As the dust settles from the JP Morgan Healthcare Conference in mid-January, followed by Davos discussions and ongoing geopolitical realignments, pharmaceutical executives face a clarifying moment. While JPM 2026 generated extensive investor and banker commentary, the question for life sciences companies remains: what do these strategic shifts actually mean for bringing innovative medicines to patients?

The 44th Annual J.P. Morgan Healthcare Conference, held January 12-15, 2026 in San Francisco, revealed an industry navigating fundamental transitions. Four clear themes illuminate both the opportunities and execution challenges ahead.

1. Obesity market maturation: commercial innovation at scale

The GLP-1 obesity market dominated JPM 2026. Novo Nordisk’s new CEO Maziar Doustdar’s candid acknowledgment of the company’s “difficult 2025” after ceding market leadership to Eli Lilly captured the reality: therapeutic innovation alone no longer guarantees success (Fierce Pharma, 2026).

Three commercial innovations emerged. Oral formulations transforming patient access—Eli Lilly’s orforglipron awaits FDA approval with fast-track review, while Novo launched oral Wegovy in early January 2026 (BioSpace, 2026). Direct-to-patient sales channels reshaping distribution—Eli Lilly CEO David Ricks revealed “a million people a month” purchase GLP-1 medications directly via LillyDirect, with vials becoming “the second top selling obesity drug” (Pharmaceutical Executive, 2026). Expanded indications across heart failure, chronic kidney disease, and MASH positioning these as comprehensive metabolic disease management (Chemical & Engineering News, 2026).

Pfizer CEO Albert Bourla projected growth to $150 billion by 2030 in this “competitive, consumer-driven market” (Fierce Pharma, 2026).

2. The dual challenge: Pipeline depth and m&a desperation

The pharmaceutical industry faces a staggering revenue challenge. According to Deloitte, the sector will lose approximately $236 billion in revenue by 2030 as patents expire on 190 drugs—roughly 46% of sales at risk for the top ten pharmaceutical companies (GeneOnline, 2025).

Global pharmaceutical R&D spending grew 1.5% to reach $288 billion in 2024, with large pharma R&D growing 9.7% that year (BioSpace, 2025; Statista, 2024). Top 20 companies spent approximately $180 billion on R&D in 2024 (PharmaShots, 2025). Merck highlighted “80 Phase III studies underway” representing “the first wave of the next 20 growth drivers” (Pharmaceutical Executive, 2026). Johnson & Johnson expressed being “increasingly bullish” on 5-7% annual sales growth forecasts (Fierce Pharma, 2026).

If any doubt remains over the critical importance of R&D pipeline replenishment, consider Sanofi’s announcement yesterday (February 12, 2026). Facing a patent cliff with Dupixent—its mega-blockbuster immunology drug with peak sales expectations above €13 billion—losing patent protection in the early 2030s, Sanofi’s Board decided not to renew CEO Paul Hudson’s mandate. Hudson had invested heavily in R&D to transform Sanofi into a research powerhouse, but recent clinical setbacks undermined that strategy. The Board appointed Belén Garijo, CEO of Merck KGaA and former 15-year Sanofi veteran, as his replacement, effective April 29, 2026. Hudson’s last day as CEO is February 17, 2026—an abrupt departure contrasting sharply with the months-long transitions given to departing CEOs at GSK and Novo Nordisk (Sanofi, 2026; Bloomberg, 2026; Endpoints News, 2026). The swiftness underscores how seriously boards view pipeline execution amid patent cliffs.

M&A activity surged—total pharmaceutical M&D deal value increased 31% year-over-year from $137 billion in 2024 to $180 billion in 2025 (Pharmaceutical Technology, 2025). JPM 2026 itself generated approximately $8.3 billion in announced deals concentrated in oncology, obesity assets, and neurodegenerative therapeutics (DelveInsight, 2026).

The M&A response shows competitive intensity.

Novartis’s acquisition of Avidity Biosciences illustrates this. CEO Vas Narasimhan initially approached with a $7.4 billion offer. After multiple rejections and escalations, Novartis reached $12 billion in October 2025—a 62% increase (BioSpace, 2025). Novartis’s strong total return to shareholders and operating momentum through commercial execution strengthened its share price and balance sheet, giving it powerful acquisition currency and investor backing. The company’s market capitalisation increased from $190 billion in January 2025 to $302 billion in February 2026—adding approximately $112 billion in market value. That financial strength made it easier to justify paying a premium for Avidity to secure a high-value long-term growth platform (Public.com, 2026; MacroTrends, 2026).

Pfizer’s Metsera acquisition illustrates different dynamics. With Pfizer’s stock declining 3.1% year-to-date through 2025 and Novo Nordisk’s falling 43.4%, the bidding war reflected Pfizer attempting to buy market entry after repeated in-house GLP-1 failures while Novo sought to defend its eroding obesity position (Yahoo Finance, 2025). Pfizer’s initial September 2025 offer valued Metsera at $4.9 billion. When Novo jumped in, Pfizer won with approximately $10 billion—more than double the original value (Pfizer, 2025; CNBC, 2025).

The premiums paid—Metsera doubling, Avidity rising 62%—reveal the intense pressure to plug revenue gaps.

3. Higher expectations—but significant underperformance

Despite the imperative to deliver on expectations created by shareholder investment in R&D and M&A, launch performance consistently underperforms.

Multiple studies confirm approximately 50% of pharmaceutical launches underperform. Bain shows “nearly 50% of launches over the past eight years have underperformed analyst expectations, and more than 25% have failed to reach even 50% of external revenue forecasts” (Bain, 2017). L.E.K. found “about half of all products launched over the past 15 years have underperformed pre-launch consensus forecasts by more than 20%” (L.E.K., 2025). Trinity reported “50% of the 2023 U.S. pharmaceutical launch class underperformed their pre-launch first year forecast” (Trinity, 2024).

Key reasons span multiple domains: limited market access and payer restrictions, inadequate understanding of market needs, poor product differentiation in crowded therapeutic spaces, insufficient resource allocation, and challenges demonstrating real-world value beyond clinical trial efficacy. Slow uptake of evidence-based interventions—taking an average of 17 years to become routine practice—combined with formulary restrictions, reimbursement barriers, and variable guideline adherence create substantial friction between regulatory approval and meaningful patient access (Bain, 2017; L.E.K., 2025; BMC Health Services Research, 2021).

4. Navigating complexity to drive adoption

Pharmaceutical companies face multiple interlocking challenges requiring strategic navigation years before launch.

Global payment dynamics intersecting with geopolitics

Trump administration policies demanding most-favoured-nation pricing, threatening tariffs, and seeking to narrow wide US-ROW pricing discrepancies created unprecedented market access complexity. Seventeen pharmaceutical companies received MFN pricing ultimatums in July 2025, with 14 signing agreements by December including Pfizer ($70 billion US investment commitment), Eli Lilly ($27 billion), Novo Nordisk ($10 billion), and AstraZeneca ($50 billion) (AJMC, 2025; Mintz, 2025). Switzerland temporarily faced potential 60% tariffs before negotiating agreements capping pharmaceutical tariffs at 15% coupled with $200 billion in US investment commitments (Fierce Pharma, 2025; Swiss Info, 2025). This affects HTA trade-offs in Europe around confidential price discounts. There will be new questions about economic viability of European launches given pricing pressures (EFPIA, 2024; Pharmaceutical Technology, 2025).

Consumer willingness to pay creates new pathways beyond payers

Globally, consumers demonstrate substantial willingness to self-pay for obesity treatments. Not all products will experience this, but it does raise new avenues to consider. Employers evaluating productivity benefits and government departments beyond health ministries assessing welfare costs represent additional value sources. Having raised this question with obesity poses questions about conditions with similar burden-of-disease profiles—cardiovascular, renal, metabolic diseases—and other high-impact conditions.

The race for compelling evidence—clinical and operational

Companies pursue Phase III endpoints to make wider claims—Novo and Lilly advancing trials in heart failure, CKD, sleep apnea, and MASH to expand indications for Ozempic, Wegovy, Mounjaro, and Zepbound. Evidence requirements extend beyond clinical outcomes to delivery models. In the UK, NICE approved GLP-1s as cost-effective for approximately 3.4 million eligible patients of 57 million, but NHS restricted initial access to just 220,000 over three years—only 6.5% of eligible—due to capacity and affordability concerns related to evidence on delivery support requirements (Health Policy Partnership, 2025). This shows pharmaceutical companies must consider total cost of ownership—not just clinical profiles but cost of delivery pathways and implementation requirements. Taking into account these requirements requires the tighter integration of evidence generation and influencing uptake planning, making it critical to consider this years in advance of launch.

Clinical uptake depends on navigating guidelines

This means both managing access via guidelines and using guidelines to define optimal care—and where gaps exist. Carnall Farrar research revealed significant unmet care gaps: just 37% of CVD patients have cholesterol under control, only 28% of people with type 2 diabetes have optimal HbA1c, only 6% of eligible dementia patients receive treatment (Carnall Farrar, 2025).

Data, digital, and AI create opportunities requiring navigation

Health systems’ deployment presents opportunities to detect disease earlier, intervene earlier, improve outcomes, and lower costs. Carnall Farrar research demonstrates using integrated data to identify care gaps, digital tools to engage patients throughout pathways, and AI algorithms to identify patients more than one year before diagnosis—enabling 24% mortality reduction from targeted lung health checks and potential 40-60% cost savings through earlier intervention (Carnall Farrar, 2024).

Establishing supportive policy environments

Policy shifts accelerate adoption. The Act FAST stroke campaign dramatically increased public awareness that stroke is treatable if caught early, changing emergency response behaviour and enabling wider use of acute interventions (PLOS ONE, 2014; BMC Public Health, 2013). Similar shifts—recognising cancer as beatable rather than fatal, cervical cancer and hepatitis C as eliminatable, attitudes toward dementia requiring transformation—create environments where innovations gain traction.

The path forward

JPM 2026 revealed pharmaceutical companies facing an imperative: replenishing pipelines to offset $236 billion at risk through 2030. The bidding wars—Metsera from $4.9 billion to $10 billion, Avidity from $7.4 billion to $12 billion—signal excellent opportunities for biotech companies with late-stage assets.

But the deeper shift extends beyond M&A. With half of launches underperforming despite unprecedented investment, success requires deep understanding of health systems and their population priorities—understanding how they work far beyond regulatory approval and how pharmaceutical companies can leverage data, guidelines, diverse payment models, and policy environments to drive adoption.

The winners won’t simply be those with the best molecules or deepest pockets. They’ll be companies coupling innovation with sophisticated execution strategies—bridging the gap between medical breakthrough and patient access.

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CF is a leading consultancy dedicated to making an enduring impact on health and healthcare. We work with leaders and frontline teams to improve health, transform healthcare, drive adoption of innovation and create value through investment.

About the authors

Ben Richardson

Ben is Managing Partner at CF and works at the intersection of health systems and life sciences in the application of health data to create insights, enable intervention and generate evidence. He is an expert in population health, the uptake of innovation, real world evidence and the economics of health. Ben leads CF’s Life Sciences and Health Investing practices and Data Sciences capability.

Email [email protected] to get in touch.

  1. Bain & Company (2017) ‘How to Make Your Drug Launch a Success’
  2. BioSpace (2025) ‘Avidity Played Hardball’, 1 December
  3. BioSpace (2026) ‘JPM26 Day 1’, 13 January
  4. BioSpectrum Asia (2025) ‘Mitigating Patent Cliff Fallout’
  5. BMC Health Services Research (2021) ‘Barriers and facilitators to uptake of new medicines’, 5 November
  6. BMC Public Health (2013) ‘The impact of the UK ‘Act FAST’ stroke awareness campaign’, 2 October
  7. Carnall Farrar (2024) ‘Future State Programme: The Impact of Data, Digital and AI in Healthcare’. Available at: https://www.carnallfarrar.com/future-state-programme-the-impact-of-data-digital-and-ai-in-healthcare/
  8. Carnall Farrar (2025) ‘Value in Health: Unmet Care Gaps’. Available at: https://www.carnallfarrar.com/value-in-health-unmet-care-gaps-in-the-treatment-of-chronic-diseases/
  9. Chemical & Engineering News (2026) ‘GLP-1 pills, immunology, and China’, 15 January
  10. CNBC (2025) ‘Pfizer wins $10 billion bidding war for Metsera’, 10 November
  11. DelveInsight (2026) ‘Key Takeaways from JPM Healthcare 2026’, 17 January
  12. Fierce Pharma (2026) ‘JPM26, Day 1’, 13 January
  13. GeneOnline (2025) ‘Pharma Faces $236 Billion Patent Cliff’, 7 March
  14. Health Policy Partnership (2025) ‘Are weight-loss treatments contributing to health inequalities?’, 7 March
  15. L.E.K. Consulting (2025) ‘Variability in Large Pharma Launch Performance’, 5 February
  16. LSE (2016) ‘Access to medicines in Europe’
  17. MacroTrends (2026) ‘Novartis AG Market Cap’, 9 February
  18. Pharmaceutical Executive (2026) ‘JP Morgan 2026: Eli Lilly’s Continuing GLP-1 Success’, 14 January
  19. Pharmaceutical Technology (2025) ‘Looking at the Potential Impact of JCA on Pharma’, 29 October
  20. Pfizer (2025) ‘Pfizer Completes Acquisition of Metsera’, 13 November
  21. PLOS ONE (2014) ‘A Time Series Evaluation of the FAST National Stroke Awareness Campaign in England’, 5 August
  22. Public.com (2026) ‘Novartis Market Cap’, 10 February
  23. Trinity Life Sciences (2024) ‘Half of 2023 U.S. Pharma Launches Miss First-Year Forecasts’, 6 November
  24. Yahoo Finance (2025) ‘Novo Nordisk or Pfizer: Which Healthcare Giant Is the Better Bet?’, 27 November

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