Bristol Myers pivots from Revlimid drag to Eliquis-fuelled transition year

Growth engines almost offset a $4bn legacy hole

Bristol Myers Squibb closed 2025 in a manner that underlined both the scale of its patent cliff and the extent to which it has already rebuilt around a new stable of drugs.

Total fourth-quarter revenue came in flat at about $12.5bn, but the still headline number masked a sharp internal reshaping. The so‑called growth portfolio – the company’s newer medicines, many still early in their commercial lives – rose 15 per cent to $7.4bn and now accounts for close to 60 per cent of sales. Over the full year, that portfolio grew 17 per cent and “nearly offset” a roughly $4bn fall in legacy revenue, management said.

Oncology and haematology remain the company’s centre of gravity. Opdivo, the flagship immuno-oncology drug, delivered another quarter of mid‑single‑digit growth, up 7 per cent to nearly $2.7bn, with new first‑line lung cancer indications doing much of the heavy lifting. Opdualag – the fixed‑dose Opdivo/LAG‑3 combination that has become a standard of care in first‑line melanoma – continued to grow strongly, helping Bristol Myers push its share of the metastatic melanoma market above 65 per cent in the US.

The true standouts, though, were the newer assets that have quietly crossed the billion‑dollar Rubicon. Reblozyl, a treatment for MDS-associated anaemia, grew 21 per cent in the quarter and now generates more than $2bn annually, with management still talking about “meaningful runway” as first‑line RS‑negative patients and ex‑US launches contribute. Breyanzi, the CD19-directed CAR‑T therapy, expanded 47 per cent in Q4 and is now approved across five lymphoma indications, including the newly added marginal zone lymphoma. Camzyos, for obstructive hypertrophic cardiomyopathy, grew 57 per cent to $353m in the quarter, having been rolled out in more than 50 countries.

Two first‑year launches, CoBinfy in schizophrenia and Qvantik, the subcutaneous formulation of Opdivo, were singled out as outperforming analogues. CoBinfy posted $51m in Q4 revenue, with over 100,000 total prescriptions since launch and access now near universal in US public payers and approaching 70 per cent in commercial plans. Qvantik booked $133m in the quarter and, helped by a permanent J‑code from July, is now seeing a broadening pattern of use across tumour types and combinations. Management reiterated its aim to convert 30–40 per cent of Opdivo’s IV business to subcutaneous before loss of exclusivity.

Against that, the erosion of the legacy portfolio – above all, the decline of Revlimid and Pomalyst – is now clearly visible in the P&L. Gross margin fell 210 basis points year on year in Q4 to 71.9 per cent, a direct function of mix: more Eliquis, less high‑margin Revlimid and Pomalyst. That pressure is expected to intensify in 2026, with Bristol Myers guiding gross margin down to 69–70 per cent.

Eliquis: price cut today, step‑down tomorrow

In a year crowded with scientific talking points, Eliquis, the anticoagulant it co‑markets with Pfizer, still dominated the financial narrative.

Fourth‑quarter sales edged up 6 per cent to nearly $3.5bn, with US revenue ahead 4 per cent on the back of both volume growth and share gains. But 2026 is where the story becomes more intricate. Bristol Myers is guiding Eliquis to 10–15 per cent growth this year, despite implementing a roughly 40 per cent cut to its wholesale acquisition cost in the US from January 1.

The calculus reflects the new reality of US drug pricing under the Inflation Reduction Act. With Eliquis now subject to mandated Medicare discounts, the company has re‑engineered its economics: the price cut eliminates accumulated inflation‑based rebate penalties and aligns with a newly finalised $0 Medicaid agreement. At the same time, Medicare Part D redesign removes catastrophic‑phase liabilities for manufacturers. Management argues that the combination of structurally cleaner net pricing and continued demand growth – Eliquis now holds about 75 per cent share of US novel anticoagulant prescriptions – will allow the brand to be “an important driver of growth” in 2026 even at a lower list price.

Beyond that, the picture is less benign. While Bristol Myers has stopped giving multi‑year financial guidance, it chose this quarter to refresh one critical datapoint: it now expects Eliquis sales in 2027 to fall by $1.5–2bn versus 2026. Executives attribute this mainly to ex‑US patent expiries, noting that key European Union patents cluster around late 2026 and that they assume a rapid, steep generic erosion pattern once those fall away. Litigation and appeals in individual markets may shift the timing, but the direction of travel is clear.

The decision to contribute about $7bn worth of Eliquis active pharmaceutical ingredient to the US government’s strategic reserve raised questions about earnings impact; Bristol Myers described that as immaterial relative to the overall scale of the franchise.

Cost discipline and a quieter balance sheet

Amid the moving pieces of the top line, the company’s cost base has been undergoing its own restructuring. Bristol Myers has now delivered roughly $1bn of savings against its $2bn “strategic productivity” target, chiefly via operating expense cuts. Full‑year 2025 opex, excluding in‑process R&D, fell to $16.6bn, down $1.2bn on 2024, even as the company ploughed money into launches like Camzyos, CoBinfy and Qvantik and funded recent deals such as Orbital Therapeutics and the pemigatinib partnership with BioNTech.

For 2026, management is guiding opex down again to about $16.3bn, implying that incremental investment in growth brands and late‑stage R&D will be more than offset by further efficiencies through 2027. The company has also drawn a line under a period of heavy balance‑sheet repair. It ended 2025 with around $11bn in cash and marketable securities and confirmed that it has completed its targeted $10bn of debt pay‑down ahead of schedule. Operating cash flow in the fourth quarter was about $2bn, giving Bristol Myers the wherewithal to continue funding business development while maintaining its dividend.

The income statement bears the marks of these cross‑currents. The effective tax rate rose to 22.1 per cent in Q4, up from 19.9 per cent a year earlier, reflecting a non‑tax‑deductible in‑process R&D charge related to the Orbital deal. Reported diluted EPS was $1.26 for the quarter and $6.15 for the full year, with in‑process R&D and licensing adjustments amounting to $0.60 per share in Q4 and $1.40 for the year.

On a non‑GAAP basis, 2026 EPS is guided to $6.05–6.35, essentially flat to modestly down, as legacy erosion and mix‑driven margin pressure offset growth portfolio expansion and cost savings. The guidance assumes other income and expense of roughly $700m, partly reflecting the expiry of royalty‑bearing diabetes product licences at the end of 2025, and a stable tax rate around 18 per cent.

A data‑heavy pipeline aims to reshape the 2030s

If 2026 is a transitional year financially, it is also shaping up as an inflection point for Bristol Myers’ scientific narrative. Chief executive Christopher Boerner described it as a “data‑rich period” for 10 new medicines, with “over 30 meaningful launch opportunities by 2030” and a burst of pivotal read‑outs concentrated in the second half of this year.

The company expects top‑line registrational data in 2026 for six potential new products:

• Nilvexin (milvexian) in atrial fibrillation and in secondary stroke prevention, a Factor XIa inhibitor that could redefine anticoagulation if it can match Eliquis on efficacy with a meaningfully cleaner bleeding profile.
• Admilparent (edmiprant), a first‑in‑class LPA1 antagonist for idiopathic pulmonary fibrosis, where earlier Phase 2 data showed a 60 per cent reduction in forced vital capacity (FVC) decline in IPF and more than 70 per cent in non‑IPF progressive pulmonary fibrosis.
• Iberdomide and mozignamide (MEZI), the next‑generation CELMoD agents in relapsed or refractory multiple myeloma, where Bristol Myers aims to “replace” the ageing IMiD backbone of Revlimid and Pomalyst.
• Arlocell, a BCMA‑directed cell therapy in myeloma patients previously exposed to both BCMA and GPRC5D therapies.
• RAISE‑101 in second‑line and later neuroendocrine tumours.

Overlaying those is a further wave of pivotal line‑extension trials: Sotyktu is reading out in lupus and Sjögren’s disease, while CoBinfy is being tested in Alzheimer’s‑related psychosis and cognition as part of a broad neuropsychiatric lifecycle programme.

The milvexian story, in particular, is central to the company’s attempt to manage the twilight of Eliquis. Bristol Myers has now fully enrolled its Librexia AF trial, with more than 20,000 patients, and repeatedly noted that its data safety monitoring board continues to endorse ongoing trial conduct – a contrast, executives pointed out, with the early termination for lack of efficacy seen in a rival Factor XI programme. The design aims first to show non‑inferiority on stroke prevention versus apixaban, then test for superiority on bleeding outcomes. Management declined to quantify the magnitude of bleeding risk reduction it believes would constitute a clinically meaningful delta but emphasised that “fear of bleeding” remains the dominant reason many atrial fibrillation patients are untreated or undertreated today.

Elsewhere in the pipeline, Bristol Myers is pushing the boundaries of its existing franchises. Breyanzi’s expansion into systemic sclerosis with the Break Free SSC trial marks one of the industry’s more ambitious efforts to bring CAR‑T into autoimmune disease. The company is also preparing the first oral data on nablometastat, a potential first‑in‑class PRMT5 inhibitor, in pancreatic cancer at an upcoming ESMO targeted therapies meeting.

The pemigatinib collaboration with BioNTech, anchored in triple‑negative breast cancer but expanding into non‑small cell lung cancer and other tumours, is being scaled up rapidly: eight registrational studies are expected to be running by year‑end, with pemigatinib envisioned as a backbone bispecific that could both “replace” current PD‑1/PD‑L1 inhibitors in existing indications and “expand” into settings where those drugs underperform.

Neuropsychiatry stakes out a broader territory

Beyond the familiar oncology and cardiology franchises, Bristol Myers is quietly rebuilding a presence in neuroscience, an area it exited once before. CoBinfy, born of the Karuna acquisition, is the spearhead: a muscarinic M1/M4 agonist plus a peripherally acting anticholinergic, designed to tackle both positive and negative symptoms in schizophrenia with a more tolerable side‑effect profile.

The company is positioning CoBinfy as the nucleus of a broader neuropsychiatric platform. A sprawling development plan encompasses not only schizophrenia but Alzheimer’s disease psychosis, Alzheimer’s cognition and agitation, and bipolar disorder. Management stressed that, while several competitors are pursuing related muscarinic mechanisms, Bristol Myers enjoys a multi‑year head start in market experience and believes its exenatide‑plus‑trospium construct offers the right balance of central activity and peripheral tolerability. Behind it, a suite of internal and Karuna‑derived assets continue to target muscarinic receptors and disease‑modifying Alzheimer’s mechanisms.

The strategic logic is straightforward: with a dedicated psychiatry commercial infrastructure now in place and access hurdles for CoBinfy largely cleared, bolt‑on neuro assets could drop into an existing channel. Executives were explicit that neuroscience is one of the areas where they would look to add “breadth and depth” via business development, provided the science and economics align.

Management tone: execution first, deals on their terms

Through the prepared remarks, a few themes recurred with unusual frequency. Boerner repeatedly invoked Bristol Myers’ “say‑to‑do ratio” – a cultural shorthand for doing what it promises – as he sought to convince investors that the company can steer through the twin shoals of a major loss‑of‑exclusivity cycle and a crowded late‑stage pipeline.

The rhetoric around business development was notably disciplined. With a late‑stage pipeline that management believes can deliver “industry-leading sustainable growth into the 2030s and beyond”, the company insists it does not need to “chase deals” or pay up for fashionable areas like obesity. While executives acknowledged watching metabolic disease closely, their stated priority is still to reinforce existing franchises – oncology, haematology, cardiovascular, immunology and neuroscience – where they argue Bristol Myers can best assess science, influence development and extract commercial value.

Taken together, the quarter’s numbers and the 2026 outlook paint the picture of a company in mid‑transition: revenue held flat while a $4bn legacy decline was almost fully offset; margins compressed as mix shifted towards Eliquis and away from Revlimid; operating costs fell even as the late‑stage pipeline ballooned. The test, over the next 18–24 months, will be whether the dense cluster of pivotal read‑outs – and the pivotal shift from Eliquis to milvexian, from IMiDs to CELMoDs, from today’s PD‑1/PD‑L1s to pemigatinib – can convert that careful rewiring into the “durable growth profile” that Bristol Myers is now staking its decade on.