Novartis posted full-year 2025 net sales of $54.5 billion, up 8% at constant currency, with core operating income rising 14% and core margins reaching 40.1%. Fourth-quarter sales slipped 1% at constant currency amid U.S. generic erosion and revenue deduction adjustments, but priority brands continued to surge: Kisqali, Kesimpta, Pluvicto, Scemblix, and Cosentyx each delivered double-digit growth. The company raised its dividend to CHF 3.70, guided to low single-digit net sales growth and a low single-digit decline in core operating income for 2026, and reiterated plans to close the proposed acquisition of Avidity Biosciences in the first half of 2026.
The headline is a paradox: margin expansion at scale while signaling a step down in 2026 profitability. That tension reflects a deliberate reweighting of the portfolio toward complex, higher-growth modalities—radioligand therapy, gene and cell therapy, and targeted immunology—while absorbing near-term headwinds from U.S. pricing dynamics and the largest loss of exclusivity cycle in the company’s history. The strategic question is whether momentum in oncology and immunology can offset policy and LOE pressure quickly enough to protect earnings through 2026.
For Commercial leaders, this is a lesson in mix management. Volume drove 15 percentage points of annual growth, while pricing detracted one point for the year and four points in Q4. U.S. revenue deductions and generic entries are now material planning variables. Yet the growth engines are delivering: Kisqali’s early breast cancer expansion is reshaping adjuvant CDK4/6 dynamics; Kesimpta’s trajectory in multiple sclerosis underscores payer acceptance of self-administered anti-CD20s; Pluvicto’s continued uptake pre-taxane in mCRPC, with an FDA submission now filed in mHSPC, signals radioligand therapy’s march earlier in the prostate cancer continuum. Scemblix’s first-line expansion in Europe positions it as a potential new baseline in CML, intensifying competitive pressure on legacy TKIs. Cosentyx’s lifecycle work, including hidradenitis suppurativa and a positive PMR Phase III, keeps the brand relevant as IL-17 competition widens.
Medical Affairs teams face a busy year translating label expansions into standard practice. Earlier-line Pluvicto will demand safety operations, imaging coordination, and site enablement beyond academic centers. Kisqali’s NATalee data raises real-world adherence and toxicity monitoring questions in a broad early breast population. Scemblix’s move to first line will hinge on education around mechanism, tolerability, and long-term outcomes vs. established TKIs. The approval of Itvisma as a gene replacement therapy for a broad SMA population widens access beyond infant presentations, calling for payer evidence on durability, retreatment strategy, and care pathway integration.
The Avidity deal is more than pipeline fill; it pushes Novartis deeper into RNA delivery to muscle, with late-stage DM1 and FSHD assets that could open a new rare neuromuscular franchise. In a market where large caps are buying platform biotechs to bridge LOE gaps, this reflects a broader pivot to modality-led differentiation. Radiopharma scale-up, gene therapy manufacturing, and xRNA capabilities become as commercially decisive as brand positioning.
Two forces will define 2026: the implementation of Novartis’s U.S. price-lowering agreement and the cadence of pipeline conversions. If Pluvicto wins in mHSPC, pelabresib files on strong Phase III durability, and ianalumab advances with breakthrough momentum in Sjögren’s, the company’s margin resilience could hold. The open question for competitors and payers alike: will complex modalities, supported by credible RWE and site enablement, outpace the drag from LOE and U.S. pricing reform, or will 2026 mark a reset year before growth re-accelerates in 2027?
Jon Napitupulu is Director of Media Relations at The Clinical Trial Vanguard. Jon, a computer data scientist, focuses on the latest clinical trial industry news and trends.
