2024 Gross-to-Net Realities at 9 Top Drugmakers: A New Era of Market Access

It’s time for Drug Channels’ annual update on drug pricing trends at the largest pharmaceutical manufacturers.

This year’s review includes the following nine companies: Bristol Myers Squibb, Eli Lilly and Company, Genentech, GlaxoSmithKline, Johnson & Johnson, Sanofi, Takeda, Teva, and UCB. You can find links to each company’s data below.

These data highlight divergent trends reshaping the gross-to-net bubble:

• Rebates, discounts, and other fees reduced the selling prices of brand-name drugs at the biggest drugmakers to less than half of their list prices.

• When accounting for all list price reductions, average brand-name drug prices declined at four manufacturers and increased at five others.

• Gross-to-net difference in price changes ranged from −12.8% to +4.2%, reflecting significant differences in the manufacturers’ portfolio mix and pricing strategies.

As I noted in last week’s gross-to-net bubble analysis, manufacturers’ evolving market access strategies increasingly aim to offset—or circumvent—growing pricing pressure from both commercial and government payers. Drug pricing flat earthers (#DPFE) will be challenged by falling net prices, while policy wonks will be amazed at the unintended consequences unleashed by our crazy system.

So, journey with me to Bikini Bottom as we again delve into the murky waters of gross-to-net drug pricing. Click here to share your thoughts with the Drug Channels community.

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If you're new to Drug Channels, I recommend checking out the following two articles:

• Gross-to-Net Bubble Hits $356B in 2024—But Growth Slows to 10-Year Low. This article answers frequently asked questions about gross-to-net pricing, drug costs, and SpongeBob SquarePants.

• Inflation-Adjusted U.S. Brand-Name Drug Prices Fell for the Seventh Consecutive Year as a New Era of Drug Pricing Dawns. This article reviews SSR Health’s product-level data on list and net prices.

For complete details on drug pricing and more, see Chapter 9 of DCI’s 2025 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers.

BUBBLETASTIC DATA SOURCES

The following nine companies publicly reported the 2024 list and net price changes for their U.S. product portfolios. Six companies also reported their average discounts from list prices. As always, I encourage you to review the original source material for yourself. Here are links to the relevant reports:

• Bristol Myers Squibb 2024 ESG Report, page 19.

• Eli Lilly and Company: U.S. Access & Affordability (In this report, Lilly did not disclose year-over-year net price changes for 2024. We therefore used the fiscal year figures provided in its financial reports for 2024.)

• Genentech has not updated its Science of Pricing webpage since 2021. However, Genentech privately provided the 2024 figures to me.

• GSK: ESG Performance Report 2024, page 14

• Johnson & Johnson Innovative Medicines Transparency Report. This report is the most detailed and useful resource in the marketplace, because JNJ provides a breakdown of the major components of its gross-to-net gap.

• Sanofi: 2025 Pricing Principles Report, page 6.

• Takeda: 2024 Price Transparency Report

• Teva: Healthy Future 2024 Report, page 33. (Note: Figures are for innovative branded medicines.)

• UCB: Integrated Annual Report 2024, page 317.

Here are the notable omissions from this year’s list:

• Pfizer reported a −2% change in its average net price for 2024, but did not disclose a corresponding change in list price. See Pfizer: 2024 Impact Report, page 57.

• Last year, Merck published its Merck: Pricing Action Transparency Report 2023. However, it has not released an updated edition with 2024 data.

• Novartis did not report any “Affordability & Pricing” metrics for 2024. The company last reported gross and net price changes for 2021. See Novartis in Society – 2021 US Report, page 26.

• Novo Nordisk did not disclose any detailed pricing information in its 2024 Annual Report, despite having presented these data in its 2023 report. However, the company did state that “average prices after rebates for the Novo Nordisk portfolio in 2024 in the United States declined.”

If I have missed reports from other companies, please email me.

2024 GROSS-TO-NET TRENDS

The table below summarizes 2024's year-over-year changes in list and net prices for the brand-name product portfolios of the nine large manufacturers, along with average discounts.

[Click to Enlarge]

Key observations about the manufacturers’ data for 2024:

• List prices for brand-name drugs grew slowly. For 2025, brand-name drug list prices grew by 5.5% or less at all eight companies. The unweighted average increase was +3.8%.

• Drugmakers sold their products for about half of the list price. Six of the nine companies reported average discounts from list prices. The unweighted average discount from list price across the six companies was −50.0%, i.e., half of the list prices. Weighted average discounts across brand-name portfolios ranged from −36% to −60%.

• Average discounts from list prices deepened for some (but not all) manufacturers. Due partly to the gross-to-net differences discussed below, the average discount was smaller for some companies. For example, Lilly’s average discount rate went from −66% in 2023 to −60% in 2024, while Takeda’s rate went from −44% to −43%. Such disparities reflect differences between product portfolios and pricing approaches.

• Net prices at most manufacturers increased at a rate slower than overall inflation. The unweighted average change in net prices was only +0.4% for 2024. Overall U.S. inflation was +2.9% for 2024, so net price increases were below inflation for six of the nine manufacturers. Net prices declined at only four of the nine manufacturers and rose for the other five.

• Gross-to-net gaps in price changes exhibited varying patterns. Across the nine companies, the unweighted average gross-to-net price change differential was −3.4%. This average masked the divergent pricing patterns among manufacturers.
  
  For three manufacturers (Eli Lilly, GSK, and Takeda), the gross-to-net difference was positive, i.e., net prices rose more quickly than list prices. Among these three companies, unweighted list prices grew by an average of +3.3%, while net prices rose by +6.6%.
  
  For the other six manufacturers, the gross-to-net discount was negative. Unweighted list prices grew by an average of +4.0%, while net prices declined by −2.6%. Hence, the average gross-to-net gap was −6.6%.

THE NEW ERA

The unusual patterns for 2024 reflect a new era of drug pricing and market access relative to our previous analyses. The five forces of changes that I outlined last week are already altering the seascape.

Some manufacturers are voluntarily popping the gross-to-net bubble for high-list/high-rebate products. Exhibit 247 of our 2025 pharmacy/PBM report highlights 15 brand-name drugs for which manufacturers lowered the list prices for 2024. On average, list prices for these products were cut in half. Notably, these reductions included products from GSK and Lilly.

These list price reductions were likely motivated, at least in part, by the American Rescue Plan Act of 2021, which eliminated the Medicaid rebate cap at the end of 2023. In other words, Congress incentivized manufacturers of high-list/high-rebate products to cut list prices and avoid the absurd scenario of having to pay the Medicaid program for the use of their products.

Highly rebated drugs that reduce list prices can paradoxically see an increase in net price. This unusual effect occurs because the Medicaid rebate calculation and the 340B ceiling price are both intricately linked to changes in a drug’s list price relative to inflation. (See Section 9.1.3. of 2025 pharmacy/PBM report for the math behind this surprising result.)

Meanwhile, new channel models—including smaller PBMs, cost-plus pharmacies, patient-paid discount card prescriptions, and manufacturers’ direct-to-patient businesses—are creating novel paths for drugs that can be sold without gross-to-net bubble distortions.

SAILING INTO THE NEW ERA

So, what did we learn on our underwater adventure through 2024’s gross-to-net currents?

Net prices sank for half the crew, discounts deepened, and a few brave manufacturers hoisted the “Lower List Prices” flag. As always, the sea of U.S. drug pricing remains murky, unpredictable, and full of jellyfish stings.