July 9, 2025 |
A billion here, a billion there...
Big Pharma Wins Again with Eliquis
July 9, 2025
What is Eliquis?
Eliquis (generic name: apixaban) is a prescription oral anticoagulant (blood thinner) used to prevent and treat blood clots. It is primarily prescribed for:
• Reducing the risk of stroke and blood clots in people with nonvalvular atrial fibrillation (AFib)
• Treating deep vein thrombosis (DVT) and pulmonary embolism (PE)
• Preventing DVT and PE from recurring
• Preventing blood clots after hip or knee replacement surgery
Eliquis works by directly inhibiting factor Xa, a crucial enzyme in the blood clotting process. By blocking this enzyme, Eliquis reduces the formation of harmful blood clots.
Production Cost
While the actual manufacturing cost is proprietary, independent analyses and Congressional reports have estimated that the cost to manufacture a typical brand-name tablet like Eliquis is often less than $1 per tablet—and in many cases, just a few cents. This is supported by the fact that international prices (where profit margins are lower and price controls exist) can be as low as $1 per pill. However, these figures do not account for research, development, regulatory, and distribution costs.
List Price
Various sources report the list price of one tablet at around $9. I have on one occasion of a lost refill been obliged to pay $10 per tablet for an emergency supply due to the intransigence of the intermedidary insurance carrier, accompanied by the crocodile tears of the pharmacist.
Medicare Cost
The actual amount Medicare pays to pharmacies is higher than the beneficiary’s copay, as Medicare plans cover the bulk of the cost through negotiated rates and rebates. In 2024, the mean pharmacy cost for Eliquis was about $550 per month (about $9.17 per tablet), with Medicare Part D plans receiving average rebates of 45% from the manufacturer. This results in the cost to Medicare being (est.) $9.17X0.55=$5.0435 per tablet. The impact of the supposed "negotiation" borders on the laughable.
Out of Pocket
As an individual Medicare participant I pay the drugstore on a quarterly basis approximately $870 per year for 730 tablets, or $1.19 each. Assuming the drugstore uses "keystone" pricing of 2:1, the cost to Medicare becomes 5.04=1.19/2, or $3.85. Further assuming that Medicare is efficient and has a record-keeping cost of only 10% (You there, stop that scoffing!) then the payment to the manufacturer is around $3.45 per tablet, a profit of $2.45 on their $1 production cost.
Aggregate Cost to Medicare
Another approach is to ask: How much did Medicare pay for Eliquis?
Perplexity replied:
Medicare Coverage of Eliquis Tablets: Most Recent Data
Key Findings
• In 2022, approximately 3.5 million Medicare Part D enrollees filled prescriptions for Eliquis (apixaban).
• The total spending by Medicare Part D on Eliquis in 2022 was about $15.2 billion.
• The average annual spending per enrollee taking Eliquis was $4,342.
Estimating the Number of Tablets Paid for by Medicare
Eliquis is most commonly prescribed as a twice-daily medication, with each prescription typically covering a 30-day supply (60 tablets per month per patient).
Calculation
• Number of enrollees taking Eliquis in 2022: 3,505,000
• Assuming a standard 30-day supply (60 tablets) per month, for 12 months:
• 60 tablets/month × 12 months = 720 tablets per year per patient
• Estimated total tablets paid for by Medicare in 2022:
• 3,505,000 patients × 720 tablets = 2,523,600,000 tablets
Note: This estimate assumes continuous, year-round use for each patient. Actual numbers may be slightly lower due to prescription gaps, shorter treatment durations, or dose adjustments.
(End of Perplexity reply.)
Multiplying the number of tablets (2.5 Bn) by the est. $2.45 Medicare price gives an estimated revenue to the manufacturer of $6,182,820,000.
So how much did it cost to develop Eliquis?
Again we asked Perplexity, which replied:
Manufacturer of Eliquis
• Eliquis (apixaban) is manufactured by Bristol Myers Squibb and Pfizer. These two pharmaceutical companies co-market and distribute the drug globally.
Estimated Cost of Developing Eliquis
• The exact cost of developing Eliquis has not been publicly disclosed by its manufacturers.
• However, industry-wide estimates for the development of a new prescription drug—including research, clinical trials, regulatory approval, and the cost of failed drug candidates—typically range from $879 million to over $2.6 billion (2018 USD).
• For a novel anticoagulant like Eliquis, which required extensive clinical trials, the development cost likely falls toward the higher end of this range, possibly around $1–2 billion.
(End of Perplexity reply.)
So if the development cost was the highest of those estimates ($2.6 Bn) and the annual Medicare payment is $6.2 Bn), then the manufacturers are making a ((6.2-2.6)/2.6=) a 138 percent return on investment year after year. This ignores the contribution of prior government subsidies and university research that may have helped the originators to create the drug.
Profitability of Eliquis
A summary of the annual profits and profit margins for Bristol Myers Squibb (BMS) and Pfizer (PFZ) for the years 2022, 2023, and 2024 appears below. Again the report was compiled by Perplexity.
In summary BMS's profit margins were 78, 76 and 71 percent. PFZ's margins were 31.3, 3.6 and (unreported). PFZ's bottom line declined due to its concentration on Covid-19-related remedies, demand for which fell in 2023-4.
Forgive me if I am skeptical about this being a fair rate of return relative to risk, especially since I know that the RETAIL price of Eliquis abroad in advanced countries with national healthcare systems hovers just above its $1 manufacturing cost due to subsidies that are a fraction of the US rates.
The current administration's attempt to place the blame for high cost on consumers and government actors and to divert it from those who most clearly benefit financially is merely another illustration of the collusion between the administration and the medical-pharmalogical complex that is the true recipient of ill-gotten gains.
Eliquis (generic name: apixaban) is a prescription oral anticoagulant (blood thinner) used to prevent and treat blood clots. It is primarily prescribed for:
• Reducing the risk of stroke and blood clots in people with nonvalvular atrial fibrillation (AFib)
• Treating deep vein thrombosis (DVT) and pulmonary embolism (PE)
• Preventing DVT and PE from recurring
• Preventing blood clots after hip or knee replacement surgery
Eliquis works by directly inhibiting factor Xa, a crucial enzyme in the blood clotting process. By blocking this enzyme, Eliquis reduces the formation of harmful blood clots.
Production Cost
While the actual manufacturing cost is proprietary, independent analyses and Congressional reports have estimated that the cost to manufacture a typical brand-name tablet like Eliquis is often less than $1 per tablet—and in many cases, just a few cents. This is supported by the fact that international prices (where profit margins are lower and price controls exist) can be as low as $1 per pill. However, these figures do not account for research, development, regulatory, and distribution costs.
List Price
Various sources report the list price of one tablet at around $9. I have on one occasion of a lost refill been obliged to pay $10 per tablet for an emergency supply due to the intransigence of the intermedidary insurance carrier, accompanied by the crocodile tears of the pharmacist.
Medicare Cost
The actual amount Medicare pays to pharmacies is higher than the beneficiary’s copay, as Medicare plans cover the bulk of the cost through negotiated rates and rebates. In 2024, the mean pharmacy cost for Eliquis was about $550 per month (about $9.17 per tablet), with Medicare Part D plans receiving average rebates of 45% from the manufacturer. This results in the cost to Medicare being (est.) $9.17X0.55=$5.0435 per tablet. The impact of the supposed "negotiation" borders on the laughable.
Out of Pocket
As an individual Medicare participant I pay the drugstore on a quarterly basis approximately $870 per year for 730 tablets, or $1.19 each. Assuming the drugstore uses "keystone" pricing of 2:1, the cost to Medicare becomes 5.04=1.19/2, or $3.85. Further assuming that Medicare is efficient and has a record-keeping cost of only 10% (You there, stop that scoffing!) then the payment to the manufacturer is around $3.45 per tablet, a profit of $2.45 on their $1 production cost.
Aggregate Cost to Medicare
Another approach is to ask: How much did Medicare pay for Eliquis?
Perplexity replied:
Medicare Coverage of Eliquis Tablets: Most Recent Data
Key Findings
• In 2022, approximately 3.5 million Medicare Part D enrollees filled prescriptions for Eliquis (apixaban).
• The total spending by Medicare Part D on Eliquis in 2022 was about $15.2 billion.
• The average annual spending per enrollee taking Eliquis was $4,342.
Estimating the Number of Tablets Paid for by Medicare
Eliquis is most commonly prescribed as a twice-daily medication, with each prescription typically covering a 30-day supply (60 tablets per month per patient).
Calculation
• Number of enrollees taking Eliquis in 2022: 3,505,000
• Assuming a standard 30-day supply (60 tablets) per month, for 12 months:
• 60 tablets/month × 12 months = 720 tablets per year per patient
• Estimated total tablets paid for by Medicare in 2022:
• 3,505,000 patients × 720 tablets = 2,523,600,000 tablets
Note: This estimate assumes continuous, year-round use for each patient. Actual numbers may be slightly lower due to prescription gaps, shorter treatment durations, or dose adjustments.
(End of Perplexity reply.)
Multiplying the number of tablets (2.5 Bn) by the est. $2.45 Medicare price gives an estimated revenue to the manufacturer of $6,182,820,000.
So how much did it cost to develop Eliquis?
Again we asked Perplexity, which replied:
Manufacturer of Eliquis
• Eliquis (apixaban) is manufactured by Bristol Myers Squibb and Pfizer. These two pharmaceutical companies co-market and distribute the drug globally.
Estimated Cost of Developing Eliquis
• The exact cost of developing Eliquis has not been publicly disclosed by its manufacturers.
• However, industry-wide estimates for the development of a new prescription drug—including research, clinical trials, regulatory approval, and the cost of failed drug candidates—typically range from $879 million to over $2.6 billion (2018 USD).
• For a novel anticoagulant like Eliquis, which required extensive clinical trials, the development cost likely falls toward the higher end of this range, possibly around $1–2 billion.
(End of Perplexity reply.)
So if the development cost was the highest of those estimates ($2.6 Bn) and the annual Medicare payment is $6.2 Bn), then the manufacturers are making a ((6.2-2.6)/2.6=) a 138 percent return on investment year after year. This ignores the contribution of prior government subsidies and university research that may have helped the originators to create the drug.
Profitability of Eliquis
A summary of the annual profits and profit margins for Bristol Myers Squibb (BMS) and Pfizer (PFZ) for the years 2022, 2023, and 2024 appears below. Again the report was compiled by Perplexity.
In summary BMS's profit margins were 78, 76 and 71 percent. PFZ's margins were 31.3, 3.6 and (unreported). PFZ's bottom line declined due to its concentration on Covid-19-related remedies, demand for which fell in 2023-4.
Forgive me if I am skeptical about this being a fair rate of return relative to risk, especially since I know that the RETAIL price of Eliquis abroad in advanced countries with national healthcare systems hovers just above its $1 manufacturing cost due to subsidies that are a fraction of the US rates.
The current administration's attempt to place the blame for high cost on consumers and government actors and to divert it from those who most clearly benefit financially is merely another illustration of the collusion between the administration and the medical-pharmalogical complex that is the true recipient of ill-gotten gains.
## Annual Profits and Profit Margins (2022–2024)
Below is a summary of the annual profits and profit margins for **Bristol Myers Squibb** and **Pfizer** for the years 2022, 2023, and 2024.
(Apologies for the unformatted tables in this HTML view, based on data from Perplexity.ai.)
### Bristol Myers Squibb
| Year | Revenue (USD Millions) | Gross Profit (USD Millions) | Gross Profit Margin (%) |
|------|------------------------|-----------------------------|------------------------|
| 2022 | 46,159 | 36,022 | 78.0 |
| 2023 | 45,006 | 34,313 | 76.2 |
| 2024 | 48,300 | 34,332 | 71.1 |
- **Note:** Gross profit margin is calculated as (Gross Profit ÷ Revenue) × 100[1][2].
### Pfizer
| Year | Revenue (USD Millions) | Net Income (USD Millions) | Net Profit Margin (%) |
|------|------------------------|---------------------------|----------------------|
| 2022 | 100,330 | 31,372 | 31.3 |
| 2023 | 58,500 | 2,110 | 3.6 |
| 2024 | 63,600 | N/A | N/A |
- **Note:** Net profit margin is calculated as (Net Income ÷ Revenue) × 100. 2024 net income for Pfizer was not available at the time of reporting[3][4][5][6].
### Key Observations
- **Bristol Myers Squibb** maintained high gross profit margins, though there was a gradual decline from 2022 to 2024.
- **Pfizer** experienced a sharp drop in net profit and profit margin in 2023, primarily due to reduced sales of COVID-19 products. 2024 net income data was not yet published as of July 2025.
**References:**
- Bristol Myers Squibb: Revenues and gross profits[1][2]
- Pfizer: Revenues and net incomes[3][4][5][6]
Sources
[1] Bristol Myers Squibb Gross Profit 2010-2025 | BMY - Macrotrends https://macrotrends.net/stocks/charts/BMY/bristol-myers-squibb/gross-profit
[2] Bristol Myers Squibb Revenue 2010-2025 | BMY - Macrotrends https://www.macrotrends.net/stocks/charts/BMY/bristol-myers-squibb/revenue
[3] Pfizer's financial performance in 2022 | Pfizer 2022 Annual Report https://www.pfizer.com/sites/default/files/investors/financial_reports/annual_reports/2022/performance/
[4] Pfizer reports drop in revenue for full year 2023 https://www.pharmaceutical-technology.com/news/pfizer-revenue-2023/
[5] Pfizer Reports Strong Full-Year 2024 Results And Reaffirms 2025 ... https://finance.yahoo.com/news/pfizer-reports-strong-full-2024-114500880.html
[6] Pfizer Revenue 2010-2025 | PFE - Macrotrends https://www.macrotrends.net/stocks/charts/PFE/pfizer/revenue
[7] Annual Report 2022 - Bristol-Myers Squibb https://annual-report.bms.com/2022
[8] Annual reports - Bristol Myers Squibb https://www.bms.com/investors/financial-reporting/annual-reports.html
[9] [PDF] 2022 Annual Report https://annual-report.bms.com/assets/bms-ar/documents/2022-annual-report.pdf
[10] Bristol Myers Squibb Reports Fourth Quarter and Full-Year Financial ... https://news.bms.com/news/details/2024/Bristol-Myers-Squibb-Reports-Fourth-Quarter-and-Full-Year-Financial-Results-for-2023/default.aspx
[11] Annual Report 2024 - Bristol Myers Squibb https://annual-report.bms.com
[12] Bristol Myers Squibb Co. Annual Income Statement - BMY - WSJ https://www.wsj.com/market-data/quotes/BMY/financials/annual/income-statement
[13] [PDF] 2023 Annual Report - Bristol Myers Squibb https://www.bms.com/assets/bms-ar/documents/2023/2023-bms-annual-report.pdf
[14] [PDF] 2024 Annual Report - Bristol Myers Squibb https://annual-report.bms.com/assets/bms-ar/documents/2024/2024-bms-annual-report.pdf
[15] Pfizer's year in review | Pfizer 2023 Annual Report https://www.pfizer.com/sites/default/files/investors/financial_reports/annual_reports/2023/
[16] Pfizer Reports Strong Q4 and Full-Year 2024 Results https://insights.pfizer.com/fourth-quarter-fy-earnings-2024
[17] Bristol-Myers Squibb (BMY) - Revenue - Companies Market Cap https://companiesmarketcap.com/bristol-myers-squibb/revenue/
[18] Bristol Myers Squibb Reports Fourth Quarter and Full-Year Financial ... https://news.bms.com/news/details/2025/Bristol-Myers-Squibb-Reports-Fourth-Quarter-and-Full-Year-Financial-Results-for-2024/default.aspx
[19] [PDF] BMY-Q42024-Earnings-Press-Release.pdf https://www.bms.com/assets/bms/us/en-us/pdf/investor-info/doc_financials/quarterly_reports/2024/BMY-Q42024-Earnings-Press-Release.pdf
[20] Pfizer Gross Profit 2010-2025 | PFE - Macrotrends https://www.macrotrends.net/stocks/charts/PFE/pfizer/gross-profit
Below is a summary of the annual profits and profit margins for **Bristol Myers Squibb** and **Pfizer** for the years 2022, 2023, and 2024.
(Apologies for the unformatted tables in this HTML view, based on data from Perplexity.ai.)
### Bristol Myers Squibb
| Year | Revenue (USD Millions) | Gross Profit (USD Millions) | Gross Profit Margin (%) |
|------|------------------------|-----------------------------|------------------------|
| 2022 | 46,159 | 36,022 | 78.0 |
| 2023 | 45,006 | 34,313 | 76.2 |
| 2024 | 48,300 | 34,332 | 71.1 |
- **Note:** Gross profit margin is calculated as (Gross Profit ÷ Revenue) × 100[1][2].
### Pfizer
| Year | Revenue (USD Millions) | Net Income (USD Millions) | Net Profit Margin (%) |
|------|------------------------|---------------------------|----------------------|
| 2022 | 100,330 | 31,372 | 31.3 |
| 2023 | 58,500 | 2,110 | 3.6 |
| 2024 | 63,600 | N/A | N/A |
- **Note:** Net profit margin is calculated as (Net Income ÷ Revenue) × 100. 2024 net income for Pfizer was not available at the time of reporting[3][4][5][6].
### Key Observations
- **Bristol Myers Squibb** maintained high gross profit margins, though there was a gradual decline from 2022 to 2024.
- **Pfizer** experienced a sharp drop in net profit and profit margin in 2023, primarily due to reduced sales of COVID-19 products. 2024 net income data was not yet published as of July 2025.
**References:**
- Bristol Myers Squibb: Revenues and gross profits[1][2]
- Pfizer: Revenues and net incomes[3][4][5][6]
Sources
[1] Bristol Myers Squibb Gross Profit 2010-2025 | BMY - Macrotrends https://macrotrends.net/stocks/charts/BMY/bristol-myers-squibb/gross-profit
[2] Bristol Myers Squibb Revenue 2010-2025 | BMY - Macrotrends https://www.macrotrends.net/stocks/charts/BMY/bristol-myers-squibb/revenue
[3] Pfizer's financial performance in 2022 | Pfizer 2022 Annual Report https://www.pfizer.com/sites/default/files/investors/financial_reports/annual_reports/2022/performance/
[4] Pfizer reports drop in revenue for full year 2023 https://www.pharmaceutical-technology.com/news/pfizer-revenue-2023/
[5] Pfizer Reports Strong Full-Year 2024 Results And Reaffirms 2025 ... https://finance.yahoo.com/news/pfizer-reports-strong-full-2024-114500880.html
[6] Pfizer Revenue 2010-2025 | PFE - Macrotrends https://www.macrotrends.net/stocks/charts/PFE/pfizer/revenue
[7] Annual Report 2022 - Bristol-Myers Squibb https://annual-report.bms.com/2022
[8] Annual reports - Bristol Myers Squibb https://www.bms.com/investors/financial-reporting/annual-reports.html
[9] [PDF] 2022 Annual Report https://annual-report.bms.com/assets/bms-ar/documents/2022-annual-report.pdf
[10] Bristol Myers Squibb Reports Fourth Quarter and Full-Year Financial ... https://news.bms.com/news/details/2024/Bristol-Myers-Squibb-Reports-Fourth-Quarter-and-Full-Year-Financial-Results-for-2023/default.aspx
[11] Annual Report 2024 - Bristol Myers Squibb https://annual-report.bms.com
[12] Bristol Myers Squibb Co. Annual Income Statement - BMY - WSJ https://www.wsj.com/market-data/quotes/BMY/financials/annual/income-statement
[13] [PDF] 2023 Annual Report - Bristol Myers Squibb https://www.bms.com/assets/bms-ar/documents/2023/2023-bms-annual-report.pdf
[14] [PDF] 2024 Annual Report - Bristol Myers Squibb https://annual-report.bms.com/assets/bms-ar/documents/2024/2024-bms-annual-report.pdf
[15] Pfizer's year in review | Pfizer 2023 Annual Report https://www.pfizer.com/sites/default/files/investors/financial_reports/annual_reports/2023/
[16] Pfizer Reports Strong Q4 and Full-Year 2024 Results https://insights.pfizer.com/fourth-quarter-fy-earnings-2024
[17] Bristol-Myers Squibb (BMY) - Revenue - Companies Market Cap https://companiesmarketcap.com/bristol-myers-squibb/revenue/
[18] Bristol Myers Squibb Reports Fourth Quarter and Full-Year Financial ... https://news.bms.com/news/details/2025/Bristol-Myers-Squibb-Reports-Fourth-Quarter-and-Full-Year-Financial-Results-for-2024/default.aspx
[19] [PDF] BMY-Q42024-Earnings-Press-Release.pdf https://www.bms.com/assets/bms/us/en-us/pdf/investor-info/doc_financials/quarterly_reports/2024/BMY-Q42024-Earnings-Press-Release.pdf
[20] Pfizer Gross Profit 2010-2025 | PFE - Macrotrends https://www.macrotrends.net/stocks/charts/PFE/pfizer/gross-profit
