In 2023, Pfizer reported losing $4.4 billion in the United States, AbbVie $3.5 billion, Merck $15.6 billion, and Johnson & Johnson $2.0 billion. Of the biggest U.S. firms, only Eli Lilly appears to have eked out a small ($0.9 billion) profit in the United States.
This is not an aberration. Large American pharmaceutical companies consistently report modest profits in the U.S., and large profits abroad (even though dr-g prices and revenue are much higher in the United States). 2023 is not fundamentally different from 2022 or, for that matter, 2021.
So high prices strangely seem to correlate with large losses. This, of course, is a clear sign that pharmaceutical companies live in a world marked by transfer pricing and tax arbitrage.
Losses in the U.S., in turn, translate into a very small U.S. income tax liability.
https://www.cfr.org/blog/american-pharmaceutical-companies-arent-paying-any-tax-united-states