The Justice Department said the speaker programs and other promotional events occurred from 2002 to 2011, while the co-payments were made from 2010 to 2014.
In connection with the settlements, Novartis agreed to curtail its speaker programs and enter a five-year corporate integrity agreement.
It also accepted responsibility for many allegations underlying the larger settlement, for which it set aside funds in July 2019.
"We are a different company today, with new leadership, a stronger culture and a more comprehensive commitment to ethics," CEO Vas Narasimhan said in a statement.
The $678 million payout includes $591.4 million in damages to the U.S. government, a $38.4 million forfeiture for violating an anti-kickback statute and $48.2 million to U.S. states.