2024 Pharm Exec Top 50 Companies

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A lot can change in one year, this we all know. But for the biopharmaceutical industry in recent decades, where the pace of change was notoriously slow-going—at least according to outside perception—it’s safe to say the last few calendar turns, impacted, of course, by a global health pandemic, have proven that things are no longer status quo.

Take, for instance, this year’s Pharm Exec 50, our newest rankings of the top 50 global manufacturers based on prescription drug sales. The list, our 24th, captures most recent full-year drug revenue performance (in this case, 2023), with data again provided in partnership with Evaluate Ltd. It also includes each organization’s top-selling drugs and R&D investment totals. While Big Pharma, by and large, remains a picture of strength and stability, highlighted, in some cases, by exponential and unprecedented financial growth, for the companies making up the Pharma 50, it has not been business as usual.

Whether the entrenched innovators and corporate giants of old or those quickly accelerating up the ranks, each, in their own way, is navigating today’s new and unique mix of issues and barriers—be it on the policy front (Inflation Reduction Act, pricing scrutiny); economic (patent expirations/biosimilar competition),operational (supply chain disruption, global unrest), or regulatory (digital disruption, compliance), to name a few. In turn, they are responding with various strategic decisions and actions, ranging from consolidations and layoffs, to pipeline reprioritization and brand expansion, to M&A and product licensing pursuits.

Viewed as a whole, the industry may look or resonate to many very much as it always has. But a peek at those underlying drivers and trends is starting to tell a new story—and one that’s clearly evolving—perhaps offering an unlikely but real challenge to that old adage: the more things change, the more they stay the same.

COURSE CORRECTION

Amid the Pharma 50’s continued makeover, a mini-resetting of sorts is also underway. While projections by Evaluate and others, not surprisingly, predicted as much, standing out in this year’s data is the end of Pfizer’s two-year reign atop the leaderboard. Following steep drops in demand for COVID-19 vaccines and therapies, Pfizer’s prescription drug revenue fell 47.2% in 2023. Its mRNA vaccine, Comirnaty, though still posting solid totals of $11.2 billion, sunk 70.3% from its peak the previous year, and its antiviral, Paxlovid, after generating $18.93 billion in 2022, plummeted as well.

“This major boom and bust of COVID is like an anomaly in storage now,” Paul Verdin, VP, head of consulting and analytics, Evaluate Ltd, tells Pharm Exec, referring as well to the other COVID-central players, such as Moderna, which dropped from 18th in our previous list to 29th this year (Spikevax sales fell 63.8%), though the company was buoyed late last month by FDA’s approval of its vaccine for respiratory syncytial virus; Pfizer’s Comirnaty partner, BioNTech, which exited the Pharma 50 after cracking the list for one year at 47th; and Novavax, which managed to nab the final spot last year, but was quickly supplanted. (Unlikely to impact its future positioning much, AstraZeneca announced the worldwide withdrawal of its COVID vaccine in early May.) “With the next-generation vaccines, there will still be a continued lower-level bubble of the COVID market, which Pfizer will be in,” adds Verdin.

Pfizer’s dive put the company at No. 6 on this year’s list, though its acquisition of oncology power Seagen for $43 billion, which was completed in December 2023, could nudge Pfizer back up the rung a bit in next year’s ledger. Executives have stated publicly the company is targeting at least eight blockbuster cancer drugs by 2030.

How the listings were compiled; click to enlarge

Dethroning Pfizer at the top of our Pharma 50 is Johnson & Johnson ($53.46 billion in Rx sales), up 6.5% and jumping from third, driven by its “fairly diversified portfolio,” notes Verdin. J&J boasts a pair of treatments among the industry’s top-10 sellers (see chart above), including its longtime immunosuppressant, Stelara, which went off-patent last year but won’t start jockeying with biosimilar versions in the market until sometime in 2025; and its monoclonal antibody Darzalex, which spiked 39.7% in sales, cementing the product firmly in the multiple myeloma space.

AbbVie once again mans second, despite dropping 6.1% to $52.73 billion—reflecting the sting, alas, from US market introduction of biosimilars to Humira. Sales of the originator product fell 32.2%, conceding its status as the world’s No. 1 drug after a several-year run, though AbbVie reinforcements Skyrizi and Rinvoq continue to perform well, growing 50.3% and 57.4%, respectively.

Rounding out the top five entrants in the Pharma 50 are Novartis (up 4.8%), which climbed one spot from the previous year; Merck & Co., which did the same behind a 2.5% overall rise, but a 19.5% jump for its PD-1 stalwart Keytruda (now approved for 17 types of cancer), which grabbed the mantle from Humira as Rx sales king; and Roche at No. 5, up a notch as well with an increase of 2.5%. Trailing Pfizer in the seventh spot is Bristol Myers Squibb (down 2.2% in Rx revenue); AstraZeneca comes in at No. 8 (up 1.8%); and Sanofi (up 1.1%) and GSK (down 3.9%) cap off the top 10.

WEIGHT LIFTERS

11-30; click to enlarge

As we noted in last year’s report, Novo Nordisk and Eli Lilly, competing in the lucrative GLP-1 receptor agonist space that, of late, has captivated the US and beyond in weight loss, are knocking loudly on the top-10 door. Both companies, who own the highest market caps, respectively, in pharma, turned in massive growth in our latest Pharma 50. Novo Nordisk Rx drug sales surged 32.8%, to $33.7 billion, catapulting the Danish company from 13th to 11th. Ozempic (semaglutide), approved for type 2 diabetes but often used off-label for obesity, entered the rarified air of a double-digit-billion-dollar drug, leaping 62.1% in Rx sales to $13.9 billion. Wegovy (higher-dose semaglutide), which was cleared for weight loss in June 2021, posted $4.55 billion in revenue in 2023.

31-50; click to enlarge

“If you take semaglutide as a total franchise, I think, combined, it’s even bigger, or shortly to be bigger, than Keytruda is now,” says Verdin on prescription drug sales comparisons.

As far as Lilly, though leapfrogged by Novo Nordisk, the company rose one spot on our list to 12th, rocketing 25.2% to $31.9 billion. GLP-1 Mounjaro (tirzepatide), approved by the FDA in diabetes in May 2022 and for weight loss in November 2023 (branded as Zepbound), generated $5.2 billion in its first full-year on the market, and quickly became Lilly’s second-best seller. Evaluate predicts combined sales for tirzepatide of $17 billion in 2028.

While access, reimbursement, and supply issues have clouded the picture somewhat, Wegovy and Zepbound’s meteoric rise and uptake in weight loss has been well-chronicled. “It’s almost like what the PD-1s were with Keytruda and Opdivo,” says Verdin, noting the two rivals at the time the novel immunotherapies burst on the scene in 2014 (Keytruda has since distanced itself; Opdivo’s 2023 sales totaled $9.1 billon). “The GLP-1s could quite possibly have the same type of trajectory. The sort of hype level is similar.”

The promise of both drugs in a host of other indications, including respiratory disease, heart failure, and sleep apnea, along with the potential of other next-generation GLP-1 agonists to come, has left some experts reportedly projecting global sales forecasts for the treatments of about $150 billion by the early 2030s. Partnering and dealmaking in the area is also expected to heat up.

“I suppose many companies are going to be looking at that space and thinking, ‘how do I get in?’” says Verdin.