Health Aff (Millwood). 2026 Aug;45(8):846-854. doi: 10.1377/hlthaff.2026.00054.
ABSTRACT
Whether US pharmaceutical markets reward novel therapies more than incremental follow-on drugs remains unclear. We examined trends in prescription drug revenues across three dimensions of pharmacological novelty-molecular structure, therapeutic target, and delivery properties-using a retrospective analysis of branded small-molecule drugs approved by the Food and Drug Administration and marketed between 2000 and 2019. Novelty measures derived from ChEMBL, a comprehensive database of bioactive molecules with druglike properties, were linked to nationally representative utilization and spending data from the Medical Expenditure Panel Survey, with rebate-adjusted net revenues estimated using SSR Health data. Beginning around 2013, gross and net revenues rose disproportionately for highly novel drugs across all three dimensions of novelty, whereas revenues for medium- and low-novelty drugs remained relatively stable. From 2013 to 2019, mean gross revenue more than tripled for drugs with high molecular or target novelty and more than doubled for those with high delivery novelty. These revenue gains were associated with increased prescription volume, rather than higher prices. The timing of this divergence coincided with the expansion of pharmacy benefit managers’ formulary exclusion policies, which may have reduced the usage of drugs with close substitutes and increased market returns to pharmacological novelty.
PMID:42546243 | DOI:10.1377/hlthaff.2026.00054
