Foreword
Last year’s Age of Uncertainty has given way to more predictable realities, including the dominance of obesity and other big diseases, a wider range of modalities and an IRA that’s here to stay.
Obesity drugs loom large over 2030 forecasts. GLP-1 agonists and related incretins are helping drive record overall prescription drug sales growth, propelling leaders Novo Nordisk and Eli Lilly to the top of the company rankings and hogging the lion’s share of the 2030 product top-ten. As competition ramps up, more potent compounds, combinations and oral formulations will likely support metabolic diseases’ dominance into the next decade and beyond.
Immuno-inflammation and oncology also make 2030’s top ten. Sanofi’s Dupixent and AbbVie’s Skyrizi will be the biggest non-obesity drugs. Resurgent CNS and respiratory are both prominent among most valuable pipeline candidates, as industry’s red-hot innovation engine drives advances across the board. New modalities and technologies continue to open up novel targets and targeting mechanisms: antibody drug conjugates (ADCs), multi-specific antibodies, RNA-based therapies, gene/cell therapies and radiopharmaceuticals are all expected to grow steeply to 2030.
Big Pharma’s appetite for Big Drugs for Big Diseases reflects ongoing patent expiry challenges, expected to spike the likes of Merck, J&J and Bristol Myers Squibb this decade. Patent expiries are a feature of the landscape, just like the M&A that can help address them. Pharma acquisitions reached a healthy $124 billion in 2023 and look similarly strong so far in 2024 – welcome news for biotechs, given stubbornly lacklustre public markets.
Pharma cash-piles and expiry pressures should drive even more deals, but pharma is also having to adapt to other realities. Inflation and interest rates remain stickier than expected, political uncertainty endures, and new technologies such as AI promise (or threaten) to upend R&D workflows. These factors – plus the M&A upsurge - may already be contributing to slowing forecast pharma R&D spend, whose growth for the rest of this decade is just a third of that seen between 2016 and 2023.
The US Inflation Reduction Act is bedding into the landscape. Industry’s legal challenges have so far failed, and price negotiations between pharma firms and Medicare/CMS are ongoing. Many implementation details of the Act remain unclear; the forthcoming US election may influence how aggressively (or otherwise) the law is translated into action.
But with payers facing unprecedented numbers of new drugs, and the public lens still firmly focused on drug pricing, it is hard to imagine any US government repealing the IRA.