Drug makers now spend $5 billion a year on advertising. Here’s what that buys.

Under fire for spending so much on advertising, drug makers are doubling down.

Even as politicians and physicians press for strict limits on prescription drug ads, the pharmaceutical industry is pouring billions into new TV and print campaigns. Ad spending soared more than 60 percent in the last four years, hitting $5.2 billion last year.

And there’s no sign it’s slowing. On the contrary: Nine prescription drugs are on pace to break $100 million worth of TV ad time this year.

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STAT analyzed data from several media research firms for an exclusive look at where drug makers are putting their advertising dollars.

The data paint a revealing portrait of a booming industry. Drug advertisers worship at the altar of TV. They’re relentless in hawking their top products to the aging baby boomers watching network shows. But they’re also spending more to reach niche audiences. It’s not unusual for drug makers to make six-figure buys in magazines like Family Handyman or the celebrity tabloid Star, or on cable TV channels such as Country Music Television or the Hallmark Channel.

The analysis also makes clear just how much ad spending is concentrated, as companies focus on promoting the drugs with the biggest potential customer base or the highest price tags — or both.

One-quarter of the industry’s $5.2 billion in spending last year went to advertise just five drugs: Humira, which treats a number of common conditions, including arthritis; Lyrica, for nerve and muscle pain, including fibromyalgia; Eliquis, an anticoagulant that can reduce stroke risk in some patients; Cialis, the erectile dysfunction drug; and Xeljanz, for rheumatoid arthritis.

The market reports STAT used for its analysis came from Kantar Media, Nielsen, and iSpot.tv. The data reflect the list price of TV and print ads, and don’t take into account any discounts the drug companies may have negotiated. The reports also leave out hundreds of millions in spending on digital ads and social media — categories that are growing fast but are harder to pinpoint.

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Natalia Bronshtein/STAT

An industry under fire

It can be easy to forget, when we’re bombarded with drug ads, how unusual the practice is. The US and New Zealand are the only countries where drug makers are allowed to market prescription drugs directly to consumers.

Increasingly, critics are expressing concern that expenditures on advertising drive up the price of drugs.

They’re frustrated, too, when patients insist on getting the brand-name medication they’ve seen on TV, though other drugs might be more effective or less expensive, or both. Prescription drugs accounted for nearly 17 percent of total health care spending in 2015, up from about 7 percent in the 1990s, due in large part to rising prices for brand-name treatments, new federal data show.

Such concerns have prompted the American Medical Association to call for a ban on direct-to-consumer advertising.

Some lawmakers are clearly receptive to the idea: Last week, Senator Al Franken (D-Minn.) introduced a bill to eliminate the tax breaks that drug makers can take to offset their spending on ad campaigns. Franken framed his move as a “common sense measure to help cut down health care costs.”

And in the House, Representative Rosa DeLauro (D-Conn.) has called for a three-year moratorium on ads for new drugs.

With high drug prices an issue in the presidential campaign, Hillary Clinton has jumped into the fray as well; she is calling to end the tax breaks for drug advertising and require drug makers to get their ads cleared by federal regulators.

The Food and Drug Administration is also scrutinizing drug ads closely. It’s studying whether the ads make it too hard for consumers to understand the potential side effects associated with medications — for instance, by using cartoon characters to downplay risks.

Pharmaceutical Research and Manufacturers of America, the industry trade group, has rejected efforts to limit ads. The group says the ads are useful for informing patients about their treatment options and prodding them to take control of chronic conditions, rather than waiting until their symptoms flare into a health emergency.

Big populations and big price tags

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Natalia Bronshtein/STAT

Ads for drugs that treat chronic conditions afflicting tens of millions of Americans, such as erectile dysfunction and type 2 diabetes, rule the airwaves.

“There’s no doubt that [direct-to-consumer advertising] is now seen as almost a must-do for a drug that wants to be big,” said Bob Ehrlich, chief executive of the consulting firm DTC Perspectives.

A few makers of drugs that target relatively small patient populations — but that carry a high price tag — are advertising heavily, too.

Take Harvoni, which can cure hepatitis C patients in a few months for $94,500. Its manufacturer, Gilead, bought more than $100 million worth of TV and print ads to advertise Harvoni last year, according to Kantar media.

Then there’s Opdivo, which treats certain patients with advanced cancers of the lung, skin, and kidney and is priced at about $150,000 a year. It was advertised almost as heavily as Viagra last year.

Big TV markets are king

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Natalia Bronshtein/STAT

The advertisers of the top 20 best-selling drugs directed two-thirds of their TV ad spending last year on just four networks — broadcast titans CBS, ABC, NBC, and FOX.

“People talk a lot about how television viewership is eroding, and traditional media is fading, and that is all true. But the decline is very slow, and so there are still big audiences. And if you’re a pharma company, and you want to reach a lot of people quickly … there’s really no better place to go still than the traditional networks,” said Timothy Calkins, a marketing professor at Northwestern University’s Kellogg School of Management.

It also helps that these viewers are getting older and older — and, thus, presumably more receptive to pitches for drugs to treat ailments like arthritis and erectile dysfunction. It’s likely no coincidence that CBS drew the most advertising dollars last year; the age of its median viewer in 2014 was nearly 59.

But niche marketing is gaining steam

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Natalia Bronshtein/STAT

The makers of the top 20 best-selling prescription drugs bought a collective $29 million worth of ads on the History Channel last year. And $12 million on the Food Network. And $8 million on Animal Planet, according to Kantar data.

Spending on cable TV ads for the top eight best-selling prescription drugs has more than doubled in the past decade, according to Kantar data. It’s risen at a faster rate over that period than spending on network TV.

Cable’s niche audiences let drug makers target their pitches carefully.

More than 80 percent of fibromyalgia patients are female, for instance. So it makes sense that in a widely aired TV ad for Pfizer’s blockbuster drug Lyrica, three women talk about their experiences with the painful condition.

Pfizer also bought $12 million worth of ads for Lyrica in the women’s magazines Good Housekeeping, Better Homes and Gardens, and Woman’s Day, according to Kantar data.

Men are significantly more likely than women to experience a recurrent blood clot. So it’s no surprise that a middle-aged man goes jogging and takes in a baseball game in an oft-aired TV ad for Eliquis,  the anticoagulant sold by Bristol-Myers Squibb and Pfizer.

The companies bought $16 million worth of spots for Eliquis in male-targeted media like Golf Magazine, Sports Illustrated, and Family Handyman.

“Pharma companies know who they’re going after,” Calkins said, “and they really focus on reaching those people.”

A previous version of this story misstated the length of a proposed moratorium on drug ads.

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