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Pfizer and AstraZeneca have retained their crowns as the most transformative companies in the industry, according (PDF) to IDEA Pharma.

On IDEA’s annual Innovation and Invention Index, Pfizer and AZ commanded the top spots for the second straight year. IDEA, a consulting firm that helps companies strategize their drug discovery and marketing, has conducted the rankings for 12 years, with one index weighing innovation and another for invention.

While the invention index measures how well companies brought technologies together to create new products that address unmet needs, the innovation index measures how well companies perform in bringing new medicines to market and commercializing them.

Pfizer seized the top spot in the innovation rankings through the development and delivery of its COVID-19 products. Its Comirnaty vaccine generated sales of $38 billion in 2022, while oral antiviral Paxlovid produced $18.9 billion in revenue.

Pfizer also showed its “adaptability and agility” in creating an updated vaccine to defend against omicron subvariants, IDEA said. Aside from Pfizer’s success with COVID products, IDEA also pointed to eight other regulatory nods and four key acquisitions to strengthen its pipeline. Pfizer also placed No. 4 in the invention category.

As for AZ, which won the invention title for the second straight year, its high R&D success rate was key. The company won 34 approvals in the top four markets (U.S., Europe, China, Japan) and achieved 29 pipeline progression events, IDEA said. Of AZ’s 179 pipeline candidates, 155 are in clinical trials.

“While several large pharma players have similarly broad pipelines, what set (AZ) apart was the potential of its products to have an outsized impact in disease areas with populations with high unmet needs,” IDEA wrote.

AZ also ranked No. 3 in the innovation index as it achieved a $7 billion increase in revenue in 2022.

Elsewhere in the industry, Johnson & Johnson ranked No. 2 in innovation and invention after slotting at No. 4 in both categories last year. While Stelara ($9.7 billion) and Darzalex ($7.9 billion) helped J&J to another big revenue year, IDEA cited the key approval of new innovative multiple myeloma drugs Carvykti, a CAR-T treatment, and Tecvayli, the first BiTE therapy for the indication.

The biggest mover was Boehringer, which vaulted from No. 27 a year ago to No. 6 this year, propelled by the first-ever FDA approval to treat generalized pustular psoriasis in addition to gaining four breakthrough-therapy and four fast-track designations. The company also saw a $7 billion increase in revenue in 2022.

Another big mover was Lilly, which ranked No. 1 in innovation two years ago before tumbling to No. 19 last year.

There was much less turnover in the invention index top 10, as three companies entered—No. 3 Regeneron, No. 6 Merck and No. 10 Vertex. Regeneron’s surge from No. 13 was prompted by novel indications for blockbuster Dupixent and an approval for lung cancer drug Libtayo.