The Initiative for Medicines, Access, and Knowledge (I-MAK) has published new research exposing how pharmaceutical companies exploit patent extension mechanisms to maintain market monopolies and drive billions in excess healthcare spending. The latest data brief in I-MAK's Overpatented, Overpriced series analyzes patenting strategies for blockbuster drugs Eliquis and semaglutide medications, revealing systematic flaws that cost U.S. healthcare systems over $200 billion while delaying generic competition for years beyond original patent expirations.
Patent Extensions Generate Massive Revenue Windfalls
The analysis demonstrates how Statutory Patent Term Adjustment (PTA) and Patent Term Extension (PTE) mechanisms create substantial financial incentives for pharmaceutical companies to delay generic entry. These regulatory tools, combined with extensive follow-on patenting strategies, generate billions in additional revenue even before accounting for extended market monopolies from subsequent patent filings.
"What we're seeing is a patent system that is designed to help drugmakers extend their patent monopolies so they can maximize profits at the expense of affordable medicines patients can access," said Tahir Amin, CEO and co-founder of I-MAK. "We need to change these different incentives in the patent system as they are being exploited to the detriment of the public."
Eliquis Case Study: $50.7 Billion in Extended Revenue
Eliquis, the prescription anticoagulant FDA-approved in 2012, exemplifies how companies exploit regulatory mechanisms to prolong market exclusivity. Originally scheduled to lose core patent protection in 2022, Eliquis received a four-year Patent Term Extension, moving the expiration date to late 2026. A follow-on patent further delays generic entry until April 2028, adding another 16 months of market exclusivity.
According to I-MAK's analysis, these patent extensions are expected to yield an additional $50.7 billion in U.S. sales—$39.1 billion during the extended PTE period and $11.6 billion from follow-on protection. This occurs while generic versions of apixaban have already launched in Canada, the UK, and the EU, where patients pay substantially less.
Semaglutide: 16-Year Extension Through Patent Thickets
Novo Nordisk has implemented an even more extensive strategy for semaglutide, the active ingredient in Ozempic, Rybelsus, and Wegovy. The company filed more than 320 U.S. patent applications and secured 49 follow-on patents, extending market exclusivity through at least 2042—16 years beyond the expiration of the original semaglutide compound patent.
This prolonged protection is projected to generate $166 billion in additional U.S. revenue between 2026 and 2031 alone. Although litigation is ongoing, no generic versions are expected to reach the market before 2032, creating what I-MAK describes as "patent thickets" that block competition and research pathways through numerous follow-on patents covering minor modifications of original inventions.
International Price Disparities Highlight System Failures
The I-MAK report reveals dramatic price disparities between the U.S. and comparable countries, largely attributed to delayed generic access and weaker pricing regulations. Cost comparisons show U.S. patients paid approximately $521 per month for Eliquis in 2023, compared to $109 in Canada, $104 in the UK, and $84 in Germany. Even with Medicare's negotiated price of $231 per month, the U.S. still pays more than every international benchmark.
For semaglutide medications, U.S. patients pay three to eight times more than patients in comparable nations. A monthly supply of Ozempic costs around $936 in the U.S., versus $169 in Japan, $147 in Canada, and $69 in France. These disparities reflect systemic differences in how countries regulate and negotiate drug prices rather than manufacturing or R&D expenses.
Generic Access Delays Cost Patients Years
The analysis reveals that patients in Europe, Canada, Japan, and similar markets benefit from earlier generic entry compared to U.S. patients, who wait years longer for low-cost alternatives. Canada already offers generic apixaban for about $20 per month—less than 10% of the U.S. Medicare-negotiated price of $231. Despite FDA approval of generics in 2019, U.S. patients must wait until 2028 for market entry due to ongoing patent protection.
The research accompanies updates to I-MAK's Drug Patent Book, a comprehensive publicly accessible database revealing detailed patent information on bestselling pharmaceutical drugs. The findings build on I-MAK's acclaimed investigation series, which has become a cornerstone resource for policymakers, researchers, and advocates working to address America's prescription drug pricing crisis.
