7. Merck

Merck's sales will grow slightly to $38 billion by 2024, according to Evaluate. (Merck)

Headquarters: Kenilworth, New Jersey
2017 prescription sales: $35.4 billion 
Projected 2024 sales: $38.0 billion 

Can one megablockbuster med drive enough mid-term growth for a Big Pharma? In the case of Keytruda for Merck & Co., the answer is probably no.  

It’s not that Keytruda itself isn’t strong enough. In fact, according to Evaluate Pharma’s projection, the PD-1 superstar will be so successful that its global sales will skyrocket from $3.82 billion last year to $12.69 billion in 2024, sitting right next to Humira as the world’s second best-selling drug. However, the overall prescription drug revenue at Merck will grow only $2.6 billion—a speed of only 1% CAGR that’s below any other company on our list. The letdown? Declines across multiple therapeutic areas including antiviral, diabetes and cardiovascular. 

Keytruda has been padding its case frequently with new indications and data, prompting it to beat Opdivo in the second quarter of 2018 as the new PD-1/L1 king. When paired with Eli Lilly’s Alimta and platinum chemo, it cut the risk of death in first-line nonsquamous non-small cell lung cancer by a whopping 51% compared with chemo alone. Merck has just turned the data into a full FDA approval under the agency’s novel oncology review program. It also upped Roche’s Tecentriq in the squamous population, won approvals in head and neck tumor and bladder cancer, and is being tested in many other combinations and cancer types.  

In the meantime, vaccines represent another bright spot for Merck. About $2.85 billion additional sales will come from the segment, with $900 million attributable to the HPV vaccine Gardasil/Gardasil 9. Fifteen-valent pneumococcal vaccine V114—slated to clash with Pfizer’s 20-valent follow-on in 2020—ratavirus shot RotaTeq and Ebola vaccine rVSV-ZEBOV will likely also help. 

However, a large chunk of those increases will be eaten away by antivirals, diabetes and CV drugs.  

In the antiviral market, Merck is nowhere near Gilead and GlaxoSmithKline. The gap will only widen in 2024, as Merck’s share will drop from 7.1% last year to 3.1%, per Evaluate’s estimate. In HIV, Merck’s Isentress lags far behind Gilead’s Biktarvy or GSK’s Tivicay-based therapies. Its recent approvals of Pifeltro (doravirine) and Delstrigo won’t likely change that. In hepatitis C, competitions and reduced patient volume have slashed Zepatier’s sales in the first half of 2018 to $243 million. 

Merck is also suffering a bloodbath in diabetes, as its DPP-4 Januvia and combo Janumet yield to GLP-1s Trulicity from Eli Lilly and Ozempic and Victoza from Novo Nordisk, as well as SGLT2s like Boehringer Ingelheim and Lilly’s Jardiance. Even though Merck and partner Pfizer recently racked up their own SGLT2 approval in fourth-to-market Steglatro, Evaluate still thinks Merck’s diabetes size will be nearly halved to $3.18 billion by 2024. 

A similar fate might lie ahead for its CV business. Where its cholesterol drugs Zetia and Vytorin were once turning multibillion dollars in sales, new drugs like Amgen’s PCSK9 Repatha will take over. In their calculations run for FiercePharma last August, Evaluate projected Zetia’s and Vytorin’s sales will drop to merely $264 million and $177 million, respectively, by 2022. 

7. Merck