Humira is no longer the world's bestselling drug annually, but it's still the all-time sales leader (until Keytruda takes the crown). The product's rise perfectly encaspulates America's broken healthcare system and the warped incentives of pharmacy benefit managers (PBMs).

Consider the annual revenue split between the United States and the rest of the world from 2007 to 2023.

Humira used to generate roughly equal revenue between these two groups. In fact, the rest of the world used to generate more revenue than the United States alone. That's what you might expect given patient populations. But then... AbbVie started taking advantage of America's dysregulated system.

• In the United States, a roughly one-month supply of Humira increased from $1,100 in 2005 to $2,300 in 2014, a leap of 109% in 10 years.
• In the 10 years from 2014 to 2023, the U.S. list price increased to $6,922 -- a jump of 201%.
• In the 19 years spanning 2005 to 2023, the U.S. list price increased 529%, or 10.1% per year. The average pace of inflation over the same period was just 2.4% per year.
• If Humira's U.S. list price increased at the same rate as inflation, then a roughly one-month supply would have cost $1,726 at the end of 2023 -- 75% lower than the actual list price.

That means, if Americans had paid the same price as international patients for the same exact product, they would have saved over $100 billion in the decade spanning 2014 to 2023. In the same period, AbbVie spent $61.2 billion on R&D, paid only $7.4 billion in U.S. income taxes, spent $63.3 billion on dividends, and deployed another $33.7 billion on share buybacks.