Dimethyl fumarate

As companies reported their fourth- quarter and 2025 sales, guidances for 2026 were particularly noteworthy as most companies are projecting a decline in growth. Twelve months ago, drugmakers came roaring into 2025, fueled by a massive year of growth that peaked in the fourth quarter of 2024. Now, the momentum has dissipated, and most companies are bracing for a slowdown in sales heading into 2026. In fact, over the last few weeks of earnings reports, drugmakers' financial results were less noteworthy than their guidances. Of 25 companies with quarterly revenue of at least $2 billion that had reported through March 5, just five projected that their sales would grow at a higher rate in 2026 than in 2025, with each of those increases slight.The pharmas offered a variety of reasons—macro and micro—for their pessimistic 2026 projections. Several mentioned pricing effects related to the Inflation Reduction Act (IRA), as well as U.S. President Donald Trump’s most-favored-nation plan and his threats of tariffs on pharmaceutical products. An anticipated decline in vaccine sales, linked to a demand shortfall in the U.S., also plays into the computation for several companies, while many others are dealing with the loss of exclusivity (LOE) of blockbuster products.The drugmaker with the most surprising projection was Novo Nordisk, which recently stunned analysts with an estimated revenue decline of between 5% and 13% in 2026.The dismal estimate is difficult to fathom, coming as the company still is awash in the success of its groundbreaking metabolic medicines Ozempic and Wegovy. The combined sales of the semaglutide drugs came out to $31.2 billion last year, up 15% from 2024. Additionally, the Danish company reported strong launch metrics last month for its highly anticipated GLP-1 obesity pill.The first signs of a sales shortfall, however, came in the third quarter of last year when Novo reported a revenue increase of just 5%. That came after 12 straight quarters of double-digit year-over-year growth. Then, in the fourth quarter of 2025, Novo’s sales declined by 8% year over year.  Novo CEO Mike Doustdar blamed “unprecedented pricing pressures” for his company's anticipated 2026 sales slide, citing “intensifying competition” and the MFN pricing deal the company struck with the Trump administration last fall. Other drugmakers projecting a revenue slide in 2026 include Bayer, Biogen, Bristol Myers Squibb, Pfizer and Teva. After a 1% drop in sales from its pharma business in the fourth quarter, Bayer is now expecting (PDF) a decline between 0% and 3% in 2026, largely attributed to declining sales of eye disease treatment Eylea and blood thinner Xarelto. Both drugs were already in decline last year, but the effect will be more pronounced in 2026, the company warned. The good news is that Bayer expects taking a big hit in 2026 will set the pharma business up for a mid-single-digit sales increase in 2027, which should persist to the end of the decade.  Following five straight years of revenue declines, Biogen saw a 2% increase in its sales in 2025. But the company expects the gain to be short-lived, projecting a 5% revenue decline at the midpoint of its 2026 guidance. Headwinds to growth include erosion in Europe for multiple sclerosis treatment Tecfidera and the recent introduction of biosimilar competition for another of its MS drugs, Tysabri. Those effects impacted sales in the fourth quarter of last year, which were down 7%.For its part, BMS is projecting (PDF) a 3% decline at the midpoint of its 2026 revenue projection. If that forecast holds true, it would mark the second straight year for BMS with a drop in annual sales, which landed at $48.3 billion in 2024 and slipped ever-so-slightly to $48.2 billion in 2025. The company cited declining sales of its legacy products, which were down 16% in 2025, for the revenue decline. That roster of aging products includes blood cancer blockbusters Revlimid and Pomalyst. Declining sales of generic Revlimid also account for an expected overall revenue slide for Teva this year. The Israeli company projects it will make $1.1 billion less from its Revlimid copycat and is projecting a 4% decline overall at the midpoint of its 2026 revenue guidance. This comes after three years of annual sales increases for the company, including a 4% bump in 2025. Another factor in the expected contraction for Teva is declining sales from its generics business as the company continues its makeover favoring development of its innovative portfolio of products.As for Pfizer, which revealed (PDF) its guidance in December of last year, the company similarly expects a 3% year-over-year sales decline at the midpoint of its 2026 revenue window, which was $61 billion. It would be Pfizer’s second straight year with a sales decline from $63.6 billion in 2024 and $62.5 billion in 2025. The company referenced an anticipated $1.7 billion decline in sales of its COVID products—from $6.7 billion in 2025 to a projection of $5 billion in 2026. It also expects to sustain a $1.5 billion hit from exclusivity losses on certain products this year. Pfizer also warned that its down revenue trajectory is likely to continue as those LOEs escalate in the coming years—to $3 billion-plus in 2027 and $6 billion-plus in 2028, according to the company.  Just 6 companies expect increased growth in 2026Companies that are projecting higher growth in 2026 compared to 2025 are AbbVie, Johnson & Johnson, Merck, Sanofi, Vertex and Viatris, although each expects only a slight increase.AbbVie anticipates continuing its roll with autoimmune juggernauts Skyrizi and Rinvoq, projecting combined sales of the drugs will exceed $31 billion in 2026, compared to $25.8 billion last year. The company predicts its overall revenue will reach $67 billion this year, which would represent 9.5% growth compared to last year’s figure of 8.6%. It’s a significant turnaround considering the hit the company took in 2023 with the LOE of Humira. In that year, AbbVie’s sales fell by 6.4%. Meanwhile, J&J, which has seen revenue increase at a higher rate each year since its 2023 spinoff of consumer health business Kenvue, is projecting sales in 2026 to come in at between $99.5 billion and $101.08 billion, easily topping the company’s pre-spinoff record haul of $94.9 billion in 2022. Also within reach for J&J in 2026 is the single-year, industry revenue record of $100.3 billion, which Pfizer achieved during the height of the pandemic in 2022 thanks to $56.7 billion in sales of its COVID products. Viatris is also guiding to an increase in revenue, from $14.3 billion in 2025 to $14.7 billion at the midpoint of its 2026 estimate. While this projected increase is slight, it is significant as it comes after four straight years of revenue declines, starting with $17.9 billion in 2021 following its formation as a merger between Mylan and Pfizer’s former generics unit Upjohn. Vertex is projecting a very small increase in growth, too, from 8.6% last year to 8.9% at the midpoint of its revenue projection for 2026. The same is true at Merck, which is projecting a 1.9% increase after a 1.3% bump in 2025. It’s difficult to zero in on Sanofi’s 2026 expectations. Like many of its European counterparts, the French company favors a more general estimate, saying it expects sales to be up by a “high single-digit” margin versus the 6% growth it realized in 2025. Eli Lilly leads again in Q4Meanwhile, the song remained much the same at the top of the rankings as Eli Lilly continued its reign with by far the largest revenue growth in the fourth quarter at 43%, which was nearly triple that of second-place Daiichi Sankyo at 15%. It was the fifth straight quarter in which Lilly had the top growth rate in the industry among companies that generated at least $2 billion in the period. Lilly has racked up 11 straight quarters in which its revenue has increased by at least 20% year over year. During its five-quarter run with the highest increases, Lilly exceeded 40% growth in four of those quarters. The last time a company other than Lilly topped the rankings was in the third quarter of 2024, when Pfizer—boosted by a surprise spike in sales of its COVID products—achieved a 32% revenue gain. Lilly’s growth has been fueled by its diabetes and obesity drugs Mounjaro and Zepbound, which achieved combined sales of $36.5 billion in 2025 and were up considerably from $16.5 billion in 2024. There’s no sign of a slowdown in the momentum as the two tirzepatide products accounted for fourth-quarter sales of $11.7 billion, up from $10.1 billion in the previous quarter and 115% year over year. While 2025 overall was a remarkable year of growth for the company at 45%, Lilly is expecting the pace to subside, projecting that 2026 sales will come between $80 billion and $83 billion. At the midpoint, this would represent a year-over-year growth of 25%. One thing to keep in mind is that at this time last year, Lilly’s projected revenue window for 2025 was between $58 billion and $61 billion. The Indianapolis drugmaker ended up exceeding the estimate by a significant margin, generating sales of $65.1 billion.  Lilly CEO David Ricks has repeatedly expressed his surprise at the unprecedented growth and the unique consumer dynamics in the obesity market.“The scale of this business and the way it’s been growing, the consumer part of it, along with the stocking dynamics, it’s just been a learning [experience] for us,” Ricks said in February of last year. “Our forecasters really nailed the rest of the portfolio. We don't have a problem with forecasting. It’s just—this market is quite different.” Slowdown in growth for Novartis, AZ, AmgenElsewhere, growth is slowing down for several other big companies in the industry.Novartis is not expecting (PDF) sales to decline in 2026 but is projecting a much smaller rate of growth, from an 8% rate in 2025 to a low single-digit increase this year. The beginning of the slowdown was apparent in the fourth quarter of last year when the company logged a sales increase of just 1%. That came after the Swiss company had posted revenue boosts of at least 8% in each of the previous nine quarters.The biggest factor in the slowdown is the loss of U.S. patent protection for Entresto, which dovetailed in July of last year with the launch of generic versions of the heart failure treatment. The pricing and competition effects were especially evident in the fourth quarter as Entresto sales fell by 45% from the same period in 2024.Amgen, which had a 10% growth rate in 2025, is projecting a 7% increase at the midpoint of its estimate as sales of three blockbusters are in decline. Bone drug Prolia reached peak sales of $4.4 billion last year. But the effect of biosimilar competition, which began last year, was apparent in quarterly results. In the first quarter, Prolia sales were up 10%, compared to the fourth quarter when they declined by 10%. Meanwhile, sales of Prolia’s sister med Xgeva fell 6% last year, and the company expects “accelerated sales erosion driven by increased competition, as multiple biosimilars have launched globally.” Sales of anti-inflammatory treatment Enbrel were already in decline in 2025, falling 33%, and should take another hit in 2026 thanks to the first wave of IRA price negotiations. After realizing a 9% increase in revenue in 2025, AstraZeneca is projecting (PDF) growth to be in the mid- to high single-digits. The company elaborated little on the forecast in its fourth-quarter presentation, though AZ is already grappling with declining sales for blockbuster Soliris, which lost its patent protection in the U.S. last year, and for Sanofi-partnered RSV antibody Beyfortus, as demand falls in the U.S.