The top 20 drugs in 2020--worldwide sales

Forecasting drug sales is a tricky business; just ask any biopharma CEO who has overpromised and underdelivered. The people who make it their business know that very well, and they update their numbers with every big shift in the market and every surprise result from a key clinical trial.

These days, the variables are many, with some more variable than others. Biosimilars are coming in the U.S., with several big products targeted in the next few years. We know that's going to hit the original biologics; we aren't sure how much. Payers are increasingly pressing for discounts, particularly in highly competitive fields like hepatitis C drugs, respiratory meds and diabetes treatments. How much will those discounts grow, and how much might the pressure spread beyond those areas? How might new approaches to cancer-drug reimbursement--such as Express Scripts' ($ESRX) indication-specific project--affect sales of those meds?

Some hotly anticipated outcomes trials could raise the prospects for some drugs, just as a cardiovascular trial did for Eli Lilly and Boehringer Ingelheim's Jardiance last year. Will they deliver the goods for Amgen ($AMGN), Sanofi ($SNY) and Regeneron's ($REGN) PCSK9 drugs? Novo Nordisk's ($NVO) Victoza?

Will new safety concerns pop up for blockbuster multiple sclerosis meds as they did for Biogen's ($BIIB) Tecfidera last year?

We'll be looking out for the answers. But for this moment in time, we present the 20 drugs expected to top the worldwide ranks in 2020, as analyzed by the market research and consulting firm EvaluatePharma. They include some old standbys--Roche's ($RHHBY) Herceptin and Avastin, Pfizer ($PFE) and Amgen's Enbrel, Merck & Co.'s ($MRK) Januvia--and some brand-new entrants, such as Bristol-Myers Squibb's ($BMY) immuno-oncology treatment Opdivo, who hits the list in third place. They range from 2020 sales at the high end of $15.92 billion--AbbVie's ($ABBV) Humira--to $4.04 billion at the low end, forecasted for another newcomer, ViiV Healthcare's HIV fighter Triumeq.

Meanwhile, three not-so-lucky contenders fell out of the top 20 just since last summer, when EvaluatePharma published its annual ranking; you can get more info on them by clicking through. Xarelto, Bayer and Johnson & Johnson's ($JNJ) blockbuster anticoagulant, lost ground after its head-to-head competitor Eliquis revved up its sales for Pfizer and BMS. For AbbVie and Johnson & Johnson's Imbruvica, a hot-selling leukemia and lymphoma med, growth depends on the results of clinical trials in new indications, always an uncertain proposition. And Lantus, Sanofi's long-dominant basal insulin, faces biosimilar competition in the U.S. by the end of 2016, not to mention some other branded competitors, including the French drugmaker's own Toujeo.

Do you have thoughts about 2020's top 20? Will the list change much as that date approaches? As always, let us know.

--Tracy Staton (email | Twitter)