Big Pharma Scored on Patient Access and Fair Pricing
The pharmaceutical industry occupies a unique position in the ethical investing debate. These are companies whose products save lives. They are also companies that have been at the centre of some of the most consequential public health lawsuits in history -- from the opioid crisis to drug pricing litigation to clinical trial controversies documented in court filings across multiple jurisdictions.
For investors who care about health as a value, the question is not whether pharma companies matter. It is whether the specific companies in your portfolio are advancing public health or extracting from it.
We scored major pharmaceutical companies across 11 independent ethical dimensions, with particular focus on Better Health for All -- the dimension that directly measures patient access, drug pricing fairness, clinical trial ethics, and the net health effect of a company's products. Our data comes from court filings, regulatory actions, investigative journalism, and NGO reports. No corporate sustainability disclosures. No self-reported ESG data.
The results show an industry where most companies score negative overall, even when their products are saving lives.
What "Better Health for All" Measures
Our Better Health for All dimension evaluates pharmaceutical companies on eight specific indicators:
- Net health effect of principal goods or services
- Revenue share from products with established negative health outcomes
- User harm frequency and severity (injuries, recalls, adverse events)
- Price accessibility of health products relative to median income
- Equitable access for low-income or marginalised populations
- Transparency and honesty of health risk disclosures
- Addiction mitigation efforts and recovery support
- Clinical trial ethics and pharmaceutical patent flexibility
A pharmaceutical company can manufacture life-saving drugs and still score poorly on this dimension if independent evidence shows those drugs are priced beyond reach, if clinical trial practices have drawn regulatory scrutiny, or if the company has faced litigation over health risk disclosures.
This is the core tension in pharma ethics: the product may be good, but the business practices around it may not be.
The Ranking: Big Pharma by Average Ethical Score
We scored five of the largest US-listed pharmaceutical companies that appear most frequently in major index funds and ESG ETFs. Here is how they rank by average score across all 11 ethical dimensions, from highest to lowest.
| Rank | Company | Ticker | Average Score |
|---|---|---|---|
| 1 | Merck | MRK | -0.5 |
| 2 | AbbVie | ABBV | -10.5 |
| 3 | Eli Lilly | LLY | -11.4 |
| 4 | Johnson & Johnson | JNJ | -14.1 |
| 5 | Pfizer | PFE | -16.4 |
Every company on this list scores negative on average. The best performer, Merck, is essentially neutral at -0.5. The worst, Pfizer, scores -16.4 -- placing it alongside fast food chains and fossil fuel companies in our broader S&P 500 analysis.
For an industry that markets itself as a force for human health, these numbers deserve scrutiny.
Company-by-Company Analysis
1. Merck (MRK) -- Average Score: -0.5
Merck is the highest-scoring pharmaceutical company in our analysis, with an average of -0.5 -- effectively neutral. It carries 4 negative dimensions out of 11.
Merck's position at the top of this ranking does not mean it has a clean record. A score of -0.5 means the positives in our data marginally outweigh the negatives. For a company of Merck's size and history, that near-neutral result likely reflects a mix of contributions to global health programmes -- including documented efforts on access to HIV and hepatitis treatments in developing countries -- offset by pricing-related concerns and regulatory findings in other areas.
Among the major pharma companies, Merck's profile is the least problematic in our data. That is a relative statement, not an endorsement.
View Merck's full score breakdown -->
2. AbbVie (ABBV) -- Average Score: -10.5
AbbVie scores -10.5 on average with 6 negative dimensions -- a significantly weaker profile than Merck.
AbbVie's ethical profile is shaped substantially by its flagship product, Humira, which has been the subject of extensive public scrutiny over pricing practices. Court filings and regulatory records document how AbbVie built a patent thicket of over 100 patents around Humira, according to public legal proceedings, effectively delaying biosimilar competition and maintaining elevated pricing. US congressional hearings have examined AbbVie's drug pricing strategy as a matter of public record.
The company's health-related score reflects this tension: a product that has helped millions of patients with autoimmune conditions, sold through a pricing and patent strategy that has drawn documented legal and regulatory attention.
View AbbVie's full score breakdown -->
3. Eli Lilly (LLY) -- Average Score: -11.4
Eli Lilly scores -11.4 on average, placing it in the lower half of our pharma ranking.
Eli Lilly's profile intersects with one of the most significant drug pricing debates in recent years: insulin affordability. As one of three major insulin manufacturers globally, Eli Lilly has faced sustained scrutiny over insulin pricing documented in multiple state and federal lawsuits, congressional investigations, and investigative reports. The company has made public commitments to cap out-of-pocket insulin costs, a move that followed years of public pressure and legal proceedings.
The company's more recent prominence in the GLP-1 agonist market (weight-loss and diabetes drugs) has generated additional questions about supply constraints and pricing accessibility that are documented in public reporting.
Eli Lilly's score reflects the gap between the life-saving nature of its products and the access barriers that independent evidence has identified around those products.
View Eli Lilly's full score breakdown -->
4. Johnson & Johnson (JNJ) -- Average Score: -14.1
Johnson & Johnson scores -14.1 on average with 8 negative dimensions out of 11 -- one of the broadest negative profiles among major pharma companies.
J&J's ethical record has been shaped by some of the most significant pharmaceutical litigation in history. The company's role in opioid distribution has been the subject of multi-billion dollar settlements documented in public court records across multiple states. Separately, talc-related product liability litigation has resulted in tens of thousands of lawsuits, with court filings documenting allegations about product safety disclosures spanning decades.
J&J's breadth of negative scores -- 8 of 11 dimensions -- indicates that concerns extend beyond health into governance, worker treatment, and environmental performance. This is not a company with one problem area. According to the independent evidence in our data, issues span multiple dimensions of corporate conduct.
View Johnson & Johnson's full score breakdown -->
5. Pfizer (PFE) -- Average Score: -16.4
Pfizer scores -16.4 on average -- the lowest-scoring pharmaceutical company in our analysis.
Pfizer's position at the bottom of this ranking may surprise investors who associate the company with its prominent role in COVID-19 vaccine development. That contribution is reflected in parts of the company's health-related scoring. However, Pfizer's broader ethical profile is weighed down by a documented history of regulatory actions spanning multiple decades: the company has paid some of the largest healthcare fraud settlements in US history, according to Department of Justice records. Marketing practices, off-label promotion findings, and pricing-related regulatory actions documented in public filings contribute to a profile that scores negatively across multiple dimensions.
The COVID-19 vaccine rollout itself generated documented controversy around pricing differentials between high-income and low-income countries, supply allocation decisions, and contractual terms with governments that have been reported by investigative journalists and public health organisations.
A company can produce one of the most important public health interventions in modern history and still carry a negative ethical score. That is the point of measuring across 11 dimensions rather than one.
View Pfizer's full score breakdown -->
The Profit-vs-Access Tension
Pharmaceutical companies operate at the intersection of two objectives that frequently conflict: generating returns for shareholders and ensuring patients can access the medicines they need.
This tension is not theoretical. It is documented in public records:
Patent strategy and drug pricing. Court filings across multiple jurisdictions document how pharmaceutical companies use patent clusters to delay generic and biosimilar competition. The US Federal Trade Commission, European Commission, and individual state attorneys general have all pursued cases related to these practices, as a matter of public record.
Clinical trial access. Public reporting has documented instances where clinical trial designs, patient selection criteria, and geographic concentration have raised questions about equitable access to experimental treatments -- particularly for patients in low-income countries.
Pricing differentials. Investigative journalism and NGO reports have documented significant price differences for identical medications between countries, with low-income nations sometimes paying prices that represent a larger share of per-capita income than those paid by patients in wealthy countries.
Opioid crisis. The most significant public health litigation of the past decade has centred on pharmaceutical companies. Court settlements totalling tens of billions of dollars are documented in public records across every US state.
These are not accusations. They are matters of public record. Our scoring reflects this evidence.
How Pharma Compares to Other Sectors
Pharmaceutical companies score poorly in our analysis, but how do they compare to other sectors?
| Sector | Average Score (Sample) | Source |
|---|---|---|
| Technology (top 10) | +10.4 | Tech ranking |
| S&P 500 (40 companies) | -6.2 | S&P 500 analysis |
| ESG ETF holdings (26 companies) | -4.5 | ETF analysis |
| Pharmaceuticals (5 companies) | -10.6 | This article |
The pharmaceutical sector's average of -10.6 places it below the S&P 500 average and below ESG ETF holdings. Only the worst-performing sectors in our broader analysis -- fossil fuels, fast food, and defence -- score lower on average.
This is notable because pharmaceutical companies are frequently included in ESG-screened funds. Their products address genuine health needs. But our independently sourced data suggests that business practices around those products generate enough documented ethical concerns to pull the sector's average well into negative territory.
What This Does Not Mean
This analysis does not argue that pharmaceutical companies are net-negative for society. Medicines developed by the companies on this list have extended and improved millions of lives. Vaccines, cancer treatments, immunotherapies, and chronic disease medications represent genuine contributions to public health.
What the data shows is that the business practices surrounding those contributions -- pricing, patent strategy, marketing, regulatory compliance, and access policies -- generate substantial independently documented concerns. A company can save lives and still score negatively on ethical integrity, because our methodology evaluates conduct, not just outcomes.
Investors should interpret these scores in context. A -16.4 for Pfizer does not mean Pfizer is "worse" than a defence contractor or an oil company in some absolute moral sense. It means that across the 11 dimensions we measure, using the independent evidence available, Pfizer's documented conduct produces a net-negative score.
How We Score
Mashinii scores companies across 11 ethical dimensions using independently sourced data: court filings, regulatory actions, investigative journalism, and NGO reports. Scores range from -100 to +100. A score of 0 means insufficient independent evidence to assess in either direction. Every score is backed by cited sources that users can review.
The Better Health for All dimension is particularly relevant for pharmaceutical companies. It tracks drug pricing accessibility, clinical trial ethics, adverse event records, addiction mitigation, and the net health effect of a company's products -- all using independently verifiable evidence.
We do not use corporate self-assessments, sustainability reports, or ESG questionnaires as inputs. Companies cannot influence their scores through disclosure or engagement.
Learn more about our methodology -->
What Should You Do?
If you hold index funds, you almost certainly own pharmaceutical companies. The five companies in this analysis -- Merck, AbbVie, Eli Lilly, Johnson & Johnson, and Pfizer -- are among the largest constituents of the S&P 500, and they appear in most major ESG ETFs.
The question is not whether these companies make important products. They do. The question is whether their broader ethical conduct aligns with your values -- and whether you know the answer before you invest.
You can find out in under 60 seconds.