In 2023, the FDA approved 55 new molecular entities—the second-highest total in 30 years and nearly double that of 2022, likely due to improvements in post-pandemic operations.
Key drug patents expired in 2023, including AbbVie’s Humira and J&J’s Stelara. More major expirations are expected from companies like Bristol Myers Squibb and Novartis in the coming years, disrupting the U.S. pharma market as generics and biosimilars enter.
Mergers and acquisitions are also reshaping the industry. In early 2024, 430 M&A deals worth $68.8 billion were announced. While no megadeals are expected, large pharma firms are likely to continue acquiring biotechs to offset revenue losses from patent cliffs.
The top 10 largest pharmaceutical companies in 2024, ranked by 2023 pharma sales revenue:
- Pfizer – $58.5B
- Johnson & Johnson – $54.76B
- AbbVie – $54.32B
- Merck & Co. – $53.6B
- Roche – $49.9B
- Sanofi – $46.16B
- AstraZeneca – $45.8B
- Novartis – $45.4B
- Bristol-Myers Squibb – $45B
- GSK – $38.4B
1. Pfizer – $58.5B (-42%)
Pfizer retained its position as the world’s top pharmaceutical company in 2024, despite a 42% drop in revenue from the previous year. The sharp decline followed a record $100B in 2022, driven largely by its COVID-19 vaccine, Comirnaty. Excluding COVID-related sales, the company posted a 7% operational revenue growth in 2023, supported by new launches and strong performance from key products.
As a leading U.S.-based pharma and biotech firm, Pfizer develops treatments across areas like immunology, oncology, cardiology, and neurology. Since the spin-off of Upjohn in 2020, it has focused exclusively on innovative biopharmaceuticals.
In 2023, Pfizer laid the groundwork for future growth with 9 new molecular entity approvals from the FDA and completed its landmark acquisition of Seagen Inc., enhancing its oncology capabilities.
CFO David Denton highlighted an 8% rise in non-COVID revenues in Q4 and reaffirmed Pfizer’s strategy to grow through new and acquired products while improving operational margins moving forward.
2. Johnson & Johnson – $54.8B (+4%)
In 2024, Johnson & Johnson rose to second place, surpassing AbbVie. Headquartered in New Jersey, J&J operates across pharmaceuticals, medical devices, and consumer health products.
Its innovative medicine division saw a 4% revenue increase in 2023, both reported and operational. Growth was fueled by strong sales of key drugs such as Darzalex (multiple myeloma), Stelara (immune-mediated diseases), Tremfya (plaque psoriasis and psoriatic arthritis), Erleada (prostate cancer), and Teclistamab (also for multiple myeloma).
CEO Joaquin Duato noted that the 2023 results highlight the company's strong and competitive business model, adding that J&J enters 2024 well-positioned to drive the next era of healthcare innovation.
3. AbbVie – $54.3B (-6%)
AbbVie ranked third in 2024, with revenues down 6% due to the U.S. loss of exclusivity for Humira and a drop in Imbruvica sales. Despite this, the company saw strong growth from Skyrizi (+50%) and Rinvoq (+64%) and is focusing on these drugs to drive future revenue. AbbVie also expanded its R&D pipeline with planned acquisitions of ImmunoGen and Cerevel. CEO Richard Gonzalez remains optimistic, projecting modest growth in 2024 and a return to strong performance by 2025.
4. Merck & Co – $53.6B (+3%)
Merck held its fourth-place position in 2024, with 2023 revenues rising 3% to $53.6B, driven by strong growth in oncology and vaccines. Keytruda, its top-selling cancer drug, brought in $25B (+19%) and made up nearly half of pharma sales. Growth was also supported by Gardasil (+29%) and MMRV vaccines, though declines in Januvia/Janumet and Pneumovax 23 offset gains.
With Keytruda's patent set to expire in 2028, Merck is expanding its pipeline, acquiring Prometheus Biosciences and Harpoon Therapeutics. CEO Robert M. Davis highlighted the company’s strong year, impactful global reach, and $30B investment in R&D to drive future innovation.
5. Roche – $49.9B (-1%)
Roche, with a long history in medical innovation, saw a slight 1% drop in pharma revenue in 2023, totaling $49.9B. Growth from oncology drug Phesgo (+2%) and eye treatment Vabysmo (+85%) helped offset declining COVID-19 product sales, which also impacted the diagnostics division.
CEO Thomas Schinecker highlighted progress in the pipeline, including promising results from inavolisib for advanced breast cancer. Roche also strengthened its portfolio through new partnerships targeting high-need areas like inflammatory bowel and cardiometabolic diseases, positioning the company for future growth.
6. Sanofi – $46.2B (+2%)
Sanofi reported $46.2B in revenue for 2023, up 2%, driven by strong growth from eczema drug Dupixent and the successful launch of the RSV vaccine Beyfortus. The company announced plans to spin off its OTC business by late 2024 to focus on prescription drugs.
As part of its tech-driven strategy, Sanofi partnered with French AI firm Aqemia to enhance drug discovery using advanced algorithms. CEO Paul Hudson described 2023 as a pivotal year, positioning Sanofi as a leader in immunology and innovation-powered growth.
7. AstraZeneca – $45.8B (+3%)
AstraZeneca, based in the UK, reported a 3% revenue increase in 2023, supported by strong global performance across its key medicines. The company expanded its rare disease and cell therapy pipelines with acquisitions of Icosavax and Gracell Biotechnologies.
CEO Pascal Soriot highlighted the company’s 25th anniversary and praised its financial and scientific progress. With a robust portfolio and strong R&D pipeline, AstraZeneca expects continued growth in 2024.
8.Novartis – $45.4B (+8%)
Novartis ranked 8th in 2024, reporting $45.4B in 2023 revenue, up 8%, as it transitioned into a focused innovative medicines company following the spin-off of Sandoz. Key growth drivers included strong sales of Eliquis and Opdivo.
The company is now concentrating on four core areas: cardiovascular-renal-metabolic, immunology, neuroscience, and oncology, with a focus on growth in key markets like the US, China, Germany, and Japan.
9. Bristol-Myers Squibb – $45B (-3%)
BMS reported $45B in 2023 revenue, down 3% due to loss of exclusivity for Revlimid. However, growth from newer products and a 9% increase in Opdivo sales helped offset declines.
CEO Christopher Boerner stated that in 2024, the company aims to strengthen commercial execution and boost long-term growth prospects.
10. GSK – $38.4B (+6%)
GSK held 10th place in 2024 with a 6% revenue rise in 2023, reaching $38.4B. The full demerger from Haleon allowed GSK to focus solely on biopharmaceuticals. Key highlights included the launch of Arexvy, the first RSV vaccine for older adults, and continued pipeline progress with 12 major launches planned by 2025.
The company also expanded through acquisitions of Bellus Health and Aiolos Bio, strengthening its respiratory portfolio. CEO Emma Walmsley expressed confidence in accelerating growth and raised outlooks for 2026 and 2031.