$546.1bn2025 sales of the top 100 drugs, from 37 companies
$643.1bn2031 base case incl. named launches (+2.8% a year)
$212.4bn2025 sales of 31 drugs losing US exclusivity in 2026–2031
$188.8bn2025 sales of 33 drugs with a Medicare negotiated price by 2028
Key findings
Growth concentrates in two areas while the old blockbusters roll off
- The top 100 barely grow without new launches. Today's top-100 products reach $585.6bn in 2031 in the base case (+1.2% a year), within a range of $410.2bn to $759.4bn. Named launches lift the total to $643.1bn.
- Diabetes & obesity and immunology carry the growth. Together they add $94.6bn by 2031 in the base case: incretins and IL-23/JAK/FcRn medicines.
- Oncology is flat as a group (+0.6% a year) because Keytruda, Opdivo, Darzalex, Xtandi and Ibrance lose US exclusivity in 2027–2029, while the overall oncology market keeps growing through new products.
- Cardiovascular & renal falls furthest (-6.2% a year): Eliquis, Entresto, Xarelto and the SGLT2 inhibitors all face generics and Medicare prices before 2031.
- Biggest gains, 2025 to 2031 (base): Skyrizi (+21bn), Mounjaro (+19bn), Zepbound (+17bn). Biggest losses: Eliquis (-12bn), Keytruda (-8bn), Jardiance (-8bn).
- US pricing policy is now a forecast input, not a footnote. 33 of the 100 drugs carry Medicare negotiated prices by 2028, and Section 232 tariffs and most-favoured-nation deals reshape US net prices from 2026.
At a glance
2025 sales and the 2031 outlook, by therapeutic area
| Therapeutic area | Drugs | 2025 sales | Share | 2031 base | 2031 low – high | CAGR 2025–31 |
|---|---|---|---|---|---|---|
| Oncology | 30 | $153.6bn | 28% | $158.9bn | $105.5bn – $215.2bn | +0.6% |
| Immunology & inflammation | 20 | $107.1bn | 20% | $164.3bn | $106.0bn – $225.5bn | +7.4% |
| Diabetes & obesity | 9 | $96.2bn | 18% | $133.6bn | $89.5bn – $179.4bn | +5.6% |
| Cardiovascular & renal | 7 | $41.5bn | 8% | $28.2bn | $17.5bn – $39.3bn | -6.2% |
| Neurology | 8 | $31.1bn | 6% | $37.7bn | $26.2bn – $50.7bn | +3.3% |
| Vaccines | 6 | $25.2bn | 5% | $25.0bn | $19.6bn – $29.9bn | -0.1% |
| Infectious disease & HIV | 4 | $23.0bn | 4% | $29.2bn | $21.9bn – $36.5bn | +4.1% |
| Respiratory | 6 | $21.2bn | 4% | $14.8bn | $10.9bn – $18.9bn | -5.8% |
| Rare disease | 3 | $17.1bn | 3% | $21.8bn | $17.0bn – $26.1bn | +4.1% |
| Ophthalmology | 2 | $12.8bn | 2% | $9.7bn | $7.2bn – $12.1bn | -4.5% |
| Bone & other | 3 | $9.1bn | 2% | $8.0bn | $5.8bn – $10.1bn | -2.2% |
| Haematology | 2 | $8.1bn | 1% | $11.7bn | $8.7bn – $14.6bn | +6.5% |
| All areas | 100 | $546.1bn | 100% | $643.1bn | $435.7bn – $858.4bn | +2.8% |
On a phone, swipe the chart sideways. CAGR from 2025 to 2031. Totals include the named launches listed under each area.
Area by area
Drivers, risks and drug-level outlook
OncologyImmunology & inflammationDiabetes & obesityCardiovascular & renalNeurologyVaccinesInfectious disease & HIVRespiratoryRare diseaseOphthalmologyBone & otherHaematology
Oncology
Flat as a group: the largest franchises lose exclusivity just as the next wave launches.
30 top-100 drugs$153.6bn in 2025
$158.9bn in 2031 (base)+0.6% a year
Range $105.5bn–$215.2bn
Base case line, low–high band, incl. named launches
- Keytruda, Opdivo and Darzalex face US biosimilars between December 2028 and 2029; Keytruda's subcutaneous Qlex (close to 10% of Keytruda sales by Q3 2026) is the main cushion.
- Xtandi and Ibrance lose US exclusivity in 2027, the same year their Medicare negotiated prices start (about 48% and 50% below list).
- Growth comes from ADCs (Enhertu, Padcev, Datroway), radioligands (Pluvicto), CAR-T (Carvykti) and BTK share shifts toward Brukinsa and Calquence.
- PD-(L)1xVEGF bispecifics are the swing factor: ivonescimab has a US decision due 14 November 2026.
IQVIA puts the whole oncology market at about $291bn in 2025, rising to about $467bn in 2030. The gap with this group is the size of the opportunity for products that are not yet blockbusters.
| Drug | Rank | 2025 $bn | 2028 base | 2031 base (range) |
|---|---|---|---|---|
| Keytruda pembrolizumab · Merck & Co US LOE 2029Ex-US LOE 2030 | #1 | 31.68 | 35.79 | 23.61 16.0–31.2 |
| Darzalex (incl. Faspro) daratumumab · J&J US LOE 2029Ex-US LOE 2031 | #7 | 14.35 | 19.08 | 14.48 8.9–20.4 |
| Opdivo nivolumab · BMS / Ono US LOE 2028Ex-US LOE 2030 | #12 | 10.05 | 9.45 | 5.21 3.7–6.6 |
| Tagrisso osimertinib · AstraZeneca | #19 | 7.25 | 8.79 | 9.79 7.5–11.9 |
| Xtandi enzalutamide · Astellas / Pfizer US LOE 2027IRA 2027 | #24 | 6.36 | 2.36 | 1.15 0.8–1.5 |
| Imfinzi durvalumab · AstraZeneca | #26 | 6.06 | 8.62 | 10.52 7.3–13.6 |
| Verzenio abemaciclib · Eli Lilly US LOE 2031IRA 2028 | #28 | 5.72 | 6.18 | 5.32 3.9–6.7 |
| Enhertu trastuzumab deruxtecan · Daiichi Sankyo / AstraZeneca | #33 | 4.98 | 8.76 | 12.12 7.5–16.9 |
| Kisqali ribociclib · Novartis US LOE 2031IRA 2028 | #35 | 4.78 | 7.38 | 7.80 4.7–11.2 |
| Tecentriq atezolizumab · Roche US LOE 2031 | #43 | 4.30 | 4.09 | 3.65 2.9–4.4 |
| Ibrance palbociclib · Pfizer US LOE 2027Ex-US LOE 2028IRA 2027 | #46 | 4.12 | 1.69 | 0.62 0.4–0.8 |
| Brukinsa zanubrutinib · BeOne | #49 | 3.90 | 7.29 | 10.47 6.3–15.0 |
| Perjeta pertuzumab · Roche US LOE 2026Ex-US LOE 2027 | #54 | 3.58 | 1.50 | 0.80 0.6–1.0 |
| Erleada apalutamide · J&J IRA 2028 | #55 | 3.57 | 4.12 | 4.84 3.4–6.2 |
| Calquence acalabrutinib · AstraZeneca IRA 2027 | #58 | 3.52 | 3.71 | 4.13 3.1–5.1 |
| Lynparza olaparib · AstraZeneca / Merck US LOE 2028Ex-US LOE 2029 | #60 | 3.28 | 2.56 | 0.82 0.6–1.0 |
| Jakafi ruxolitinib · Incyte US LOE 2028 | #61 | 3.09 | 2.04 | 0.47 0.3–0.6 |
| Revlimid lenalidomide · BMS Off-patent (US) | #64 | 2.95 | 0.36 | 0.15 0.1–0.2 |
| Phesgo pertuzumab/trastuzumab · Roche | #65 | 2.94 | 4.18 | 5.10 3.6–6.6 |
| Yervoy ipilimumab · BMS | #66 | 2.90 | 3.12 | 3.25 2.7–3.8 |
| Imbruvica ibrutinib · AbbVie / J&J IRA 2026 | #68 | 2.87 | 1.83 | 1.54 1.3–1.8 |
| Venclexta venetoclax · AbbVie / Roche | #69 | 2.79 | 3.38 | 3.77 2.9–4.6 |
| Pomalyst/Imnovid pomalidomide · BMS US LOE 2026IRA 2027 | #71 | 2.73 | 0.58 | 0.40 0.3–0.5 |
| Nubeqa darolutamide · Bayer | #72 | 2.70 | 5.05 | 7.25 4.3–10.4 |
| Kadcyla trastuzumab emtansine · Roche | #80 | 2.44 | 2.44 | 2.44 2.1–2.7 |
| Lenvima/Kisplyx lenvatinib · Eisai / Merck IRA 2028 | #87 | 2.27 | 1.90 | 1.82 1.5–2.1 |
| Tafinlar + Mekinist dabrafenib + trametinib · Novartis US LOE 2030 | #90 | 2.22 | 2.39 | 1.50 1.2–1.8 |
| Jakavi ruxolitinib · Novartis Ex-US LOE 2028 | #94 | 2.11 | 1.77 | 0.73 0.5–0.9 |
| Xgeva denosumab · Amgen Off-patent (US) | #96 | 2.08 | 0.75 | 0.49 0.4–0.6 |
| Pluvicto lutetium-177 vipivotide tetraxetan · Novartis | #99 | 1.99 | 3.87 | 5.70 3.3–8.3 |
New launches counted in this area
- PD-(L)1xVEGF bispecifics (ivonescimab and peers): $6.0bn in 2031 (range $2.0bn–$12.0bn). Ivonescimab PDUFA 14 Nov 2026; Evaluate's most valuable pipeline asset
- Datroway (datopotamab deruxtecan): $3.0bn in 2031 (range $1.5bn–$5.0bn). TROP2 ADC; $78m in Q3 2026
Immunology & inflammation
The largest growth of any area, in dollars and in rate, driven by IL-23, JAK and newer mechanisms.
20 top-100 drugs$107.1bn in 2025
$164.3bn in 2031 (base)+7.4% a year
Range $106.0bn–$225.5bn
Base case line, low–high band, incl. named launches
- Skyrizi, Rinvoq and Tremfya keep taking share in psoriasis and inflammatory bowel disease as Stelara and Humira erode under biosimilars (Stelara -41% in its first biosimilar year).
- Dupixent keeps adding indications (COPD, urticaria, bullous pemphigoid); this outlook assumes US biosimilar entry only in 2031.
- Newer mechanisms scale fast: Vyvgart (FcRn) almost doubled in 2025 and Bimzelx (IL-17A/F) nearly quadrupled.
- IRA prices hit Stelara and Enbrel in 2026, Otezla in 2027, and Cosentyx, Entyvio, Orencia and Cimzia in 2028.
Evaluate expects immunology to grow at about 10% a year to 2032.
| Drug | Rank | 2025 $bn | 2028 base | 2031 base (range) |
|---|---|---|---|---|
| Dupixent dupilumab · Sanofi / Regeneron US LOE 2031Ex-US LOE 2032 | #4 | 17.76 | 25.25 | 27.58 17.3–38.5 |
| Skyrizi risankizumab · AbbVie | #5 | 17.56 | 29.03 | 38.71 24.8–52.9 |
| Rinvoq upadacitinib · AbbVie | #16 | 8.30 | 13.72 | 18.30 11.7–25.0 |
| Cosentyx secukinumab · Novartis US LOE 2029Ex-US LOE 2030IRA 2028 | #20 | 6.67 | 7.57 | 4.36 2.9–5.9 |
| Entyvio vedolizumab · Takeda IRA 2028 | #22 | 6.40 | 6.62 | 7.09 5.6–8.4 |
| Stelara ustekinumab · J&J Off-patent (US)IRA 2026 | #25 | 6.08 | 1.32 | 0.69 0.5–0.9 |
| Tremfya guselkumab · J&J | #32 | 5.16 | 9.08 | 12.56 7.8–17.6 |
| Humira adalimumab · AbbVie Off-patent (US) | #38 | 4.54 | 1.47 | 0.90 0.6–1.1 |
| Vyvgart efgartigimod alfa · argenx | #45 | 4.15 | 8.91 | 13.90 7.7–20.8 |
| Privigen human immunoglobulin (IV) · CSL | #48 | 3.90 | 4.51 | 4.89 3.8–5.8 |
| Orencia abatacept · BMS IRA 2028 | #52 | 3.71 | 3.40 | 3.40 2.9–3.8 |
| Taltz ixekizumab · Eli Lilly | #56 | 3.56 | 4.32 | 4.81 3.7–5.8 |
| Actemra/RoActemra tocilizumab · Roche / Chugai Off-patent (US) | #63 | 2.98 | 1.37 | 1.05 0.8–1.3 |
| Simponi/Simponi Aria golimumab · J&J | #73 | 2.67 | 2.48 | 2.38 2.0–2.7 |
| Bimzelx bimekizumab · UCB | #77 | 2.52 | 6.52 | 11.42 5.7–18.2 |
| Benlysta belimumab · GSK | #82 | 2.34 | 2.97 | 3.40 2.5–4.2 |
| Otezla apremilast · Amgen US LOE 2028IRA 2027 | #86 | 2.27 | 1.45 | 0.85 0.7–1.0 |
| Enbrel etanercept · Amgen US LOE 2029IRA 2026 | #89 | 2.23 | 1.45 | 0.64 0.5–0.8 |
| Cimzia certolizumab pegol · UCB IRA 2028 | #92 | 2.21 | 1.81 | 1.69 1.4–1.9 |
| Hizentra human immunoglobulin (SC) · CSL | #97 | 2.08 | 2.46 | 2.71 2.1–3.3 |
New launches counted in this area
- Icotrokinra (oral IL-23R): $3.0bn in 2031 (range $1.0bn–$5.5bn). First oral IL-23 pathway drug
Diabetes & obesity
Second-largest growth: incretin volumes keep rising while prices, SGLT2 generics and semaglutide erosion hold the total back.
9 top-100 drugs$96.2bn in 2025
$133.6bn in 2031 (base)+5.6% a year
Range $89.5bn–$179.4bn
Base case line, low–high band, incl. named launches
- Tirzepatide (Mounjaro, Zepbound) reached $36.5bn in 2025; our base case is about $72bn in 2031, in line with Evaluate's forecast of above $70bn in 2032.
- Semaglutide faces generics in Canada, China and India from 2026, Medicare negotiated prices from 2027 (about 71% below list) and US cash prices under the November 2025 pricing deal.
- SGLT2 inhibitors fall away: US generic dapagliflozin from April 2026, empagliflozin's compound patent ends in 2029, and both carry 2026 Medicare prices.
- Oral and next-generation incretins (Foundayo, approved April 2026; retatrutide; CagriSema) add an estimated $26bn in 2031 in the base case.
Morgan Stanley sizes type 2 diabetes plus obesity at $79bn in 2025 and $190bn in 2035 in its base case.
| Drug | Rank | 2025 $bn | 2028 base | 2031 base (range) |
|---|---|---|---|---|
| Mounjaro tirzepatide · Eli Lilly | #2 | 22.97 | 36.97 | 41.74 30.3–52.2 |
| Ozempic semaglutide · Novo Nordisk IRA 2027 | #3 | 19.24 | 13.58 | 12.14 10.1–13.9 |
| Zepbound tirzepatide · Eli Lilly | #9 | 13.54 | 25.64 | 30.29 20.5–39.7 |
| Wegovy semaglutide · Novo Nordisk IRA 2027 | #10 | 11.98 | 14.21 | 16.25 12.0–20.2 |
| Jardiance empagliflozin · Boehringer Ingelheim / Eli Lilly US LOE 2029IRA 2026 | #13 | 9.93 | 8.30 | 2.39 1.7–3.1 |
| Farxiga/Forxiga dapagliflozin · AstraZeneca US LOE 2026Ex-US LOE 2027IRA 2026 | #15 | 8.41 | 3.12 | 1.93 1.2–2.8 |
| Trulicity dulaglutide · Eli Lilly US LOE 2027Ex-US LOE 2029IRA 2028 | #44 | 4.28 | 1.70 | 0.66 0.5–0.9 |
| Rybelsus oral semaglutide · Novo Nordisk IRA 2027 | #59 | 3.35 | 2.07 | 1.74 1.4–2.0 |
| Januvia/Janumet sitagliptin · Merck & Co US LOE 2026IRA 2026 | #76 | 2.54 | 0.61 | 0.46 0.3–0.6 |
New launches counted in this area
- Foundayo (orforglipron): $14.0bn in 2031 (range $7.0bn–$22.0bn). Approved Apr 2026; Evaluate puts it above $25bn in 2032
- Retatrutide: $8.0bn in 2031 (range $3.0bn–$14.0bn). 28.3% weight loss in TRIUMPH-1; filing 2026
- CagriSema: $4.0bn in 2031 (range $1.5bn–$8.0bn). Filed Dec 2025; FDA decision pending
Cardiovascular & renal
The steepest decline: the anticoagulant and heart-failure era ends inside the forecast window.
7 top-100 drugs$41.5bn in 2025
$28.2bn in 2031 (base)-6.2% a year
Range $17.5bn–$39.3bn
Base case line, low–high band, incl. named launches
- Eliquis has a 2026 Medicare price (about 56% below list), EU generics from 2026 and US generics from April 2028; it is the single largest loss in the top 100.
- Entresto generics launched in the US in July 2025 (Q3 2026 sales -38%), and Xarelto loses EU protection in 2026.
- Vyndaqel keeps US protection to mid-2031 under settlements but faces ATTR-CM competition, including Amvuttra.
- Growth assets are smaller: Repatha, Amvuttra, Winrevair and cardiac myosin inhibitors; an Lp(a) breakthrough is now less likely after pelacarsen missed its primary endpoint in September 2026.
| Drug | Rank | 2025 $bn | 2028 base | 2031 base (range) |
|---|---|---|---|---|
| Eliquis apixaban · BMS / Pfizer US LOE 2028Ex-US LOE 2026IRA 2026 | #6 | 14.44 | 6.37 | 2.44 1.7–3.2 |
| Entresto sacubitril/valsartan · Novartis Off-patent (US)Ex-US LOE 2026IRA 2026 | #18 | 7.75 | 2.77 | 2.25 1.3–3.3 |
| Vyndaqel family tafamidis · Pfizer US LOE 2031Ex-US LOE 2026 | #23 | 6.38 | 5.52 | 3.63 2.4–4.8 |
| Xarelto rivaroxaban · J&J / Bayer US LOE 2027Ex-US LOE 2026IRA 2026 | #30 | 5.28 | 1.36 | 0.70 0.5–0.9 |
| Repatha evolocumab · Amgen | #62 | 3.02 | 4.99 | 6.66 4.3–9.1 |
| Opsumit/Opsynvi macitentan · J&J US LOE 2027 | #84 | 2.33 | 1.36 | 1.13 0.9–1.3 |
| Amvuttra vutrisiran · Alnylam | #85 | 2.31 | 5.38 | 7.40 4.3–10.6 |
New launches counted in this area
- Cardiac myosin inhibitors (Camzyos, aficamten): $4.0bn in 2031 (range $2.0bn–$6.0bn). Camzyos $1.07bn in 2025
Neurology
Incumbents flatten; growth depends on Alzheimer's and psychiatry launches.
8 top-100 drugs$31.1bn in 2025
$37.7bn in 2031 (base)+3.3% a year
Range $26.2bn–$50.7bn
Base case line, low–high band, incl. named launches
- Ocrevus loses US exclusivity in March 2029; Kesimpta keeps growing in multiple sclerosis.
- Austedo (2027), Vraylar (2027) and Rexulti (2028) carry Medicare negotiated prices.
- Anti-amyloid antibodies are still small but growing: Eisai guides Leqembi to ¥250-280bn in FY2027.
- Cobenfy brings the first new schizophrenia mechanism in decades.
| Drug | Rank | 2025 $bn | 2028 base | 2031 base (range) |
|---|---|---|---|---|
| Ocrevus ocrelizumab · Roche US LOE 2029Ex-US LOE 2030 | #14 | 8.45 | 9.32 | 5.21 3.6–6.8 |
| Kesimpta ofatumumab · Novartis | #39 | 4.43 | 5.89 | 6.91 5.0–8.7 |
| Invega Sustenna/Trinza paliperidone palmitate · J&J | #50 | 3.81 | 3.27 | 3.01 2.6–3.4 |
| Botox Therapeutic onabotulinumtoxinA · AbbVie | #51 | 3.77 | 4.36 | 4.73 3.7–5.6 |
| Vraylar cariprazine · AbbVie US LOE 2029IRA 2027 | #53 | 3.62 | 3.65 | 0.75 0.5–1.0 |
| Ingrezza valbenazine · Neurocrine | #78 | 2.51 | 2.77 | 2.92 2.4–3.4 |
| Austedo/Austedo XR deutetrabenazine · Teva IRA 2027 | #88 | 2.26 | 2.75 | 3.22 2.3–4.1 |
| Rexulti brexpiprazole · Otsuka / Lundbeck IRA 2028 | #91 | 2.21 | 2.59 | 2.96 2.2–3.7 |
New launches counted in this area
- Anti-amyloid Alzheimer's (Leqembi, Kisunla): $5.0bn in 2031 (range $2.5bn–$9.0bn). Eisai guides Leqembi to ¥250-280bn in FY2027
- Cobenfy (xanomeline-trospium): $3.0bn in 2031 (range $1.5bn–$5.0bn). First new schizophrenia mechanism in decades
Vaccines
A stagnant area after the COVID-19 decline and Gardasil's collapse in China.
6 top-100 drugs$25.2bn in 2025
$25.0bn in 2031 (base)-0.1% a year
Range $19.6bn–$29.9bn
Base case line, low–high band, incl. named launches
- Gardasil fell from $8.6bn to $5.2bn in 2025 on China demand; this outlook assumes a slower decline from here.
- Comirnaty keeps shrinking with COVID-19 vaccination rates.
- Prevnar is defending against Merck's Capvaxive in adults; Shingrix and Beyfortus are steadier.
| Drug | Rank | 2025 $bn | 2028 base | 2031 base (range) |
|---|---|---|---|---|
| Prevnar family pneumococcal conjugate vaccine · Pfizer | #21 | 6.49 | 6.49 | 6.49 5.5–7.3 |
| Gardasil/Gardasil 9 HPV vaccine · Merck & Co | #31 | 5.23 | 4.03 | 3.50 3.0–4.0 |
| Shingrix recombinant zoster vaccine · GSK | #37 | 4.69 | 4.93 | 5.06 4.2–5.8 |
| Comirnaty COVID-19 mRNA vaccine · Pfizer / BioNTech | #41 | 4.37 | 2.53 | 1.90 1.6–2.2 |
| ProQuad/M-M-R II/Varivax MMR & varicella vaccines · Merck & Co | #79 | 2.45 | 2.45 | 2.45 2.1–2.7 |
| Beyfortus nirsevimab · Sanofi / AstraZeneca | #98 | 2.01 | 2.67 | 3.14 2.3–3.9 |
New launches counted in this area
- Capvaxive (21-valent pneumococcal): $2.5bn in 2031 (range $1.0bn–$4.0bn). Adult pneumococcal share
Infectious disease & HIV
HIV is durable: Biktarvy is protected in the US to 2036 under settlements.
4 top-100 drugs$23.0bn in 2025
$29.2bn in 2031 (base)+4.1% a year
Range $21.9bn–$36.5bn
Base case line, low–high band, incl. named launches
- Biktarvy carries a Medicare negotiated price from 2028, but Medicare is a small share of HIV treatment.
- Long-acting HIV prevention and treatment grows: Yeztugo (twice-yearly lenacapavir) launched in June 2025, Cabenuva keeps growing.
- Paxlovid keeps declining as COVID-19 demand fades.
| Drug | Rank | 2025 $bn | 2028 base | 2031 base (range) |
|---|---|---|---|---|
| Biktarvy bictegravir/emtricitabine/TAF · Gilead IRA 2028 | #8 | 14.33 | 15.15 | 16.22 12.8–19.3 |
| Dovato dolutegravir/lamivudine · GSK / ViiV | #57 | 3.53 | 4.69 | 5.51 4.0–6.9 |
| Descovy emtricitabine/TAF · Gilead | #70 | 2.76 | 3.19 | 3.46 2.7–4.1 |
| Paxlovid nirmatrelvir/ritonavir · Pfizer | #81 | 2.36 | 1.37 | 1.02 0.9–1.2 |
New launches counted in this area
- Yeztugo (twice-yearly lenacapavir PrEP): $3.0bn in 2031 (range $1.5bn–$5.0bn). Launched Jun 2025
Respiratory
Declining: the inhaler franchises and Xolair face generics, biosimilars and Medicare prices.
6 top-100 drugs$21.2bn in 2025
$14.8bn in 2031 (base)-5.8% a year
Range $10.9bn–$18.9bn
Base case line, low–high band, incl. named launches
- Trelegy carries a 2027 Medicare price about 73% below list; Ofev's 2027 price is about 50% below list.
- Omalizumab biosimilars erode Xolair.
- Biologics for COPD and asthma (Nucala, Fasenra, Dupixent in COPD) and Ohtuvayre partly offset the decline.
| Drug | Rank | 2025 $bn | 2028 base | 2031 base (range) |
|---|---|---|---|---|
| Xolair omalizumab · Roche / Novartis US LOE 2026IRA 2028 | #29 | 5.43 | 2.37 | 1.62 1.2–2.0 |
| Ofev nintedanib · Boehringer Ingelheim US LOE 2027Ex-US LOE 2026IRA 2027 | #42 | 4.32 | 1.20 | 0.63 0.5–0.8 |
| Trelegy Ellipta fluticasone furoate/umeclidinium/vilanterol · GSK US LOE 2029IRA 2027 | #47 | 3.94 | 3.20 | 2.10 1.6–2.5 |
| Symbicort budesonide/formoterol · AstraZeneca | #67 | 2.89 | 2.48 | 2.28 1.9–2.6 |
| Nucala mepolizumab · GSK | #74 | 2.65 | 3.07 | 3.33 2.6–4.0 |
| Fasenra benralizumab · AstraZeneca | #100 | 1.98 | 2.52 | 2.88 2.1–3.6 |
New launches counted in this area
- Ohtuvayre (ensifentrine): $2.0bn in 2031 (range $1.0bn–$3.5bn). COPD maintenance
Rare disease
Stable growth from durable franchises with long exclusivity.
3 top-100 drugs$17.1bn in 2025
$21.8bn in 2031 (base)+4.1% a year
Range $17.0bn–$26.1bn
Base case line, low–high band, incl. named launches
- Trikafta's sales are shifting to Vertex's own once-daily Alyftrek; exclusivity runs to the late 2030s.
- Ultomiris keeps converting Soliris patients (Soliris faces biosimilars).
- Evrysdi grows in spinal muscular atrophy.
| Drug | Rank | 2025 $bn | 2028 base | 2031 base (range) |
|---|---|---|---|---|
| Trikafta/Kaftrio elexacaftor/tezacaftor/ivacaftor · Vertex | #11 | 10.31 | 11.10 | 11.56 9.5–13.4 |
| Ultomiris ravulizumab · AstraZeneca | #36 | 4.72 | 6.28 | 7.37 5.3–9.3 |
| Evrysdi risdiplam · Roche | #93 | 2.12 | 2.57 | 2.86 2.2–3.5 |
Ophthalmology
Aflibercept biosimilars split the area: Eylea shrinks, Vabysmo grows.
2 top-100 drugs$12.8bn in 2025
$9.7bn in 2031 (base)-4.5% a year
Range $7.2bn–$12.1bn
Base case line, low–high band, incl. named launches
- Multiple aflibercept biosimilars launch in the US through Q4 2026, and EU commercialisation was allowed from 2026.
- Vabysmo keeps gaining share in wet AMD and diabetic macular oedema; Eylea HD partly offsets the Eylea decline.
| Drug | Rank | 2025 $bn | 2028 base | 2031 base (range) |
|---|---|---|---|---|
| Eylea / Eylea HD aflibercept · Regeneron / Bayer US LOE 2026 | #17 | 7.90 | 3.79 | 2.53 1.8–3.2 |
| Vabysmo faricimab · Roche | #34 | 4.95 | 6.29 | 7.19 5.3–8.9 |
Bone & other
Denosumab biosimilars dominate the picture.
3 top-100 drugs$9.1bn in 2025
$8.0bn in 2031 (base)-2.2% a year
Range $5.8bn–$10.1bn
Base case line, low–high band, incl. named launches
- Prolia fell about 30% in 2026 after biosimilar launches in 2025; Evenity keeps growing.
- Botox Cosmetic is flat in a weaker aesthetics market.
| Drug | Rank | 2025 $bn | 2028 base | 2031 base (range) |
|---|---|---|---|---|
| Prolia denosumab · Amgen Off-patent (US) | #40 | 4.41 | 1.60 | 1.04 0.7–1.3 |
| Botox Cosmetic onabotulinumtoxinA · AbbVie | #75 | 2.60 | 2.60 | 2.60 2.2–2.9 |
| Evenity romosozumab · Amgen | #95 | 2.10 | 3.33 | 4.33 2.8–5.8 |
Haematology
Steady growth from Hemlibra and Reblozyl.
2 top-100 drugs$8.1bn in 2025
$11.7bn in 2031 (base)+6.5% a year
Range $8.7bn–$14.6bn
Base case line, low–high band, incl. named launches
- Hemlibra keeps growing in haemophilia A against gene therapy and new rebalancing agents.
- Reblozyl grew 31% in 2025 on first-line MDS anaemia.
| Drug | Rank | 2025 $bn | 2028 base | 2031 base (range) |
|---|---|---|---|---|
| Hemlibra emicizumab · Roche / Chugai | #27 | 5.73 | 6.47 | 6.93 5.5–8.2 |
| Reblozyl luspatercept · BMS | #83 | 2.33 | 3.69 | 4.80 3.1–6.5 |
The list
The 100 best-selling drugs of 2025
Show all 100 drugs with 2025 sales and the 2031 base case
| # | Drug | Company | Area | 2025 $bn | 2031 base |
|---|---|---|---|---|---|
| 1 | Keytruda pembrolizumab | Merck & Co | Oncology | 31.68 | 23.61 |
| 2 | Mounjaro tirzepatide | Eli Lilly | Diabetes & obesity | 22.97 | 41.74 |
| 3 | Ozempic semaglutide | Novo Nordisk | Diabetes & obesity | 19.24 | 12.14 |
| 4 | Dupixent dupilumab | Sanofi / Regeneron | Immunology & inflammation | 17.76 | 27.58 |
| 5 | Skyrizi risankizumab | AbbVie | Immunology & inflammation | 17.56 | 38.71 |
| 6 | Eliquis apixaban | BMS / Pfizer | Cardiovascular & renal | 14.44 | 2.44 |
| 7 | Darzalex (incl. Faspro) daratumumab | J&J | Oncology | 14.35 | 14.48 |
| 8 | Biktarvy bictegravir/emtricitabine/TAF | Gilead | Infectious disease & HIV | 14.33 | 16.22 |
| 9 | Zepbound tirzepatide | Eli Lilly | Diabetes & obesity | 13.54 | 30.29 |
| 10 | Wegovy semaglutide | Novo Nordisk | Diabetes & obesity | 11.98 | 16.25 |
| 11 | Trikafta/Kaftrio elexacaftor/tezacaftor/ivacaftor | Vertex | Rare disease | 10.31 | 11.56 |
| 12 | Opdivo nivolumab | BMS / Ono | Oncology | 10.05 | 5.21 |
| 13 | Jardiance empagliflozin | Boehringer Ingelheim / Eli Lilly | Diabetes & obesity | 9.93 | 2.39 |
| 14 | Ocrevus ocrelizumab | Roche | Neurology | 8.45 | 5.21 |
| 15 | Farxiga/Forxiga dapagliflozin | AstraZeneca | Diabetes & obesity | 8.41 | 1.93 |
| 16 | Rinvoq upadacitinib | AbbVie | Immunology & inflammation | 8.30 | 18.30 |
| 17 | Eylea / Eylea HD aflibercept | Regeneron / Bayer | Ophthalmology | 7.90 | 2.53 |
| 18 | Entresto sacubitril/valsartan | Novartis | Cardiovascular & renal | 7.75 | 2.25 |
| 19 | Tagrisso osimertinib | AstraZeneca | Oncology | 7.25 | 9.79 |
| 20 | Cosentyx secukinumab | Novartis | Immunology & inflammation | 6.67 | 4.36 |
| 21 | Prevnar family pneumococcal conjugate vaccine | Pfizer | Vaccines | 6.49 | 6.49 |
| 22 | Entyvio vedolizumab | Takeda | Immunology & inflammation | 6.40 | 7.09 |
| 23 | Vyndaqel family tafamidis | Pfizer | Cardiovascular & renal | 6.38 | 3.63 |
| 24 | Xtandi enzalutamide | Astellas / Pfizer | Oncology | 6.36 | 1.15 |
| 25 | Stelara ustekinumab | J&J | Immunology & inflammation | 6.08 | 0.69 |
| 26 | Imfinzi durvalumab | AstraZeneca | Oncology | 6.06 | 10.52 |
| 27 | Hemlibra emicizumab | Roche / Chugai | Haematology | 5.73 | 6.93 |
| 28 | Verzenio abemaciclib | Eli Lilly | Oncology | 5.72 | 5.32 |
| 29 | Xolair omalizumab | Roche / Novartis | Respiratory | 5.43 | 1.62 |
| 30 | Xarelto rivaroxaban | J&J / Bayer | Cardiovascular & renal | 5.28 | 0.70 |
| 31 | Gardasil/Gardasil 9 HPV vaccine | Merck & Co | Vaccines | 5.23 | 3.50 |
| 32 | Tremfya guselkumab | J&J | Immunology & inflammation | 5.16 | 12.56 |
| 33 | Enhertu trastuzumab deruxtecan | Daiichi Sankyo / AstraZeneca | Oncology | 4.98 | 12.12 |
| 34 | Vabysmo faricimab | Roche | Ophthalmology | 4.95 | 7.19 |
| 35 | Kisqali ribociclib | Novartis | Oncology | 4.78 | 7.80 |
| 36 | Ultomiris ravulizumab | AstraZeneca | Rare disease | 4.72 | 7.37 |
| 37 | Shingrix recombinant zoster vaccine | GSK | Vaccines | 4.69 | 5.06 |
| 38 | Humira adalimumab | AbbVie | Immunology & inflammation | 4.54 | 0.90 |
| 39 | Kesimpta ofatumumab | Novartis | Neurology | 4.43 | 6.91 |
| 40 | Prolia denosumab | Amgen | Bone & other | 4.41 | 1.04 |
| 41 | Comirnaty COVID-19 mRNA vaccine | Pfizer / BioNTech | Vaccines | 4.37 | 1.90 |
| 42 | Ofev nintedanib | Boehringer Ingelheim | Respiratory | 4.32 | 0.63 |
| 43 | Tecentriq atezolizumab | Roche | Oncology | 4.30 | 3.65 |
| 44 | Trulicity dulaglutide | Eli Lilly | Diabetes & obesity | 4.28 | 0.66 |
| 45 | Vyvgart efgartigimod alfa | argenx | Immunology & inflammation | 4.15 | 13.90 |
| 46 | Ibrance palbociclib | Pfizer | Oncology | 4.12 | 0.62 |
| 47 | Trelegy Ellipta fluticasone furoate/umeclidinium/vilanterol | GSK | Respiratory | 3.94 | 2.10 |
| 48 | Privigen human immunoglobulin (IV) | CSL | Immunology & inflammation | 3.90 | 4.89 |
| 49 | Brukinsa zanubrutinib | BeOne | Oncology | 3.90 | 10.47 |
| 50 | Invega Sustenna/Trinza paliperidone palmitate | J&J | Neurology | 3.81 | 3.01 |
| 51 | Botox Therapeutic onabotulinumtoxinA | AbbVie | Neurology | 3.77 | 4.73 |
| 52 | Orencia abatacept | BMS | Immunology & inflammation | 3.71 | 3.40 |
| 53 | Vraylar cariprazine | AbbVie | Neurology | 3.62 | 0.75 |
| 54 | Perjeta pertuzumab | Roche | Oncology | 3.58 | 0.80 |
| 55 | Erleada apalutamide | J&J | Oncology | 3.57 | 4.84 |
| 56 | Taltz ixekizumab | Eli Lilly | Immunology & inflammation | 3.56 | 4.81 |
| 57 | Dovato dolutegravir/lamivudine | GSK / ViiV | Infectious disease & HIV | 3.53 | 5.51 |
| 58 | Calquence acalabrutinib | AstraZeneca | Oncology | 3.52 | 4.13 |
| 59 | Rybelsus oral semaglutide | Novo Nordisk | Diabetes & obesity | 3.35 | 1.74 |
| 60 | Lynparza olaparib | AstraZeneca / Merck | Oncology | 3.28 | 0.82 |
| 61 | Jakafi ruxolitinib | Incyte | Oncology | 3.09 | 0.47 |
| 62 | Repatha evolocumab | Amgen | Cardiovascular & renal | 3.02 | 6.66 |
| 63 | Actemra/RoActemra tocilizumab | Roche / Chugai | Immunology & inflammation | 2.98 | 1.05 |
| 64 | Revlimid lenalidomide | BMS | Oncology | 2.95 | 0.15 |
| 65 | Phesgo pertuzumab/trastuzumab | Roche | Oncology | 2.94 | 5.10 |
| 66 | Yervoy ipilimumab | BMS | Oncology | 2.90 | 3.25 |
| 67 | Symbicort budesonide/formoterol | AstraZeneca | Respiratory | 2.89 | 2.28 |
| 68 | Imbruvica ibrutinib | AbbVie / J&J | Oncology | 2.87 | 1.54 |
| 69 | Venclexta venetoclax | AbbVie / Roche | Oncology | 2.79 | 3.77 |
| 70 | Descovy emtricitabine/TAF | Gilead | Infectious disease & HIV | 2.76 | 3.46 |
| 71 | Pomalyst/Imnovid pomalidomide | BMS | Oncology | 2.73 | 0.40 |
| 72 | Nubeqa darolutamide | Bayer | Oncology | 2.70 | 7.25 |
| 73 | Simponi/Simponi Aria golimumab | J&J | Immunology & inflammation | 2.67 | 2.38 |
| 74 | Nucala mepolizumab | GSK | Respiratory | 2.65 | 3.33 |
| 75 | Botox Cosmetic onabotulinumtoxinA | AbbVie | Bone & other | 2.60 | 2.60 |
| 76 | Januvia/Janumet sitagliptin | Merck & Co | Diabetes & obesity | 2.54 | 0.46 |
| 77 | Bimzelx bimekizumab | UCB | Immunology & inflammation | 2.52 | 11.42 |
| 78 | Ingrezza valbenazine | Neurocrine | Neurology | 2.51 | 2.92 |
| 79 | ProQuad/M-M-R II/Varivax MMR & varicella vaccines | Merck & Co | Vaccines | 2.45 | 2.45 |
| 80 | Kadcyla trastuzumab emtansine | Roche | Oncology | 2.44 | 2.44 |
| 81 | Paxlovid nirmatrelvir/ritonavir | Pfizer | Infectious disease & HIV | 2.36 | 1.02 |
| 82 | Benlysta belimumab | GSK | Immunology & inflammation | 2.34 | 3.40 |
| 83 | Reblozyl luspatercept | BMS | Haematology | 2.33 | 4.80 |
| 84 | Opsumit/Opsynvi macitentan | J&J | Cardiovascular & renal | 2.33 | 1.13 |
| 85 | Amvuttra vutrisiran | Alnylam | Cardiovascular & renal | 2.31 | 7.40 |
| 86 | Otezla apremilast | Amgen | Immunology & inflammation | 2.27 | 0.85 |
| 87 | Lenvima/Kisplyx lenvatinib | Eisai / Merck | Oncology | 2.27 | 1.82 |
| 88 | Austedo/Austedo XR deutetrabenazine | Teva | Neurology | 2.26 | 3.22 |
| 89 | Enbrel etanercept | Amgen | Immunology & inflammation | 2.23 | 0.64 |
| 90 | Tafinlar + Mekinist dabrafenib + trametinib | Novartis | Oncology | 2.22 | 1.50 |
| 91 | Rexulti brexpiprazole | Otsuka / Lundbeck | Neurology | 2.21 | 2.96 |
| 92 | Cimzia certolizumab pegol | UCB | Immunology & inflammation | 2.21 | 1.69 |
| 93 | Evrysdi risdiplam | Roche | Rare disease | 2.12 | 2.86 |
| 94 | Jakavi ruxolitinib | Novartis | Oncology | 2.11 | 0.73 |
| 95 | Evenity romosozumab | Amgen | Bone & other | 2.10 | 4.33 |
| 96 | Xgeva denosumab | Amgen | Oncology | 2.08 | 0.49 |
| 97 | Hizentra human immunoglobulin (SC) | CSL | Immunology & inflammation | 2.08 | 2.71 |
| 98 | Beyfortus nirsevimab | Sanofi / AstraZeneca | Vaccines | 2.01 | 3.14 |
| 99 | Pluvicto lutetium-177 vipivotide tetraxetan | Novartis | Oncology | 1.99 | 5.70 |
| 100 | Fasenra benralizumab | AstraZeneca | Respiratory | 1.98 | 2.88 |
Method
How we built the outlook
- Ranking. Worldwide FY2025 net sales from each company's results release or annual report (Japanese companies: fiscal year to March 2026; CSL: fiscal year to June 2025), converted at 2025 average exchange rates. Co-marketed drugs are counted once at their worldwide total (e.g. Eylea = Regeneron US + Bayer ex-US; Xolair = Roche + Novartis). Company-reported product groups (insulin categories, plasma portfolios other than named brands, vaccine categories) are excluded.
- Momentum. Each drug grows at an assumed 2026 rate that fades by about 18% a year (faster for tirzepatide), set from 2025 growth, 2026 reported results and company guidance.
- Loss of exclusivity. From the US and ex-US LOE year, sales follow erosion curves: small molecules in the US keep 60%, 28% and 17% of pre-LOE sales in years 1–3; biologics 85%, 62% and 48%; ex-US generics erode more slowly. Curves are checked against Entresto, Stelara and denosumab.
- US Medicare negotiation. From the year a negotiated price applies, the Medicare share of US sales is reduced by the published discount (third-cycle discounts, not yet published, assumed at 40%).
- Scenarios. Low: weaker momentum, faster erosion, deeper price effects. High: stronger momentum, slower erosion. Base sits between.
- New launches. Only named assets with public data are added, on an S-curve to an assumed 2031 value. Everything else that launches by 2031 is outside these totals.
These are modelled scenarios built on stated assumptions, not guarantees, and not investment advice. Company-reported figures can be restated. For a product, market or country cut of this analysis, brief us on a custom analysis.
Sources
- Company FY2025 results releases and annual reports (Merck & Co, Lilly, Novo Nordisk, Sanofi, Regeneron, AbbVie, BMS, Pfizer, J&J, Roche, Novartis, AstraZeneca, GSK, Gilead, Amgen, Vertex, Takeda, Bayer, Boehringer Ingelheim, Astellas, Daiichi Sankyo, argenx, CSL, BeOne, Incyte, UCB, Neurocrine, Alnylam, Eisai, Teva, Otsuka, United Therapeutics, Biogen, Jazz, Viatris)
- CMS: negotiated prices effective 2026 (first cycle)
- CMS: 15 negotiated prices effective 2027
- CMS: third-cycle drugs (prices effective 2028)
- Pfizer FY2025 10-K (Eliquis, Ibrance, Xtandi, Vyndaqel exclusivity)
- Lilly FY2025 10-K (Jardiance, Trulicity exclusivity)
- Novartis Q3 2026 (Entresto generic erosion)
- Amgen Q2 2026 10-Q (denosumab biosimilar erosion)
- Gilead Biktarvy settlements (US generics 2036)
- Semaglutide generics in Canada
- Aflibercept biosimilars in the US and EU
- IQVIA, Global Medicine Use Trends 2026
- Evaluate World Preview 2026
- Evaluate: tirzepatide above $70bn in 2032
- Morgan Stanley: GLP-1 market to 2035
- Lilly/Novo pricing agreement, Nov 2025
- Section 232 pharmaceutical tariffs (Apr 2026)
- Pelacarsen Lp(a) HORIZON result
Product-level sources are in the CSV download.