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Novartis said further generic erosion of three blockbuster medicines, including its top-selling heart failure drug Entresto, will leave a $4 billion hole in its sales this year. Generic competition started to make a mark in the fourth quarter, as Entresto sales plummeted 45% from the year-earlier period in constant currencies to $1.25 billion. Sales of thrombocytopenia treatment Promacta plunged 63% to $226 million, while blood cancer drug Tasigna declined 58% to $179 million. Even with the three generic rivals entering the market around mid-2025, Novartis was able to produce total fourth-quarter sales of $13.3 billion, relatively steady compared to the previous year. As for the coming full year, the company is predicting an increase in the low-single digits. “We expect to grow in 2026 through the largest patent expiries in Novartis history,” CEO Vas Narasimhan told the media. “This demonstrates the strength of our growth drivers and the strength of our pipeline.” Novartis’ revenue forecast suggests 2026 sales of $56.2 billion to $57.9 billion, Jefferies analysts wrote in a same-day note. At the same time, Novartis foresees core operating income declining by low-single digits, according to its latest earnings report . Full-year 2025 sales were up 8% from the year before, at $54.5 billion, supported by two products that passed the $1 billion mark for the first time. Blood cancer drug Scemblix pulled in $1.29 billion in 2025, up 85% from 2024. And sales of cholesterol medicine Leqvio grew 57% to hit $1.19 billion. Investors seemed to be reassured by these figures. The company’s share price remained flat on the Swiss exchange early Wednesday. On the pipeline side, Novartis discontinued several early- to mid-stage programs following a review. The majority of culled candidates were in Phase 1 development for cancer, namely: Novartis also dropped a candidate for tendinopathy called NGI226 that was in Phase 2 development. A company spokesperson wrote in an email that the cuts were “balanced by the addition of new projects entering our pipeline.” Novartis also slightly delayed some of its highly anticipated R&D milestones. It now expects to report Phase 3 data for pelacarsen in this year’s second half, as opposed to the first half, according to an earnings presentation . The drug is for certain patients who have elevated levels of lipoprotein(a). The company also said Phase 3 data for its rare kidney disease drug zigakibart would come in the first half of 2027, instead of this year. Novartis amended the protocol of a trial in IgA nephropathy so that kidney biomarker data would come at the same time as results on the primary endpoint of proteinuria, which is considered a more robust marker of kidney function. Elsewhere, Narasimhan said Novartis was still “very active” when it came to deals in China. Last month, it spent $50 million upfront to license a radiopharmaceutical candidate from Zonsen PepLib Biotech. Oncology will be a core focus for Novartis’ M&A deals going forward, Narasimhan told analysts on a separate earnings call. On the media call, the CEO described China’s biotech environment as “very important” and “exciting,” adding that US and European regulators could take lessons from some of the ways China has “streamlined regulatory oversight” and “modernized its clinical trial enrollment approach.” Novartis isn’t the first company to double down on its interest in China. Last month, AstraZeneca announced it would spend $15 billion on manufacturing and R&D projects in China through 2030. In December, Novartis said it had reached a deal with President Donald Trump’s administration to lower drug prices in the US. That deal included an agreement to launch future medicines with “comparable prices” across high-income countries. Narasimhan told analysts the company is “working through strategies” for anticipated launches, including its Sjögren’s disease candidate ianalumab, which is expected to launch in the G7 countries next year. Editor’s note: This article was updated to add comments from Novartis’ analyst call.

Novartis chief executive Vas Narasimhan said Thursday that "the largest patent expiry" in the company's history will wipe out $4 billion in sales in 2026, although overall revenue is still predicted to grow this year in the low single-digits on a constant currency basis. Generic competition to Entresto, Tasigna and Promacta entered the US in 2025, leading to sharp declines in sales of the products in the second half of the year.This is expected to continue in the first half of 2026. "This creates, of course, a full-year effect that comes mainly in half one," explained Chief Financial Officer Harry Kirsch.Kirsch — speaking on a media call — echoed Narasimhan's assessment, calling it "the biggest generic effect that we ever had in the last 20 years." However, he said in terms of guidance, it's "easy to model" the impact. "You take the US sales…of last year first half. And then you see that basically most of this goes away fully as of half one this year. And so it's really an achievement to grow the company."Despite the expected uptick in sales this year, which will be led by Novartis' current growth drivers — Kisqali, Kesimpta, Pluvicto, Scemblix and Cosentyx — core operating income is predicted to decline in the low single-digits on a constant currency basis.Two new blockbustersContributing to 2026 growth will be two newly-crowned blockbuster products, with sales from both Leqvio and Scemblix crossing the $1-billion threshold for the first time in 2025. Revenue from the lipid-lowering drug Leqvio jumped 59% last year to $1.2 billion, while sales of chronic myeloid leukaemia treatment Scemblix surged 87% to $1.3 billion.Narasimhan said that while Leqvio has benefited from "solid, but not spectacular growth in the US," its performance in other markets, particularly in China, has driven growth. The product recently received NRDL listing in China, which Narasimhan suggested will "be a significant accelerant…for the brand."Meanwhile, Narasimhan noted that Scemblix has posted "very strong growth," with the company remaining confident that the drug could generate peak sales of over $4 billion. "So both of these medicines will be very important for our growth through the end of the decade, but also into the middle of the 2030s," Narasimhan said.The performance of Leqvio and Scemblix, coupled with Novartis' other growth drivers, propelled sales in 2025 up 8% to $50.3 billion, while net income rose 17% to $11.9 billion.Revenue growth was more muted in the final quarter of the year, rising 1% to $13.3 billion, with generic competition having a negative impact of 15 percentage points. Sales of Entresto fell 43% in the fourth quarter to $1.3 billion, Promacta was down 61% to $226 million and Tasigna slipped 56% to $179 million.In contrast, three-month revenue from Cosentyx increased 13% to $1.8 billion; Kisqali grew 46% to $1.3 billion; Kesimpta was up 29% to $1.2 billion; and Pluvicto lifted 72% to $605 million.