13. Gilead Sciences

Gilead has come under competitive pressure in hepatitis C, and now market watchers think the company is looking at cancer as its next growth engine. (Gilead China)

Gilead Sciences 
2018 revenue: $22.13 billion 
2017 revenue: $26.1 billion 
Headquarters: Foster City, California 

Once-high-flying Gilead is looking for a new direction. Fueled by explosive growth in hepatitis C, the company had climbed our pharma sales rankings in previous reports, but more recently, it's been losing momentum.

From a high point of $32.15 billion in 2015, Gilead’s sales sank to $21.68 billion last year. The company reported another $450 million in royalty and other revenues last year, for a total of $22.13 billion. Just as hepatitis C success led Gilead to high points once upon a time, struggles in that market have taken a big bite out of its revenues lately.  

Gilead’s big-selling suite of hepatitis C drugs stormed out of the gate in 2014 and 2015, and it was great while it lasted. New competition hurt the company's pricing power, though, and quarter after quarter, the company's management rolled out troubling signs about the market. Payer pressure and bad optics on patients' out-of-pocket costs prompted Gilead to set up a generics subsidiary to knock off two of its own blockbuster drugs. And this year, the company rolled out its first authorized generics—copies of Harvoni and Epclusa—in a bid to improve patient access and open avenues for new sales. 

RELATED: Gilead, looking for cancer sales, swipes Roche pharma chief Daniel O'Day for CEO post 

All that hepatitis C woe has dragged Gilead down even as its HIV franchise swelled, thanks in part to its blockbuster combo Biktarvy and its fellow next-generation drugs. And along the way, market watchers and investors clamored for M&A, which Gilead finally delivered in 2017. The company shelled out $12 billion for Kite Pharma to gain a foothold in the budding CAR-T market. Now, it boasts one approved cell therapy drug in Yescarta, which pulled in $264 million in 2018. 

That didn't quell investor calls for action. And now, the company has brought in new CEO Dan O’Day, formerly the head of Roche Pharmaceuticals, to steer the ship. Given his experience running the pharma division at the world's biggest cancer drugmaker, many market watchers saw O’Day's appointment as further evidence that Gilead will look to cancer for the next stage of its growth. 

RELATED: Gilead executives predict patience—and some deal scouting—from new CEO Daniel O'Day 

Modest early sales for Yescarta won’t do much to fill a multibillion-dollar sales gap left by hepatitis C erosion, though. On Gilead’s fourth-quarter conference call—when O’Day hadn't yet joined the company—executives predicted the new CEO would bring patience and dealmaking to the role. For 2019, the company has rolled out sales guidance of $21.3 billion to $21.8 billion, which could mean either growth or another sales decline depending on where the company lands. 

13. Gilead Sciences