Pharma's next cash cows could be specialized treatments

Pharmaceutical companies facing a steep patent cliff are concluding the key to future profits may be customized treatments tailored to patients' genes and lifestyles — not blockbusters aimed at large patient populations. Why it matters: The pivot could influence which diseases get treated in the decades to come, and how much the health system pays. The stakes are huge. More than $500 billion in brand-name drug sales is potentially at risk from generic competition between 2026 and 2032, according to the consulting firm Evaluate. The latest: The race is on to find new treatments that each generate at least $2.4 billion in global sales, a new Iqvia Institute report finds. They're increasingly specialty treatments, biologics and rare disease drugs — with a small group of flagship products accounting for an outsized share of industry sales. GLP-1 drugs like Novo Nordisk's Ozempic and Eli Lilly's Zepbound now define that elite category. The next wave could include "biological missiles" that combine antibodies with chemotherapy to target specific cancer cells. "As precision medicine continues to advance, similar approaches may extend beyond oncology into areas such as immunology, metabolic disease and neurology," the report states. Reality check: It's not clear whether all of the innovation will cure more people, or just make health care more expensive. Novel RNA drugs and cell and gene therapies are expensive, hard to make and target small groups of patients. Challenges identifying eligible patients and getting insurers to pay for treatments have already revealed a disconnect between promising R&D and patient benefit. Widespread concern over high drug prices will force manufacturers to find more unmet needs and build sales more quickly after a drug's launch, according to the report. Context: Top-selling drugs historically were aimed at large patient populations with chronic conditions like high cholesterol. The ulcer drug Tagamet became the first to exceed $1 billion in s