4. Novartis

In the last few years, Novartis has moved into several new fields by licensing R&D programs or buying smaller companies. (Novartis)

Estimated 2026 sales: $54.25 billion
2019 sales: $46.08 billion
2019-26 CAGR: 2.36%

Novartis has a broad portfolio with star meds spanning immunology, cardiology, neuroscience, oncology and beyond. And the company is aggressively expanding its territory, both with new indications for existing drugs and entirely new treatments.

That’s all according to a strategy championed by CEO Vas Narasimhan, who took the reins at the Swiss drugmaker in 2018. He's aiming to transform Novartis into a focused medicines company built on novel therapy platforms.

In the last few years, Novartis has moved into several new fields: It built a radiopharmaceuticals presence with the acquisitions of Advanced Accelerator Applications and Endocyte, tapped into gene therapy with its AveXis buyout, and entered RNA therapeutics—and beefed up its heart disease portfolio at the same time—through a $9.7 billion deal for The Medicines Company.

Meanwhile, it sold its over-the-counter business to its joint venture partner GlaxoSmithKline and spun off eye medtech business Alcon—and did its best to shed the Sandoz oral generics franchise in the U.S., only to be derailed by extra antitrust scrutiny.

Now leading Novartis’ portfolio is IL-17 inhibitor Cosentyx, with 2019 sales at $3.55 billion after a 25% year-over-year growth. Just a few weeks ago, the drug snagged an FDA approval in non-radiographic axial spondyloarthritis, a condition that affects more than 1 million U.S. patients a year. But it faces some new competition in AbbVie's IL-23 inhibitor Skyrizi, which just topped Cosentyx in a head-to-head psoriasis study.

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Another major growth driver for Novartis lately has been heart med Entresto, whose $1.73 billion haul in 2019 marked a 68% growth over 2018. In a phase 3 trial last year, the drug narrowly missed statistical significance at reducing deaths and emergency hospitalizations in heart failure patients with preserved ejection fraction (HFpEF). Nevertheless, after talking to the FDA, Novartis applied for the new indication, which could help Entresto hit its $5 billion sales goal.

Then there’s spinal muscular atrophy gene therapy Zolgensma. Right now, it has reached a bottleneck in the U.S., where it’s treating about 100 patients a quarter and raking in south of $200 million. That’s why Novartis is counting on recent go-aheads in Japan and Europe for growth.

Plus, an intrathecal version—injected into the spinal canal rather than the vein—could help it reach older patients and potentially steal market share from Biogen’s Spinraza, but only if Novartis can work out an FDA partial clinical hold on its higher dose. But a major obstacle on Zolgensma's path to blockbusterland is taking shape in Roche’s risdiplam, which aims to be the first oral treatment for SMA.

Meanwhile, some of Novartis’ recent launches have not exactly been successful. CAR-T therapy Kymriah and multiple sclerosis drug Mayzent are not living up to their expectations. But as slow-starting Entresto shows, Novartis knows how to turn around a launch.

Other setbacks have cropped up, too. A surprising safety alert put anti-VEGF eye med Beovu’s future into question, though Novartis still believes it’s a blockbuster in the making. Also in the ophthalmology department, the company just pulled an EU application for Xiidra, making its $3.4 billion upfront deal with Takeda look less appealing.

As for oncology, a key focus area at Novartis, Kisqali has been picking up speed, thanks to data showing it can help women with HR-positive, HER2-negative metastatic breast cancer, regardless of their menopausal status, live longer. Now, competing with Pfizer’s market-leading Ibrance and Eli Lilly’s Verzenio, Novartis is testing Kisqali as an adjuvant treatment for HR-positive, HER2-negative early breast cancer, with a clinical readout expected in 2022.

Plus, MET inhibitor Tabrecta just won FDA clearance for metastatic non-small cell lung cancer bearing MET mutations, kicking off its rivalry against Merck KGaA’s Tepmetko, which isn’t yet approved in the U.S.

RELATED: The 10 most-anticipated drug launches of 20203. Inclisiran

Looking into the pipeline, Novartis has cholesterol-lowering therapy inclisiran, the centerpiece of its $9.7 billion MedCo buyout. Despite the lackluster performance of the PCSK9 class, Novartis hopes its commercial experience in cardiology—paired with inclisiran’s novel RNAi mechanism and less frequent dosing—can help smash the blockbuster goal.

Plus, its repurposed MS candidate ofatumumab, currently sold as leukemia drug Arzerra, could be an in-class challenger to Roche’s fast-growing Ocrevus.

As is the case with several Big Pharma companies, Novartis is counting on China to fuel its growth, too. In the five years leading up to 2024, the Swiss drugmaker is planning more 50 new drug approvals in the country, and it's hoping to double its business there from the current $2.2 billion in annual sales. From there on, the goal is to deliver almost all its China submissions simultaneously with global filings.

Editor's Note: This story has been corrected as both Kisqali and Verzenio have demonstrated statistically significant improvements in overall survival.

4. Novartis