A new data brief from the Initiative for Medicines, Access and Knowledge (I-MAK), titled Overpatented, Overpriced, reveals how pharmaceutical giants Bristol Myers Squibb (BMS), Pfizer, and Novo Nordisk have used aggressive patenting strategies to delay generic competition and inflate US drug prices.

The report scrutinizes the pricing and patent tactics behind two key Medicare-negotiated drugs—Eliquis and semaglutide-based products, including Ozempic, Rybelsus, and Wegovy—highlighting how these strategies have cost US patients, taxpayers, and insurers billions. The report accompanies updates to I-MAK’s Drug Patent Book database and sheds light on how these widely used medications have become symbols of systemic flaws in the US pharmaceutical patent system.

Eliquis: A Case Study in Delayed Competition and Soaring Costs

Eliquis (apixaban), a blockbuster anticoagulant developed by BMS and Pfizer, has become a focal point in the national drug pricing debate. Despite receiving US Food and Drug Administration (FDA) approval for generic versions in 2019, Eliquis will likely remain free from generic competition in the US until at least 2028—thanks to a combination of Patent Term Extensions (PTE), Patent Term Adjustments (PTA), and follow-on patents.

Eliquis raked in over $13 billion in sales last year. The drug sales continue to be strong, with Eliquis pulling in about $3.6 billion in sales in the first quarter (Q1) of 2025, as per BMS’s results.

The core compound patent for apixaban, US Patent No. 6,967,208, originally expired in 2022. However, due to a granted PTE and PTA, its protection was extended to April 2027. Adding to this, a follow-on patent (US Patent No. 9,326,945) further delays competition until 2031. Bristol Myers Squibb has stated that the earliest possible generic entry is now 1 April 2028.

These extensions have staggering financial consequences. Between 2023 and 2026—the years gained solely through the PTE—Eliquis is projected to bring in $39.1 billion in US revenue, as per the report. The ‘945 patent adds another $11.6 billion in estimated revenue between 2026 and 2028. In total, I-MAK estimates an extra $50.7 billion in revenue extracted from patients, insurers, and taxpayers due to extended patent protection.

Eliquis has been particularly burdensome for Medicare. In a single year (June 2022 to May 2023), Medicare Part D spent over $16.4 billion on the drug, covering 3.7 million enrollees. While Medicare negotiations under the Inflation Reduction Act (IRA) have driven the 30-day supply price down from $521 to $231, this still exceeds the full list price in every other high-income country surveyed, such as Germany ($84), Canada ($109), and Switzerland ($154).

Semaglutide: Ozempic, Rybelsus, Wegovy, and the 49-Year Patent Wall

The I-MAK report also dissects Novo Nordisk’s patent strategy for semaglutide-based products, which include Ozempic (injectable for diabetes), Rybelsus (oral), and Wegovy (injectable for obesity). These drugs are among the most commercially successful products in history, and Novo Nordisk has employed an extensive patent thicket to preserve its market dominance.

Ozempic, Rybelsus, and Wegovy each generated DKK120.3 billion (approximately $18.68 billion), DKK23.3 billion ($3.6 billion), and DKK58.2 billion ($9 billion), respectively, in sales last year.

The active ingredient semaglutide was first filed for patent in 2006. While the primary patents (Nos. 8,129,343 and 8,536,122) would typically expire in 2026, Patent Term Extensions have pushed this to December 2031. Meanwhile, Novo Nordisk has filed over 320 related patent applications, including 91 for formulations, 41 for delivery devices, and 45 for treatment methods. These “follow-on” patents extend legal protections as far as 2042.

The financial implications are vast. From 2026 to 2031—the five-year PTE/PTA extension—Novo Nordisk is projected to earn an additional $166 billion in US revenue, according to the I-MAK report. With no generics expected before 2032, American patients will continue paying 3–8 times more than patients in countries like Canada, the UK, and Japan. For instance, in 2024, a monthly supply of Ozempic cost $936 in the US, compared to $103 in Germany and $87 in Australia.

The US Federal Trade Commission (FTC) has flagged several of Novo’s patents for improper listing in the FDA’s Orange Book, calling the tactic a potential violation of antitrust laws. These listings can trigger automatic litigation stays and create disincentives for generic manufacturers, thereby prolonging market exclusivity.

Medicare Negotiations: Progress, But Limited Impact

The IRA allows Medicare to negotiate prices for selected high-cost drugs—60 in total through 2029. While this is a significant policy shift, it only applies to Medicare beneficiaries, who make up about 19% of the U.S. population. The other 81%, including those on employer insurance or uninsured, receive no direct benefit.

Starting in 2027, semaglutide products (Ozempic, Rybelsus, Wegovy) will have negotiated prices under the IRA. CMS estimates suggest this could yield $3.6 to $8.6 billion in annual savings. However, limitations remain: negotiations only begin years after patent extensions take effect, and follow-on patents still obstruct earlier generic entry.

The report makes it clear: while IRA negotiations provide temporary relief, they fail to address the root cause of inflated drug prices—strategic patent abuse. According to I-MAK, pharmaceutical companies routinely exploit statutory provisions to extend monopolies far beyond the original 20-year limit. These practices inflate costs across the healthcare system and disproportionately burden American patients.

“This isn’t about rewarding innovation—it’s about prolonging monopoly profits at public expense,” the report notes. “Without patent reform that limits patent thickets, prevents improper patent listings, and promotes timely generic competition, the affordability crisis in American healthcare will persist.”

About the Study

The data brief Overpatented, Overpriced: A Data Brief on Medicare-Negotiated Drugs: Eliquis, Ozempic, Rybelsus and Wegovy was published by the Initiative for Medicines, Access and Knowledge (I-MAK) on 16 June 16 2025. It draws on patent and pricing data from public databases, company filings, and market estimates, and forms part of I-MAK’s ongoing effort to promote transparency and reform in pharmaceutical patenting.

I-MAK is a non-profit organization that provides evidence-based research and policy analysis focused on making medicines more accessible and affordable. It does not accept funding from the pharmaceutical industry. The full report and database can be accessed via i-mak.org.