Twelve months ago, drugmakers were hurtling toward 2025, fueled by a year of strong growth that peaked in the fourth quarter of 2024. Now that momentum has been lost, most companies are bracing for a slowdown in sales heading into 2026.
In fact, in recent weeks of earnings reports, the drug company’s results were less noteworthy than the guidance. Of the 25 companies with quarterly sales of $2 billion or more that reported through March 5, only five expected their sales to grow faster in 2026 than in 2025, and each by a small percentage.
Pharmaceutical companies offered a variety of macro and micro reasons for their pessimistic forecasts for 2026. Several cited the impact of pricing related to the Inflation Control Act (IRA), as well as President Donald Trump’s most-favored-nation program and threats of tariffs on pharmaceuticals. An expected drop in vaccine sales related to lack of demand in the US is also impacting some companies’ calculations, while many others are grappling with the loss of exclusivity (LOE) for blockbuster products.
The drugmaker with the most surprising forecast was Novo Nordisk, which recently surprised analysts by predicting a 5% to 13% decline in sales in 2026.
It’s hard to fathom this dire estimate when the company is still reeling from the success of its breakthrough metabolic drugs Ozempic and Wigovy. Total sales of semaglutide drugs last year were $31.2 billion, an increase of 15% from 2024. Additionally, the Danish company reported strong launch metrics for its long-awaited GLP-1 obesity drug last month.
But the first signs of a revenue shortfall appeared in the third quarter of last year, when Novo reported a modest 5% revenue increase. This comes after posting 12 consecutive 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 Doosder blamed the company’s expected 2026 sales decline on “unprecedented pricing pressures,” citing “increased competition” and the MFN pricing agreement the company struck with the Trump administration last fall.
Other drug companies predicting revenue declines in 2026 include Bayer, Biogen, Bristol-Myers Squibb, Pfizer, and Teva.
After a 1% decline in pharmaceutical sales in the fourth quarter, Bayer now expects a 0% to 3% decline in 2026 (PDF). This was mainly due to lower sales of eye disease drug Eylea and blood thinner Xarelto. Both drugs were already on the decline last year, but the company warned that the impact will be even more pronounced in 2026. The good news is that even with a big hit in 2026, Bayer expects pharmaceutical industry sales to return to mid-single-digit growth in 2027, and this growth should continue through the end of the 2020s.
After five consecutive years of revenue declines, Biogen saw sales increase 2% in 2025. But the company expects that increase to be short-lived, with a 5% revenue decline expected at the midpoint of its 2026 guidance. Headwinds to growth include the decline of multiple sclerosis drug Tecfidera in Europe and the recent introduction of biosimilar competition for another of the company’s MS drugs, Tysabri. These impacts led to a 7% decline in sales in the fourth quarter of last year.
Meanwhile, BMS predicts a 3% decline at the midpoint of its 2026 revenue forecast (PDF). If this prediction holds true, BMS’s annual revenue will decline for the second year in a row, reaching $48.3 billion in 2024, before dropping slightly to $48.2 billion in 2025. The company cited lower sales of legacy products, which fell 16% in 2025, as the reason for the decline in revenue. The aging product roster includes blood cancer blockbusters Revlimid and Pomalyst.
Declining sales of Revlimid’s generic drug are also contributing to the expected decline in Teva’s overall revenue this year. The Israeli company expects revenue from Revlimid counterfeits to decline by $1.1 billion, or 4% overall at the midpoint of its 2026 revenue outlook. This comes after three years of annual sales growth for the company, including a 4% increase in 2025. Another factor in Teva’s expected decline is lower sales in its generic drug business as the company continues its transformation focused on developing an innovative product portfolio.
Pfizer, which released guidance (PDF) last December, similarly expects sales to fall 3% year-over-year to a midpoint of $61 billion in 2026. Pfizer’s sales will decline for the second consecutive year from $63.6 billion in 2024 and $62.5 billion in 2025.
The company noted that COVID-19 product sales are expected to decline by $1.7 billion, from $6.7 billion in 2025 to a projected $5 billion in 2026. The company also expects a $1.5 billion hit from loss of exclusivity for certain products to continue this year. Pfizer also warned that the downward trend in revenue is likely to continue as these LOEs expand in the coming years, reaching more than $3 billion in 2027 and more than $6 billion in 2028.
Only 6 companies expected to grow further in 2026
Companies predicting higher growth in 2026 compared to 2025 are AbbVie, Johnson & Johnson, Merck, Sanofi, Vertex, and Viatris, but all expect only modest increases.
AbbVie expects to continue its role with autoimmune drug giants Skyridge and Rinvoke, projecting combined sales of both drugs to exceed $31 billion in 2026, up from $25.8 billion last year. The company expects overall revenue to reach $67 billion this year, which would represent 9.5% growth compared to 8.6% last year. This is an important change in direction considering the blow the company took with Humira’s LOE in 2023. AbbVie’s sales fell 6.4% that year.
Meanwhile, J&J, which has seen strong revenue growth every year since spinning off its consumer health business Kenview in 2023, projects sales of $99.5 billion to $101.08 billion in 2026, easily surpassing the company’s pre-spinoff record of $94.9 billion in 2022. Also in 2026 for J&J, Pfizer achieved $100.3 billion thanks to $56.7 billion in sales of its coronavirus products at the height of the pandemic in 2022.
Viatris also aims to increase its revenue from $14.3 billion in 2025 to $14.7 billion at the midpoint of its 2026 forecast. Although this expected increase is small, it is significant because it comes after four consecutive years of revenue declines since Mylan began 2021 with sales of $17.9 billion after its merger with Upjohn, the former generic pharmaceutical arm of Pfizer.
Vertex also forecasts a very small increase in earnings, from 8.6% last year to 8.9% at the midpoint of its 2026 forecast. Merck is similarly forecast to increase by 1.9% in 2025, after increasing by 1.3% in 2025.
It’s hard to focus on Sanofi’s 2026 expectations. Like many of its European peers, the French company stood by its more general estimates, saying it expected sales to increase by “high single digits” compared to the 6% growth realized in 2025.
Eli Lilly continues to lead in the fourth quarter
Meanwhile, Eli Lilly recorded by far the largest increase in sales in the fourth quarter at 43%, nearly three times the 15% increase from second-place Daiichi Sankyo, and the song remained almost flat at the top of the rankings as it continued its reign. Lilly posted the industry’s top growth rate for five consecutive quarters among companies that generated at least $2 billion over the same period.
Lilly has had 11 consecutive quarters of at least 20% year-over-year sales growth. Lilly recorded growth of more than 40% in four of the five quarters with the highest growth rates. The last time a company other than Lilly topped the ranking was in the third quarter of 2024, when Pfizer posted a 32% revenue increase, driven by an unexpected surge in sales of COVID-19 products.
Lilly’s growth has been fueled by its diabetes and obesity drugs Munjaro and Zepbound, with combined sales reaching $36.5 billion in 2025, a significant increase from $16.5 billion in 2024. The two tirzepatide products accounted for $11.7 billion in sales in the fourth quarter, up 115% from $10.1 billion in the previous quarter, and shows no signs of slowing down. Year after year.
Overall, the company had an impressive year of 45% growth in 2025, but Lilly expects that pace to slow, with 2026 sales expected to be between $80 billion and $83 billion. At the midpoint, this equates to 25% year-on-year growth. 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 significantly exceeding expectations, with sales of $65.1 billion.
Lilly CEO David Ricks has repeatedly expressed surprise at the unprecedented growth and unique consumer trends in the obesity market.
“The size of this business and the way it’s grown, the consumer part of it, the purchasing trends, it’s been a real learning experience for us,” Ricks said last February. “Our forecasters hit the rest of the portfolio very well. We have no problems with predictions, but this market is completely different.”
Novartis, Arizona, Amgen’s growth slows
Growth at several other large players in the industry has also slowed.
Novartis does not expect a decline in sales in 2026 (PDF), but it does predict a much smaller growth rate, from 8% in 2025 to a low-single-digit increase this year. The beginning of the slowdown was evident in the fourth quarter of last year, when the company’s sales increased by just 1%. This came after the Swiss company posted revenue growth of at least 8% in each of the past nine quarters.
The biggest factor in the economic slowdown was the loss of U.S. patent protection for Entrest in July last year, in conjunction with the launch of a generic heart failure drug. The impact of pricing and competition was particularly noticeable in the fourth quarter, with Entresto’s sales down 45% compared to the same period in 2024.
Amgen had expected growth of 10% in 2025, but now expects growth of 7% at the midpoint of its forecast due to declining sales of its three blockbusters. Bone drug Prolia reached peak sales of $4.4 billion last year. However, the impact of the biosimilar competition that began last year became clear in the quarterly results. Prolia’s revenue increased 10% in the first quarter, but decreased 10% in the fourth quarter.
Meanwhile, sales of Prolia’s sister product Kusugeva fell 6% last year, and the company expects “sales decline to accelerate due to intensified competition as multiple biosimilars have been launched globally.” Sales of the anti-inflammatory drug Enbrel are already on the decline, down 33% in 2025, and should take a further hit in 2026 thanks to the first wave of IRA price negotiations.
AstraZeneca projects 9% revenue growth in 2025 followed by mid-to-high single-digit growth (PDF). The company offered little detail about the outlook in its fourth-quarter presentation, but AZ is already grappling with declining sales of its blockbuster Soliris, which lost patent protection in the U.S. last year, and its RSV antibody Bayfortus, partnered with Sanofi, as demand in the U.S. wanes.
