The Pharma Giants' 2023 Playbook: Who's Winning and Who's Struggling

The global pharmaceutical market continues to be a money-printing machine. With industry revenues hitting US$1.6 trillion in 2023 and projected to climb further, investors are closely watching which players are maintaining momentum and which are facing headwinds.

The Pecking Order Shifts: A Tale of Winners and Losers

Last year painted a mixed picture across the sector’s heavyweights. Johnson & Johnson maintained its commanding position with US$85.16 billion in revenues, though its future hinges on navigating biosimilar threats to its immunology powerhouse Stelara. Meanwhile, competitors scrambled to adjust their strategies as market dynamics shifted dramatically.

Roche Holding brought in US$65.32 billion, benefiting from its diversified portfolio spanning diagnostics and pharmaceuticals. The company’s eye disease treatment Vabysmo is emerging as a genuine challenger in a competitive space, while its hemophilia therapy Hemlibra continues firing on all cylinders with 16 percent sales growth.

The COVID Hangover: Pfizer’s Dramatic Fall from Grace

Perhaps the most striking story was Pfizer’s stunning 41 percent revenue decline to US$58.5 billion. The company’s rocket-fueled rise to US$100.33 billion in 2022 was heavily anchored to pandemic products, and when that demand normalized, the market exposed deeper structural challenges. Stripping out COVID-related revenues reveals a healthier underlying business with 7 percent growth in core pharmaceutical sales.

The Real Growth Stories

Merck & Company demonstrated resilience with Keytruda, its checkpoint inhibitor cancer drug, becoming the world’s best-selling medicine at US$25 billion annually. The drug’s trajectory suggests potential to reach US$30 billion within two years, though patent cliff concerns loom when exclusivity expires in 2028.

AstraZeneca posted a more modest 3.3 percent increase to US$45.81 billion, but its oncology division was the breakout performer with 20 percent growth. The company’s immuno-oncology portfolio combined for US$4.2 billion in sales, up a remarkable 55 percent year-over-year.

The Patent Cliff Problem

This is where the narrative gets thorny. AbbVie faces significant headwinds as Humira—historically one of pharma’s most profitable franchises—lost exclusivity in the US market. Biosimilars are now eating into market share across key regions. The company must lean more heavily on Skyrizi and Rinvoq to offset these losses.

Bristol-Myers Squibb tells a similar story. Its revenue dipped 2 percent to US$45 billion as Revlimid slowly loses ground. Management is placing increasing bets on Eliquis and Opdivo to compensate, but the company is entering a transition period marked by looming patent expirations and pricing pressures from the Inflation Reduction Act.

The Survivors and the Bright Spots

GSK, rounding out the top 10 at US$38.4 billion, showed 3.4 percent growth bolstered by strong vaccine performance. Its shingles vaccine Shingrix delivered 17 percent growth, while the newly approved RSV vaccine Arexvy provides fresh revenue streams—a timely win in the preventive medicine space.

Novartis revenues grew 7.7 percent to US$45.44 billion after spinning off its generics and biosimilar business Sandoz. This strategic pivot toward pure innovative medicines could prove advantageous as the company leans into cell and gene therapies.

What’s Next for the Industry

The pattern is clear: companies with diversified pipelines, strong pipeline momentum in emerging therapy areas, and manageable patent cliff exposure are outperforming peers. Meanwhile, those overly reliant on single blockbuster drugs face turbulence ahead. The sector’s trajectory remains bullish—prescription drug sales are expected to hit US$1.7 trillion by 2030—but winners will be differentiated by execution, innovation speed, and strategic M&A choices.