney general’s office and the drug manufacturer Pfizer is creating an OB/GYN department at the medical school...The new department will provide education for medical students in obstetrics and gynecology, as well as training for primary care residents and research...Having a department dedicated to research and the education of students and physicians in their understanding of women’s health ensures we are delivering the best care for patients...

At the American Diabetes Association Scientific Sessions in San Diego, drugmakers have been rolling out studies that illustrate how competitive every class in the diabetes field has become. For instance, partners Merck & Co. and Pfizer, Eli Lilly and Boehringer Ingelheim, and solo flyer AstraZeneca all unveiled SGLT2 drug studies, with more to come...we’ve gathered the top stories here…

• Johnson & Johnson's Invokana outcomes study makes it the second heart-helping SGLT2 on the block.
• Novo Nordisk and its long-acting insulin Tresiba have a tough task: going up against Sanofi's blockbuster insulin Lantus.
• Lilly and Boehringer have reason to believe their SGLT2 inhibitor, Jardiance, may improve outcomes for chronic kidney disease patients—so they’re putting the med to the test.
• Sanofi’s Toujeo has plenty of competition in the basal insulin market, but new real-world data shows it may outdo its peers at cutting the risk of hypoglycemia for older patients.
• Sanofi and Regeneron still have months to wait for final data from a key cardiovascular outcomes study of their PCSK9 therapy Praluent, which is in a heated battle with Amgen’s Repatha.
• Novo Nordisk is in a tough market race against Sanofi with combo product Xultophy, which hit the market after the French drugmaker’s similar Soliqua.
• Boehringer and Lilly still don’t know what’s responsible for the dramatic reduction in cardiovascular death risk that Jardiance (empagliflozin) posted in the Empa-Reg outcomes trial.
• Merck and Pfizer last year rolled out positive results from two phase 3 studies they hoped would buoy SGLT2 candidate ertugliflozin once it got to market.