Retail blockbusters, then specialty drugs. Now a new era of mega-blockbusters | Asembia AXS26 Summit

The pharmaceutical industry is entering an era of mega-blockbusters, drugs with sales of $10 billion or more, that will dominate the market, Luke Greenwalt, MBA, predicted at the 2026 Asembia AXS26 Summit.

Greenwalt, vice president and lead of U.S. thought leadership at IQVIA and a member of the Managed Healthcare Executive editorial advisory board, kicked off the general session with a nearly glowing depiction of the state of the pharmaceutical industry, albeit with some qualifications about the difficulties drugmakers face in launching new drugs because of “hypercompetition” in some areas and obstacles to market access. He also spoke about the Inflation Reduction Act (IRA), the Trump administration’s most-favored-nation (MFN) drug policies and the pharmacy benefit management reforms signed into law earlier this year as creating an unsettling “trifecta of policy.”

“Many of you have been absolutely overwhelmed with the pace of change over this last year. You are not alone. Everyone is feeling the same thing, even those of us who are deeply dedicated to understanding what’s occurring,” Greenwalt told the audience of thousands in a ballroom of the Encore hotel.

Greenwalt said everyone in the room should be proud of the drug industry’s annual sales figure: “It represents more than 2,000 product launches in the last 15 years, it represents trillions of dollars of R&D [research and development] investment and the delivery of 50 billion prescriptions in the U.S. market alone and the improvement of the lives of millions, if not billions, of people globally.”

Greenwalt also spoke about the “loss of exclusivity,” noting that 32 brand-name drugs with more than $1 billion in net sales will lose patent protection by 2030. The result will be list price reductions, more biosimilars and direct-to-patient sales by drugmakers. He also noted that 8,000 retail pharmacies closed between 2018 and 2025, “as rigid cost structures could not keep up with declining reimbursement and shifting markets.” He shared projections showing that through 2030, drugs for obesity and cancer treatment will be responsible for the large shares of the growth in drug sales, with drugs for immunologic disorders, such as rheumatoid arthritis and Crohn’s disease, growing but at a smaller pace. Greenwalt noted the run that development of oncology drugs has been on: 155 novel drugs approved by the FDA over the past 10 years, by his count, and 350 new indications for previously approved drugs, totaling some 500 launches in oncology. “As we project that forward, this continues to be a major drive of the industry,“ he said.

In a fast-paced presentation that surveyed a wide range of trends in drug sales and distribution channels, Greenwalt touched on the ramifications of the Trump administration’s MFN policies. He questioned the strategy of waiting to launch drugs overseas because of MFN pricing. “If you are waiting, what are you waiting for?” he said. Even if drugmakers are successful in negotiating higher prices in countries where prices would factor into an MFN price, Greenwalt said, a sizable increase of, for example, 25% wouldn’t be all that meaningful given that U.S. prices are four to five times higher than those in the “most generous” countries when it comes to drug prices.

CMS price negotiations under the IRA garner most of the attention, but Greenwalt spoke about the provisions that cap out-of-pocket costs at $2,000 a year for people enrolled in Medicare Part D plans that cover prescription drugs. Enrollment in Medicare Part D plans has increased by 46% over the past five years as baby boomers aged into Medicare eligibility, and Greenwalt noted that Part D is now “the largest payer channel in the industry.” The cap on beneficiaries’ out-of-pocket costs has resulted in greater utilization of drugs, fueling revenues for drugmakers in the process. Greenwalt cautioned that the Part D plans have responded with narrower formularies, thereby “funneling the market into fewer and fewer choices.”

Greenwalt also touched on the 340B Drug Pricing Program, which lets many health systems buy drugs at discounted prices while being reimbursed by payers at higher prices, with the difference creating revenue for hospitals. He shared IQVIA figures showing that 340B discounts grew from $33 billion in 2020 to $84 billion in 2025, adding that the amount of 340B discounts has grown partly because the 50 largest health systems now have 47,000 off-site “child sites” that bring patients and their prescriptions into the program.

Greenwalt sketched a recent history of the prescription drug industry, dividing it into three eras. The retail blockbuster era from 2005 to 2015 was fueled in part by the Medicare Part D prescription drug coverage that started in 2006. The era had a retail focus, and price increases were detached from patient out-of-pocket costs. Next in Greenwalt’s telling was the specialty drug era from 2015 to 2025 that coincided with the Affordable Care Act, the growth in 340B and greater payer control (partly in reaction to the growth in spending on specialty drugs).

Greenwalt said evidence that the prescription drug market was entering a new era dominated by a relatively few top-selling drugs included IQVIA data showing that 87% of the sales growth from 2024 to 2025 came from 25 branded drugs. Since 2020, the number of mega-blockbusters, drugs with $10 billion in net sales while they have been on the market, has increased tenfold, according to Greenwalt. The glucagon-like peptide-1 drugs for weight loss and Type 2 diabetes, Wegovy (semaglutide) and Zepbound (tirzepatide), are among them.

Greenwalt shared a projection that spending on new brand-name drugs is expected to be $127 billion through 2030, which is half of the historical average. “Mega-blockbuster brands crowd out other spending, and we start to see it as we look at the launch environment,” he concluded.