Big Pharma Invests in U.S. Manufacturing

Editor’s Take: Big Pharma’s next phase will be shaped as much by manufacturing capacity and supply strategy as by the products driving today’s growth.

Eli Lilly takes the top spot in this year’s Top 20, but only by a small margin. Its $65.2 billion in 2025 prescription drug sales edged Merck’s $65.0 billion by just $168 million. Roche and Pfizer were close behind at roughly $62.6 billion.

The bigger story is how Lilly got there. Mounjaro and Zepbound brought in a combined $36.5 billion and accounted for more than half of the company’s revenue. Merck also depends heavily on Keytruda, which generated $31.7 billion. Dupixent remains a major product for both Sanofi and Regeneron, while Skyrizi and Rinvoq have helped AbbVie move past the worst of Humira’s decline.

When a few products become that important, manufacturing becomes just as important as sales. A delay, shortage or quality problem can affect a much larger part of the business. That is one reason manufacturing shows up again and again in this year’s company profiles.

Manufacturing Becomes a Bigger Part of the Story

The amount of money going into U.S. manufacturing is hard to miss. Lilly, Merck, Roche, Johnson & Johnson and AstraZeneca each announced multiyear U.S. investment plans of $50 billion or more. Novartis, GSK and Gilead also outlined major spending plans.

Not all of that money is going into factories, and the projects will play out over several years. Even so, the message is clear. Large drugmakers want more production in the U.S., especially for the products they believe will drive future growth.

The investments cover a wide range of needs. Lilly is adding capacity for APIs, peptides, biologics and injectable drugs. Merck is building for biologics and antibody-drug conjugates. Johnson & Johnson is expanding cell therapy production. Novartis is adding more radioligand therapy capacity.

This is not only about bringing production back to the U.S. Pipelines are becoming more complex, launches are getting larger, and companies need backup capacity, faster technology transfer and tighter control over critical materials and production steps.

The push from Washington is also part of the picture. President Trump’s most-favored-nation pricing plan, which is meant to bring U.S. drug prices closer to those paid in other countries, is putting new pressure on the industry. The agreements are not all the same, but several include lower prices, direct-to-patient discounts, participation in TrumpRx and tariff relief tied to U.S. investment.

For drugmakers, that creates a difficult situation. They are being asked to lower prices on some products while also spending heavily on U.S. plants and continuing to fund R&D. Novo Nordisk pointed to pricing pressure, stronger competition and its most-favored-nation agreement when it warned that sales could fall in 2026. Pfizer and Novartis have also said the new pricing environment will affect their businesses.

It is still too early to know where all of this goes. The policy could affect launch plans, product pricing and where companies choose to invest. It may also push more companies toward direct-to-patient programs.

For contract manufacturers, the push for more U.S. production could create new opportunities. Drug companies may build more of their own capacity, but they will still rely on outside partners for additional production, backup supply and specialized expertise.

Obesity Drugs Keep Driving Investment

No area had a bigger effect on this year’s ranking than obesity and diabetes. Lilly’s jump to No. 1 came from Mounjaro and Zepbound. Novo Nordisk’s Ozempic and Wegovy generated a combined $31.1 billion, although Novo now faces stronger competition from Lilly and more pressure on pricing.

The manufacturing push is moving beyond those two companies. Roche is planning a large U.S. plant for future weight-loss drugs. AstraZeneca’s planned Virginia site will support future diabetes and obesity products. Amgen moved MariTide into Phase III, and Pfizer acquired Metsera to add injectable and oral GLP-1 candidates.

The next round of obesity products will not all look the same. Some will be injections, some will be pills, and others may be given less often. That means companies will need different types of manufacturing, from peptide production and tableting to sterile fill-finish, devices and packaging.

Obesity is only part of the picture. The Top 20 are also spending on antibody-drug conjugates, radiopharmaceuticals, cell and gene therapies, plasma products, long-acting injectables and biosimilars. These products are often harder to make, test and scale up than a traditional tablet.

That is why companies are investing in their own plants while also working with outside partners. Johnson & Johnson made a 10-year, $2 billion commitment for dedicated capacity at Fujifilm’s Holly Springs site. Sanofi agreed to transfer its Ridgefield, NJ, sterile fill-finish and packaging plant to Thermo Fisher while keeping manufacturing support for several products. BMS opened a radiopharmaceutical facility in Indianapolis.

Companies are no longer choosing between making products themselves and relying on outside partners. They are expanding their own plants for key products while still using CDMOs and other partners for extra capacity, special skills and backup support.

Patent Losses and Portfolio Changes

New manufacturing projects get a lot of attention, but older products losing patent protection are still shaping the industry.

AbbVie is one of the best examples of a company getting through a major patent loss. Humira continued to fall because of biosimilar competition, but Skyrizi and Rinvoq generated nearly $25.9 billion and have become the new center of AbbVie’s immunology business.

Bristol Myers Squibb’s results show how uneven these changes can be. Sales from its newer products rose 17%, but the older part of the business fell 15% under generic pressure. Pfizer is dealing with the continued drop in COVID-related revenue, while Takeda is cutting costs as Vyvanse loses exclusivity. CSL is simplifying its operations, even as it continues to invest in manufacturing. Viatris ended the year with a broader strategic review after another decline in sales.

These shifts also create work for outside partners. When companies sell facilities, move products or tighten their manufacturing networks, they often need help with technology transfer, supplier changes and ongoing product support. Cost cutting may reduce some outside spending, but it can also make outside capacity more appealing than building another facility.

Artificial intelligence also comes up throughout the report. Companies are looking at AI and digital tools in clinical development, manufacturing and technology transfer. The real test will be whether those tools help companies move faster or avoid problems.

This year’s Top 20 shows an industry that is still growing, but also dealing with more pressure. Many companies are relying heavily on a few major products while facing patent losses, tougher pricing and more difficult manufacturing demands.

Their response has been to keep investing, but with a closer eye on where the money goes. Manufacturing, supply and launch preparation are becoming a bigger part of those decisions.

For Contract Pharma’s audience, that should mean a busy market. Large drugmakers are putting more money into their own U.S. facilities, but they are also developing products that require specialized skills and outside support.

The Top Company ranking shows which companies sold the most prescription drugs in 2025. The profiles show how they are preparing for what comes next.