Main players, trends 2024 to 2026, regulation and cases
Who the main companies are by region (unranked, sourced), what changed from 2024 to 2026, the regulation you need to know, and how to crack typical pharma and medtech cases.
Industry brief, with a one-minute summary: Pharma, biotech and medtechFirm processes and online tests change from year to year and differ by office. Use this to prepare, and confirm the exact current steps on the firm's own careers page.
Key takeaways
- Pharma cases turn on four things: how many patients can be treated, what price payers will accept, how many years of protection are left, and how likely the science is to work.
- Common traps: Treating the doctor as the only customer and forgetting the payer.
- Obesity and diabetes drugs became the biggest growth story.
- Tariffs and new US factories.
Key idea
Pharma cases turn on four things: how many patients can be treated, what price payers will accept, how many years of protection are left, and how likely the science is to work.
| Region or group | Examples of large or notable companies | Note |
|---|---|---|
| Global research-based pharma (US and Europe) | AbbVie, Eli Lilly, Johnson & Johnson, Merck & Co., Pfizer (US); AstraZeneca, GSK (UK); Novartis, Roche (Switzerland); Novo Nordisk (Denmark); Sanofi (France) | All appear among the 20 largest drugmakers by revenue in Fierce Pharma's yearly rankings |
| Japan and South Korea | Takeda, Astellas, Daiichi Sankyo (Japan); Samsung Biologics, Celltrion (South Korea) | Samsung Biologics is a contract manufacturer; Celltrion is known for biosimilars |
| China | Jiangsu Hengrui; WuXi AppTec and WuXi Biologics (contract research and manufacturing) | Chinese companies were the source of a large share of 2025 licensing deals |
| India | Sun Pharma, Dr. Reddy's, Cipla, Lupin (generics and specialty medicines); Serum Institute of India (vaccines) | India is a major supplier of generics and vaccines to the world |
| Middle East | Hikma (listed in London, with roots in Jordan and a large Middle East business), SPIMACO (Saudi Arabia), Julphar (UAE) | Gulf governments are encouraging local manufacturing |
| Africa and Latin America | Aspen Pharmacare (South Africa); EMS, Eurofarma and Aché (Brazil) | Local makers matter where public tenders buy most medicines |
| Medical devices | Medtronic, Abbott, Stryker, Boston Scientific, BD (US); Siemens Healthineers, Philips (Europe); Olympus, Terumo (Japan); Mindray (China) | Device markets are split by specialty: heart, orthopaedics, imaging, diagnostics |
Unranked examples, checked September 2026. For size rankings, use a dated source such as Fierce Pharma's yearly revenue ranking or company annual reports.
So-what
Name players to show awareness; rank them only with a dated source.
Trends 2024 to 2026 (checked on 28 September 2026)
- Obesity and diabetes drugs became the biggest growth story. Eli Lilly reported 2025 revenue of USD 65.2 billion, up 45 percent, with its tirzepatide medicines Mounjaro (about USD 23.0 billion) and Zepbound (about USD 13.5 billion) the main drivers (Lilly results, February 2026). The open questions for 2026 onward are supply, price cuts and new competitors.
- US drug pricing changed. Under the Inflation Reduction Act, Medicare's first negotiated prices for 10 drugs took effect on 1 January 2026, with discounts CMS reported as 38 to 79 percent off list prices. In 2025 the US government also agreed "most favored nation" pricing deals with drugmakers, starting with Pfizer on 30 September 2025, linking some US prices to lower prices abroad in return for relief from threatened tariffs on medicines.
- Tariffs and new US factories. The threat of US tariffs on imported medicines led several large companies to announce new US manufacturing investment in 2025; Pfizer, for example, pledged USD 70 billion for US manufacturing and research as part of its agreement.
- China became a major source of new drugs. Chinese companies signed a record of about USD 136 billion of out-licensing deals in 2025, up from about USD 52 billion in 2024 (South China Morning Post, citing data from China's drug regulator, the NMPA). At the same time, the US BIOSECURE Act, signed into law in December 2025 inside the yearly defense law (NDAA), restricts US federal contracts involving certain "biotechnology companies of concern".
- Patent cliffs. Many large drugs lose exclusivity in the late 2020s. Merck states in its 2025 annual report that the main US compound patent on Keytruda, its biggest cancer drug, expires in December 2028.
- Europe. EU institutions reached a provisional deal on 11 December 2025 to reform EU pharmaceutical law, changing how long new medicines are protected from copies (for example, eight years of protection for their trial data). The deal still needed formal approval by both the Council and the Parliament before becoming law. For devices, the move to the stricter Medical Device Regulation was extended to 31 December 2027 or 31 December 2028, depending on the device's risk class (Regulation (EU) 2023/607).
- AI in research. Companies use AI to find targets, design molecules and plan trials. Claims of large time savings are common, but as of 2026 evidence that AI raises approval rates is still limited, so test such claims in a case.
Regulation basics
Every country has a regulator that decides whether a medicine or device is safe and effective enough to sell (see the examples in the first lesson). Approval is not payment. A separate body often decides whether the public system or insurers will pay, and at what price. NICE in England assesses cost-effectiveness. Germany assesses a new drug's added benefit, then the price is negotiated with the statutory insurers. India controls the prices of many essential medicines through the National Pharmaceutical Pricing Authority. Rules also cover how companies may promote medicines to doctors, how they report side effects, and how factories are inspected. In a case you do not need legal detail. You need to know that approval, price and reimbursement are three separate gates.
| Prompt | Structure hint | Check this driver first |
|---|---|---|
| Should we launch this new drug, and at what price? | Patient funnel (prevalence, diagnosed, treated, eligible, our share), then price against value and current treatment, then payer access | The number of treatable patients and what payers will pay |
| Our biggest drug loses its patent next year. What do we do? | Size the revenue at risk. Options: new formulation, our own generic, price change, move the sales force, buy or license new products, cut costs | How fast sales fall after LOE (faster for chemical drugs than for biologics) |
| Should we buy this biotech? | Probability-adjusted value of the pipeline, fit with our portfolio, synergies, price paid | Probability of success of the lead drug and years to launch |
| A generic maker's margins are falling. Why? | Price (more competitors per molecule, tender pricing), volume, cost (ingredients, quality compliance) | The number of competitors on each key molecule |
| Should a device maker enter India or Saudi Arabia? | Market size by procedures, who pays, route to market (distributors), regulation and local manufacturing rules, competition | Procedure volumes and who pays for them |
| How can we speed up our clinical trials? | Operations: trial sites, patient recruitment, data, regulatory steps | Patients recruited per site per month |
So-what
In almost every pharma case, check patients, net price, years of protection and probability of success before anything else.
For full practice cases, see the Healthcare and pharma case type. The Pricing, Market entry, and Mergers, acquisitions, and due diligence case types also use pharma and medtech examples.
Worked case
Patient funnel: a diabetes treatment in Saudi Arabia
The prompt
A fictional company asks how many patients in Saudi Arabia could use its new type 2 diabetes treatment. Use these rounded assumptions for the exercise: about 35 million people, 70 percent adults, 20 percent of adults with diabetes, 60 percent of those diagnosed, 70 percent of diagnosed patients treated with medicines, and 10 percent of treated patients with the profile the drug targets. How many target patients is that?
The structure
- Patient funnel
- Population x adults
- x prevalence of diabetes
- x diagnosed
- x treated with medicines
- Key: x target profile
Working it through
1. Adults
70 percent of 35 million.
Adults (millions):35 × 0.7 = 24.52. With diabetes
20 percent of adults.
Adults with diabetes (millions):24.5 × 0.2 = 4.93. Diagnosed and treated
60 percent diagnosed, then 70 percent treated.
Treated with medicines (millions):4.9 × 0.6 × 0.7 = 2.064. Target patients
10 percent of treated patients.
Target patients:35,000,000 × 0.7 × 0.2 × 0.6 × 0.7 × 0.1 = 205,800
The recommendation
The company should plan around about 206,000 target patients in Saudi Arabia, because the funnel narrows sharply from 35 million people. First, of 4.9 million adults with diabetes, only about 2.06 million are diagnosed and treated with medicines. Second, only 10 percent of those fit the profile the drug targets. The risk is that payers limit uptake, since the government pays for citizens and employers insure private-sector staff. As a next step, test the price payers will accept and how the drug compares with the many diabetes medicines already available.
Treating the doctor as the only customer and forgetting the payer. Using list price instead of net price. Forgetting that most drugs in development fail. Assuming sales continue after the patent ends. Mixing up approval (is it safe and effective?) with reimbursement (will anyone pay?). Applying US prices to other countries, where prices are usually much lower. Ranking companies from memory.
Using the funnel above, the drug reaches 25 percent of the 205,800 target patients at a net price of SAR 6,000 per patient per year. What are peak sales, in SAR millions?
An acquisition target's lead drug has a 60 percent chance of approval and would be worth USD 2,000 million if approved (and nothing if it fails). The seller asks USD 1,500 million. What is the probability-weighted value, in USD millions?
Your client's top-selling drug loses exclusivity in two years. What do you ask first?
Approval by a regulator means...
What most often explains a sudden fall in a pharma company's revenue?
Which is a sensible first step in a drug launch case?
Sources for this lesson (10)
- Fierce Pharma special reports, including yearly revenue rankings of the largest drugmakers
- Eli Lilly: fourth-quarter and full-year 2025 results (February 2026)
- CMS fact sheet: Medicare Drug Price Negotiation Program, negotiated prices for initial price applicability year 2026
- AHA News: administration announces agreement with Pfizer to lower drug costs (30 September 2025)
- South China Morning Post: Chinese drug makers strike a record USD 136 billion in out-licensing deals in 2025
- Arnold & Porter: the BIOSECURE Act becomes law in the United States (December 2025)
- Merck & Co., Form 10-K for fiscal year 2025 (SEC filing)
- Council of the EU press release: pharma package deal between Council and Parliament (11 December 2025)
- Regulation (EU) 2023/607 extending the Medical Device Regulation transition (EUR-Lex)
- Invest India (Government of India): pharmaceuticals sector overview
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