Pharma TV ad spend drops 4% in 2025 as digital gains 21%, VAB data shows

The Video Advertising Bureau on November 3, 2026 released The Pharmacy, an 81-page guide that sets out to answer seven questions about prescription drug advertising on US television. One of its own charts shows how far pharma budgets have tilted away from the medium VAB represents. According to VAB, the pharmaceutical category spent $6.9 billion on TV in 2025, 4% less than in 2024, while digital spending rose 21% to $18.7 billion. Digital took 73% of the combined $25.6 billion, up from 68% a year earlier.

The guide sets that split against a year of Food and Drug Administration enforcement. Between September 9, 2025, when the agency began what VAB calls a crackdown on "deceptive" pharma communications, and September 30, 2026, the FDA sent 296 letters about promotional material to drug companies. Of the 212 warning letters among them, 98% were aimed at digital platforms, according to VAB, and 201 concerned branded websites. TV ads were named in 52 letters over the same period. Forty-eight of those were untitled letters, a lower tier of FDA correspondence.

Prescription drug commercials have also grown longer. Units of 45 seconds or more made up 80% of pharma Rx TV ad units in the second quarter of 2026, up from 68% two years earlier. VAB connects the change to regulatory pressure. Its own quarterly figures show that most of it happened before the FDA acted.

In Short

A group that speaks for TV companies published a guide about drug commercials, and its numbers show drug makers now spend almost three times as much on online ads as on TV ads. Over the past year, the US drug regulator sent most of its warning letters about drug websites, while drug commercials on TV kept getting longer, with most now running a minute or more. The group says TV ads push people to search for medicines, visit drug websites and ask their doctors about them. Its own charts show the commercials were already getting longer before the regulator acted, and some of its spending numbers do not match a report the same group published in May.

What VAB released

The full title is "The Pharmacy: A Supply of Vital Insights Answering Seven Key Questions in the Pharma DTC Category." According to VAB's announcement, dated November 3, 2026 in New York, the guide distills 18 months of "house calls" with agencies, media publishers, conference organizers, trade publications and other stakeholders. The seven questions cover the "patient-driven" case for pharma TV advertising, minority audiences, the category's advertising investment, the effect of the FDA's crackdown, ad unit lengths, Spanish-language TV, and the effect of multiscreen TV on patient discovery, education and sales.

The guide defines pharma DTC, or direct-to-consumer pharma advertising, as "the marketing and advertising of prescription remedies / pharmaceutical products directly to consumers as patients." Every page carries the line "This information is exclusively provided to VAB members and qualified marketers."

VAB calls the document a "one-stop shop" that updates its earlier pharma research. Those reports include "Dedicated to Your Good Health," "Why banning Pharma TV ads would disproportionately affect minority groups," "How Premium Video Drives Sales in the Pharmaceutical Category" and "How has the FDA's crackdown on deceptive drug advertising affected multiscreen TV?" The last of those appeared in May, and PPC Land reported its headline finding, a 53% jump in pharma TV spending after the crackdown, on May 31.

"The evidence is compelling: pharmaceutical advertising plays a profound role in the patient journey, and multiscreen TV proves instrumental at every step, from discovery to education to informed decision-making," said Jason Wiese, executive vice president, strategic insights and measurement, at VAB. "As questions arise about the future of pharma advertising, The Pharmacy cuts through the noise with clear, data-backed answers."

Audience data is VAB's analysis of MRI-Simmons' Spring USA studies from 2019 to 2026. Spending and ad-length data come from Nielsen Ad Intel, the competitive tracking platform to which Nielsen added an AI query layer in July, with data as of September 25, 2026. The FDA counts are VAB's tally of letters published on the agency's website as of October 7, 2026. Digital spending is an eMarketer forecast from August 2026. The sales analysis draws on company filings with the Securities and Exchange Commission, search interest data and Comscore website traffic data.

VAB's position matters for reading all of it. The organization says it plays "a dual role" in video advertising: it is "fiercely advocating for the changes that bring about a more innovative and transparent marketplace," and it supplies insights to marketers. Its members include "premium multiscreen TV providers and distributors." The guide does not describe any outside review of its analysis.

Where pharma's ad money goes

TV against digital

VAB's chart of category spending covers four years.

Digital spending grew in every year shown. TV peaked in 2024. The chart's subtitle concedes the gap: "Although there is more than twice as many pharma ad dollars spent in digital than invested in TV, consumers are much more likely to get remedy information from TV ads."

The two lines are not measured the same way. TV is VAB's analysis of Nielsen Ad Intel, covering cable, network, Spanish-language cable and network, spot, syndication and streaming, and excluding promos and public service announcements. Digital is eMarketer's forecast, which the guide says "includes pharma category advertising that appears on desktop and laptop computers as well as mobile phones, tablets and other internet-connected devices," with CTV among them. Both series therefore contain some streaming TV advertising. The guide adds them together to reach "over $25 billion" a year without saying whether any spending is counted twice.

Prescription brands and corporate campaigns

Total pharma TV spending has hovered around $7 billion. VAB splits it into prescription remedy advertising and corporate branding by "pharma houses."

Prescription brands spent $5.1 billion in 2019, $5.3 billion in 2020, $5.5 billion in 2021, $5.0 billion in 2022, $5.6 billion in 2023, $6.6 billion in 2024 and $6.5 billion in 2025. Corporate branding ran from $0.1 billion in 2019 to a peak of $0.7 billion in 2022, and stood at $0.4 billion in 2025. VAB's headline figure, prescription spending "up +29% over the last three years," compares 2025 with 2022, the lowest year in the series. Measured against 2024, prescription TV spending fell by about 1.6%, according to PPC Land's calculation from VAB's figures of $6,487.7 million and $6,590.8 million.

The guide also compares drug brands with the telehealth companies that have become regular TV advertisers. Telehealth, which VAB defines through Nielsen's online retail-drug and online medical services categories and illustrates with Ro, Mochi Health, Hims & Hers, LifeMD and SingleCare, spent $64.4 million on TV in 2023, $158.5 million in 2024, $183.9 million in 2025 and $136.2 million in the first half of 2026. Prescription brands spent $5,560.1 million, $6,590.8 million, $6,487.7 million and $3,468.9 million in the same periods. VAB rounds the gap to "40x." The totals, $22.1 billion against $543 million, give a ratio of 40.7, by PPC Land's arithmetic. Telehealth's growth shows up elsewhere: telemedicine applications to the ad certifier LegitScript rose 101% in a year.

The biggest spenders

Twenty brands accounted for 62% of the $6.5 billion in prescription drug TV advertising in 2025, according to VAB. Their combined spending was $4.03 billion, by PPC Land's sum of VAB's figures. Most treat chronic or serious conditions.

Tremfya led with $485.1 million, ahead of Skyrizi at $474.4 million and Rinvoq at $439.1 million. Dupixent followed at $333.6 million, Wegovy at $311.7 million, Rexulti at $241.5 million and Zepbound at $209.6 million. Five of the 20 treat obesity or diabetes: Wegovy, Zepbound, Jardiance, Ozempic and Mounjaro. Biktarvy, an HIV treatment, closed the list at $83.8 million. In 2024, the top 20 brands took 55% of category TV spending, according to VAB.

By therapeutic area, obesity remedies led 2025 TV spending with $539.5 million, up 37% from $392.4 million. Crohn's disease was second at $526.4 million, up 52%. Psoriasis ($477.7 million), eczema ($461.0 million, up 17%), cancer ($380.1 million, up 11%), depression ($378.2 million, up 33%) and type 2 diabetes ($363.6 million) completed the top seven. The steepest increases came from small bases. Schizophrenia remedies went from $2.0 million to $71.6 million, a rise VAB puts at 3,565%. Hypertrophic cardiomyopathy grew 227% to $76.9 million, and psoriatic arthritis 136% to $92.2 million.

Advertising as a share of costs

One page addresses an argument that runs through debates about drug ads: whether advertising inflates prices. VAB took the 2025 annual reports of six drug makers, Pfizer, AbbVie, Merck, Eli Lilly, Bristol Myers Squibb and Amgen. Their combined revenue was $338.9 billion and their expenses $248.8 billion. Advertising expenses totaled $12.3 billion, or 4.9% of expenses and 3.6% of revenue. Cost of sales and research and development took 35% and 32% of expenses on average.

Lilly had the highest advertising share of expenses at 7.4% ($2.9 billion), and Bristol Myers Squibb the lowest at 3.3% ($1.3 billion). The source line says the figures are global, and they cover all advertising, not only TV.

From these numbers VAB concludes that advertising "is such a limited expense to pharmaceutical companies' bottom line (and at a fraction of other much larger expenses) that any fluctuations to this wouldn't affect drug prices." The guide contains no analysis of drug pricing to support that last step.

The FDA's letters

What happened in September 2025

The guide opens its regulatory section with seven news headlines from September 9 and 10, 2025, from The Wall Street Journal, Politico, The New York Times, CNBC, Reuters, TheWrap and NPR. The Times summary it reproduces reads: "The administration is proposing a return to a 1990s-era policy that kept most drug ads off TV. That could dent the revenues of drugmakers and major networks." TheWrap's summary says HHS and the FDA "will close a 1997 loophole that allowed drug companies to limit the number of side effects disclosed in TV commercials, while stepping up violation enforcement efforts."

That background explains why a TV trade body tracks the letters so closely. A rule that forced more side effects into commercials, or pushed drug ads off the air, would land directly on VAB's members.

Letters by platform

VAB sorted the FDA's communications-related letters by the platform each one concerned. The guide notes that some letters referenced more than one platform, so platform counts do not always add up to the totals.

The difference between the two kinds of letter matters. According to the guide's definition, "Untitled letters are used for violations that do not meet the threshold of regulatory significance for a warning letter. Unlike a warning letter, an untitled letter does not include a statement that warns the individual or firm that failure to promptly correct the violation may result in enforcement action."

Read with that in mind, the table tells two stories. Formal warnings went overwhelmingly to websites: 201 of 212 over the year, and 109 of 112 in 2026 alone. VAB's headline for the nine months to September reads "only one was for a TV ad." TV commercials were not ignored, though. They drew 52 letters in the year, the second-largest platform after branded websites, and 42 of them came between September 9 and the end of 2025. Untitled letters then thinned out, from 60 in that period to 24 in the first nine months of 2026.

The remaining platforms appear only a handful of times each over the 12 months, led by promotional videos (8), YouTube (4), sponsored links (3) and social media (3). A podcast, a CTV ad, a print ad and a Microsoft Teams branded background were each named once. Digital platforms accounted for 65% of all letters sent on September 9, 72% of those sent through the end of 2025, 90% in 2026 and 80% across the year, according to VAB.

Some of the counts differ slightly from VAB's May report. That analysis, as PPC Land reported, put the September 9 letters at 59 warning letters for brand website content and 34 untitled letters for TV ads. The new guide shows 58 and 35. Its own subtitle for September 9 says "120+" letters were sent, while the footnote gives 118.

TV spending after the crackdown

VAB measures the crackdown's effect on spending by comparing the nine months from October to June across three years. Prescription brands spent $5.01 billion from October 2023 to June 2024, $4.89 billion from October 2024 to June 2025, a 2% decline, and $5.39 billion from October 2025 to June 2026, a 10% increase. The number of prescription brands active on TV went from 155 to 159 to 177, up 11% in the latest period.

VAB's takeaway is direct: "The marketplace clarity provided by the FDA's actions spurred increased investment across multiscreen TV platforms over the nine months following the crackdown, with an 11% increase in Pharma Rx advertisers and 10% increase in total TV vs. previous period." The guide offers no evidence beyond the timing to show that one caused the other.

The May figures do not reconcile

The new numbers are hard to square with VAB's May report. That report, according to PPC Land's coverage, put prescription brands' multiscreen TV spending for October 2025 to March 2026 at $4.95 billion, up 53% from $3.23 billion a year earlier. It gave $1.86 billion for the fourth quarter of 2025 and $3.09 billion for the first quarter of 2026, a 94% increase.

The guide's nine-month total, $5.39 billion, is only $0.44 billion above May's six-month figure. If both were right, prescription TV spending in April to June 2026 would have been about $0.44 billion. The two reports' prior-year figures imply roughly $1.66 billion for the same quarter of 2025 ($4.89 billion minus $3.23 billion). The guide's telehealth chart points the same way: it puts prescription TV spending for the first half of 2026 at $3.47 billion, which would leave about $0.38 billion for the second quarter if May's first-quarter figure still stood. These are PPC Land's calculations from VAB's published numbers.

Either second-quarter spending collapsed by roughly three-quarters, which would contradict the guide's own story of post-crackdown growth, or the earlier figures were revised downward. The guide mentions neither the 53% figure nor any revision.

Longer ads

The quarterly record

The ad-length data, from Nielsen Ad Intel's distribution of national TV commercial units by duration, cover national broadcast, national cable, Spanish-language broadcast and cable, and streaming, from January 2024 to June 2026. Promos, PSAs, vignettes and sponsorships are excluded.

VAB's headline, "increased from 68% to 80%," starts from the lowest quarter in the series. Measured from the first quarter of 2024, the gain is six points. Most of the movement also came before September 2025. The share climbed 11 points between the second quarters of 2024 and 2025, then held between 80% and 82% in the four quarters that followed. VAB's direct comparison of the three quarters before and after the crackdown, October 2024 to June 2025 against October 2025 to June 2026, shows units of 45 seconds or more rising from 77% to 81% and their share of commercial time from 88% to 91%.

The mix shifted inside that band. In the second quarter of 2025, 60-second units made up 55% of pharma Rx ads, 75-second units 8% and 90-second units 5%. A year later, 60-second units were 67%, while 75-second and 90-second units had fallen to 3% and 1%. Thirty-second spots slipped from 18% to 15%. Within the longer formats, the shift went to the standard 60-second slot and away from 75-second and 90-second units.

So did the crackdown push pharma into longer ads? VAB's explanation is compliance. According to the guide, "Rx brands are being more mindful of proactively adhering to pharma advertising rules and regulations across multiscreen TV platforms as they present a fair balance between their product's risks and benefits and include information regarding major side effects and considerations." Longer spots leave more room for risk information, which is the issue TheWrap's summary of the September 2025 announcement describes. The guide does not show the content of the ads, so the data measure length, not what fills it.

Pharma against everyone else

Between January 2024 and June 2026, 68% of pharma Rx TV ad units ran 60 seconds or longer, against 4% for all other categories combined. Measured by commercial time, the split was 80% against 18%. Prescription drugs accounted for 49% of every TV ad unit of 60 seconds or more in that period. Professional services, the legal, referral and warranty advertisers, came second with 11%, and all other categories shared the remaining 40%. VAB rounds the ratio between pharma and professional services to "4x"; the figures give about 4.5.

Within pharma, the longest formats cluster in particular conditions. Rheumatoid arthritis, depression and tardive dyskinesia ran 100% of their units at 60 seconds. Alzheimer's was at 99% (plus 1% at 75 seconds), HIV at 90% (plus 10% at 90 seconds), bipolar disorder at 91% and age-related macular degeneration at 86% (plus 14% at 75 seconds). Diabetes split 57% at 60 seconds and 43% at 75 seconds. Cancer remedies ran 42% at 60 seconds, 27% at 75 seconds and 31% at 90 seconds. Obesity was the outlier: 57% of its units ran 90 seconds, 21% ran 75 seconds and only 7% ran 60 seconds.

The May report used a different threshold, units longer than 30 seconds, and put the share at 82% for October 2025 to March 2026 against 76% a year earlier. Since pharma units under 45 seconds are 15-second and 30-second spots, the two measures match.

Spanish-language television

Prescription brands spent $233.7 million on Spanish-language broadcast and cable networks from October 2025 to June 2026, up 65% from $141.4 million a year earlier. Two years earlier, the same period brought $163.0 million. The number of brands on Spanish-language TV almost doubled, from 14 to 27, after falling from 17.

The base remains small. Spanish-language networks took between 3.1% and 6.3% of prescription brands' national TV spending in each quarter from 2023 to mid-2026, with an average of 4.5%. It has been above 5% in three of the four quarters since July 2025. VAB's network list covers seven broadcasters, including Telemundo, Univision and UniMas, and 15 cable networks.

Few prescription advertisers use these networks at all. VAB counts 14 national TV advertisers on Spanish-language networks in 2023 (8.4% of the total), 22 in 2024 (14.0%), 28 in 2025 (15.8%) and 22 in the first half of 2026 (13.9%). VAB reads that as room to grow.

Spending there is concentrated. HIV remedies accounted for $253.6 million of Spanish-language prescription TV spending between 2023 and mid-2026, or 29.9%. Eczema ($87.9 million), diabetes ($81.5 million), Crohn's disease ($80.4 million), vaccines ($71.7 million) and obesity ($71.7 million) followed. Obesity's arrival is recent: nothing in 2023, $1.9 million in 2024, $19.5 million in 2025 and $50.4 million in the first half of 2026. The 12 largest categories took 97.6% of Spanish-language spending, against 64.3% for the 12 largest on English-language networks.

Spanish-language pharma ads also run longer. The share of units at 60 seconds or more rose from 62% in the second quarter of 2024 to 81% in the second quarter of 2026, averaging 74% over ten quarters. That series moves more sharply than the national one: it reached 84% in the second quarter of 2025, before the crackdown, then fell to 70% in the third. For all other categories on Spanish-language TV, the share was 6%.

Other research has pointed at the same audience. EDO found Spanish-language TV ads produced 24% more effect per viewer than English-language ads in a report covering August 2025 to July 2026, and VAB's World Cup analysis credited Spanish-language networks with 28% of the tournament's average audience.

The audience case

Patients, according to MRI-Simmons

VAB's first question, the "patient-driven" case, rests on survey data. According to its analysis of MRI-Simmons' Spring 2026 study, 77% of US adults, or about 204 million people, had a medical ailment in the previous 12 months, 13 million more than in 2021. Backache or back pain affected 71.8 million (27%), allergies 50.0 million (19%), high blood pressure 46.9 million (18%), high cholesterol 46.7 million (18%) and heartburn 44.5 million (17%). Among those with an ailment, 76%, or 153.8 million adults, used a prescription remedy, up 18.1 million since 2021. The guide's definition of prescription remedy covers both branded and generic drugs.

Attitude questions point the same way. According to VAB, 62% of adults said they research treatment options on their own before asking a doctor, 75% look for as much information as possible before taking a drug, and 70% agreed: "I always do what my doctor tells me to do."

The TV link comes through heavy viewers, defined as the top viewing quintile: men who watch 49.5 hours or more a week and women who watch 53 hours or more. They over-index on 14 of the 15 most common ailments, with diabetes at 174 and arthritis at 160. Of heavy viewers, 39% had taken an action after seeing a healthcare ad, an index of 113 against all adults. They were 39% more likely to have asked a doctor to prescribe a specific drug and 35% more likely to have discussed an ad with a doctor.

Asked where they had obtained information about an ailment or prescription drug, adults were seven times as likely to name TV ads as magazine ads, three times as likely as direct mail, 53% more likely than websites or apps and 37% more likely than social media. The website comparison excludes health information sites and apps. Against social media, the margin was 20% among adults aged 18 to 49 and 66% among those 50 and over.

Minority audiences

The second question repeats an argument from VAB's earlier report on why banning pharma TV ads would "disproportionately affect minority groups." In 2026, 82% of non-Hispanic white adults reported an ailment, against 72% of Black, 71% of Hispanic and 63% of Asian adults. Since 2019, the number of sufferers grew 23% among Hispanic adults, 20% among Black adults, 15% among non-Hispanic white adults and 9% among Asian adults. Prescription use among sufferers stood at 77% for non-Hispanic white and Black adults and 70% for Hispanic and Asian adults.

According to VAB, 41% of Hispanic adults, 39% of Black adults and 33% of Asian adults had taken an action after a healthcare ad, against 32% of non-Hispanic white adults. Black adults were 93% more likely than non-Hispanic white adults to have called a toll-free number and 56% more likely to have consulted a pharmacist. TV ads beat social media as an information source for every group except Asian adults, who were 12% less likely to cite TV ads than social media.

VAB reads the narrowing gap in prescription use as evidence of "the critical role that advertising plays in terms of both awareness and action among minority groups." The survey records prescription use and ad response separately; it does not tie one to the other. The guide's summary page also misstates its own figures. It says Black adults are 27% and Hispanic adults 24% more likely to act after an ad, while the detailed pages give indexes of 122 for Black adults and 127 for Hispanic adults. VAB made a related case in June, when its report on Black audiences compared TV with TikTok and other social platforms.

Searches, site visits and sales

What VAB measured

The last question, TV's effect on discovery, education and sales, uses 17 of the top 20 prescription TV advertisers of 2024, the ones whose parent companies are publicly traded. The brands are Skyrizi, Rinvoq, Breztri, Wegovy, Tremfya, Vraylar, Ozempic, Otezla, Camzyos, Ingrezza, Dupixent, Eylea, Arexvy, Sotyktu, Caplyta, Keytruda and Botox. VAB looks at three stages: online searches, website visits and US sales revenue.

Searches

For searches, VAB used Google Trends, comparing each brand's weekly search index before and after its first TV campaign. Ozempic's index reached 2.4 times its previous week's level in the week its first TV campaign began on July 29, 2018, seven months after FDA approval. Other launch-week jumps ranged from 1.4 times for Vraylar, which went on air 29 months after approval, to five times for Ingrezza, which waited 49 months, and Sotyktu, which waited five.

According to VAB, 14 of 16 brands, or 88%, recorded their highest branded search interest after their TV campaign launched. Botox was excluded because its first TV ad aired in 2002, before Google Trends data began in 2004. The guide notes that the spikes occurred "presumably after search & social campaigns began for many brands," an acknowledgment that other media were probably already running when TV started. Google Trends gives relative interest within a chosen window, not absolute search volume, and the guide does not say which two brands peaked before TV. VAB used the same method in August for its World Cup report.

Website visits

For website traffic, VAB used Comscore data for the eight brands whose sites were measured throughout: Dupixent, Ozempic, Tremfya, Skyrizi, Ingrezza, Botox, Keytruda and Otezla. Monthly unique visitors averaged 214,000 between July 2021 and December 2023 and 388,000 between January 2024 and June 2026, an 81% increase. Average monthly US TV spending for the same brands rose 34%, from $13.5 million to $18.1 million. The guide's methodology page describes the traffic window as July 2021 to June 2025; the results page uses June 2026.

Sales

The sales analysis compares revenue reported in SEC filings with TV spending for the 17 brands.

Revenue rose 163% over four years, a compound annual rate of 27%, while TV spending rose 85%, or 17% a year. VAB's headline states that "increased mid-funnel results driven by higher TV investment has more than doubled the collective sales of the 17 brands over the last four years."

The table supports a narrower reading. Revenue grew much faster than TV spending, so TV fell from 4.3% of these brands' revenue in 2021 to 3.0% in 2025, by PPC Land's calculation. In the final year, TV spending fell 9% while revenue rose 14%. The group includes Ozempic and Wegovy, and the guide does not show how much of the combined growth came from them. Their US revenue, like that of Dupixent and Arexvy, was reported in foreign currency, and the guide does not state a conversion method. The guide's methodology page gives the revenue window as 2021 to 2024, while the table runs to 2025.

Brand-level examples follow. Skyrizi's US revenue rose 512% between 2021 and 2025, from $2,486 million to $15,202 million, while its TV spending rose 174%, from $167 million to $457 million. Caplyta's revenue rose 757%, from $82 million to $700 million, with TV up 424% to $175 million. Breztri's revenue rose 434% to $614 million while its TV budget grew only 41%, to $83 million. VAB calls these "a tight correlation." The TV figures in these tables leave out streaming, and some differ slightly from the top-20 ranking, which includes it: Tremfya shows $477 million rather than $485.1 million.

Nothing in the analysis separates TV's contribution from new approvals and indications, insurance coverage, pricing or the brands' other media. It uses company revenue rather than prescription data, so it does not measure script lift, the change in prescriptions attributed to a campaign. VAB's chart titles nonetheless state the causal case outright, as in "TV drives a direct impact on sales."

Why this matters for marketers

For digital marketers, the guide's most useful numbers are not the ones VAB emphasizes. Pharma's digital spending, by eMarketer's estimate, reached $18.7 billion in 2025, and the FDA's formal enforcement over the past year concentrated on brand websites. Of 212 warning letters, 201 named a branded website. The letters also cited sponsored links, YouTube videos, social media posts, emails and a podcast, so the scrutiny reaches well beyond the commercials VAB's members sell. StackAdapt cited projections of more than $20 billion in US healthcare digital advertising for 2026 when it brought self-serve NPI targeting to pharmaceutical advertisers in January.

The platforms have been adjusting. Google began a small US test of healthcare ads in AI Mode in May, excluding creatives that use text disclaimers. DeepIntent built a live sports CTV offer around pharma budgets in June, and Doceree tied CTV and LinkedIn campaigns to 6 million verified physician identities in September. Outside approved medicines, LegitScript found online ads for unapproved peptides up 208% in 2024.

Measurement is the other issue. VAB's "multiscreen TV" counts streaming alongside linear TV, and the split matters for any reading of pharma's TV totals. iSpot estimated that streaming took 48.7% of US national TV ad spend in the third quarter of 2026 while delivering 21.9% of impressions. VAB's guide does not break pharma spending down by linear and streaming at all.

The guide also belongs to a run of VAB research comparing its members' premium video with platforms such as YouTube, including The Impression Gap, published with TVision in February. Like those reports, The Pharmacy compiles a large amount of data and frames it toward conclusions that favor TV. Here the compilation holds up better than the conclusions. The longer ads, the concentration of warning letters on websites and the growth of Spanish-language spending are all visible in the figures. The claims that the crackdown drove TV investment, that TV drove sales and that ad budgets cannot affect drug prices rest on timing and correlation. The guide leaves its spending figures for the first half of 2026 unexplained.

Timeline

• 1997 - The FDA policy that TheWrap later described as a "loophole" allowing drug companies to limit the number of side effects disclosed in TV commercials.
• 2002 - Botox airs its first TV ad, before Google Trends data begins in 2004.
• July 29, 2018 - Ozempic launches its first TV campaign; its Google Trends index reaches 2.4 times the prior week.
• 2021 - The 17 brands in VAB's sales analysis record $37.6 billion in US revenue and $1.6 billion in TV spending.
• Second quarter of 2024 - Pharma Rx units of 45 seconds or longer fall to 68%, the low point of VAB's series.
• 2024 - Pharma TV spending peaks at $7.2 billion; digital reaches $15.5 billion.
• Second quarter of 2025 - Units of 45 seconds or longer reach 79%.
• September 9, 2025 - The Trump administration announces its crackdown on drug advertising; the FDA sends 118 communications-related letters, 66 of them warning letters.
• September 10, 2025 - TheWrap and NPR report the memo directing the FDA to act.
• December 13, 2025 - PPC Land reports LegitScript data showing online ads for unapproved peptides up 208%.
• December 31, 2025 - The FDA's tally since September 9 reaches 160 letters, 100 of them warning letters.
• 2025 - Pharma TV spending falls 4% to $6.9 billion while digital rises 21% to $18.7 billion; 20 brands account for 62% of $6.5 billion in prescription TV spending.
• January 6, 2026 - StackAdapt brings self-serve NPI targeting to pharmaceutical advertisers.
• February 24, 2026 - VAB and TVision publish The Impression Gap.
• May 2026 - VAB's earlier FDA report puts October 2025 to March 2026 pharma Rx TV spending at $4.95 billion, up 53%; PPC Land covers it on May 31.
• May 2026 - Google confirms a small US test of healthcare ads in AI Mode.
• June 2026 - DeepIntent launches a live sports CTV suite aimed at pharma budgets.
• June 2026 - VAB publishes its report on Black audiences, TV and social media.
• June 30, 2026 - End of VAB's nine-month comparison: $5.39 billion in pharma Rx TV spending, up 10%; Spanish-language spending up 65% to $233.7 million.
• July 27, 2026 - Nielsen launches Ad Intel AI.
• August 2026 - eMarketer forecast used for the guide's digital spending figures; VAB's World Cup report uses Google Trends to track brand searches.
• September 2026 - Doceree ties CTV and LinkedIn ads to verified physician IDs.
• September 22, 2026 - LegitScript reports telemedicine applications up 101% in a year.
• September 25, 2026 - Cut-off date for the Nielsen Ad Intel data in the guide.
• September 30, 2026 - End of the 12-month FDA count: 296 letters, 212 warning letters, 98% of warnings aimed at digital platforms.
• September 30, 2026 - EDO publishes its Spanish-language TV outcomes report.
• October 7, 2026 - Cut-off date for VAB's tally of FDA letters.
• October 26, 2026 - PPC Land reports iSpot's estimate that streaming took 48.7% of US national TV ad spend in the third quarter.
• November 3, 2026 - VAB releases The Pharmacy.

Related PPC Land coverage

• Pharma TV spend jumps 53% after FDA crackdown on deceptive drug ads - VAB's May analysis of pharma TV spending, FDA letters and ad length after September 2025.
• Spanish-language TV ads beat English ones by 24% per viewer, EDO finds - EDO's third annual report on Spanish-language TV ad outcomes.
• TV beats social for Black audiences - and the numbers are staggering - VAB's June report comparing TV and social platforms among Black viewers.
• Casamigos gains 2x brand searches on $19.5M of World Cup TV spend - VAB's World Cup report, which used Google Trends indexes to track brand searches after TV airings.
• VAB and TVision report: premium video beats YouTube on every CTV metric - The Impression Gap study comparing premium video platforms with YouTube.
• Streaming takes 48.7% of US TV ad spend on 21.9% of impressions, iSpot finds - iSpot's third-quarter 2026 split of national TV spending between streaming and linear.
• Nielsen gains real-time view of 5.5 million brands with Ad Intel AI - The Nielsen ad tracking platform behind VAB's spending and ad-length data.
• Google breaks healthcare ad ban in AI Mode with a small US test - Google's limited test of healthcare ads in AI Mode.
• DeepIntent bets pharma budgets on live sports CTV with verified inventory - A healthcare DSP's live sports offer for pharma advertisers.
• Doceree ties CTV and LinkedIn ads to 6 million verified physician IDs - Healthcare professional targeting extended to CTV and LinkedIn.
• StackAdapt brings self-serve NPI targeting to pharmaceutical advertisers - Self-serve physician targeting and the projected size of US healthcare digital advertising.
• Telemedicine applications to ad certifier LegitScript jump 101% in a year - Growth in telehealth advertisers seeking certification for health ads.
• Unapproved peptides ads surge 208% as marketplaces see 276% sales growth - LegitScript research on online advertising for unapproved drugs.

Summary

Who: The Video Advertising Bureau, a trade body whose members include premium multiscreen TV providers and distributors, and Jason Wiese, its executive vice president of strategic insights and measurement. The guide covers prescription drug advertisers including Tremfya, Skyrizi, Rinvoq, Dupixent, Wegovy and Zepbound, the FDA's enforcement against drug promotion, and telehealth advertisers such as Ro and Hims & Hers.

What: An 81-page guide, The Pharmacy, answering seven questions about pharma direct-to-consumer advertising. It shows pharma TV spending falling 4% to $6.9 billion in 2025 while digital rose 21% to $18.7 billion; 296 FDA letters in the year after September 9, 2025, with 98% of 212 warning letters aimed at digital platforms and 52 letters naming TV ads; a 10% rise in prescription TV spending in the nine months after the crackdown; and an increase in pharma Rx ad units of 45 seconds or longer from 68% to 80% between mid-2024 and mid-2026. Its nine-month spending total does not reconcile with VAB's May report without either a near-collapse in second-quarter 2026 spending or a revision of earlier figures.

When: Released November 3, 2026. Nielsen data run to June 2026, as of September 25, 2026; FDA letters run to September 30, 2026, as of October 7, 2026.

Where: United States, covering national broadcast, cable, Spanish-language, spot, syndicated and streaming TV, plus eMarketer's estimate of pharma digital advertising.

Why: VAB argues that TV drives patient discovery, education and drug sales, and that the FDA's actions brought "marketplace clarity" that increased TV investment. For marketers, the figures show where pharma money and FDA scrutiny are concentrated: the bulk of the budget, and nearly all formal warnings, sit in digital channels and on brand websites, while TV commercials are getting longer. The guide's causal claims rest on timing and correlation rather than controlled analysis.