Bristol-Myers Squibb makes medicines for people with serious diseases. Cancer, blood disorders, heart problems, immune diseases, and brain conditions. Patients take these medicines regularly, often for years, which means the company earns money again and again from the same prescription. BMS sells its drugs mainly to wholesalers and specialty pharmacies in the United States, which account for about 69% of total revenues, with the rest coming from international markets. The company splits its products into two groups: a Growth Portfolio of newer medicines that are still gaining patients, and a Legacy Portfolio of older medicines whose patents are expiring and whose sales are falling as cheaper generic copies enter the market. Understanding how money flows from patients through that two-speed portfolio is the key to reading this business. The diagram below traces where the money goes.
Five years of financial data tell a story of a company holding its footing while the ground shifts beneath it. Total revenues were $46.4 billion in 2021, dipped slightly to $45.0 billion in 2023, then recovered to $48.3 billion in 2024 and held at $48.2 billion in 2025. On the surface that looks stable. But underneath, the mix is changing fast. Newer medicines like Opdivo, Reblozyl, Breyanzi, and Camzyos are growing quickly. Meanwhile, older blockbusters like Revlimid and Sprycel are being eaten alive by generic competition. Revlimid revenue fell 49% in 2025 alone. Sprycel fell 70% in the U.S. The Growth Portfolio is currently winning that race, but only barely.
Gross margin tells a more uncomfortable story. In 2021 it was 78.6%. By 2025 it had fallen to 71.1%. That is a meaningful drop. It reflects the growing weight of royalty payments, the cost of manufacturing complex cell therapies, and the price pressure from government programs. Free cash flow, however, remains substantial. The company generated $15.2 billion in operating cash flow in 2021 and $14.2 billion in 2025, with free cash flow of $12.8 billion in 2025. That is a machine that still generates serious cash. The concern is that the company is also carrying serious debt.
Net debt jumped to $39.3 billion in 2024, driven by large acquisition spending including the purchase of Mirati Therapeutics for the cancer drug Krazati. It came down to $34.9 billion by the end of 2025. The company can service that debt with its cash flows, but it leaves less room to absorb surprises. Research and development spending was $10.0 billion in 2025. That is what it costs to keep the pipeline alive and try to replace what the patent cliff will take away.
BMS is facing one of the pharmaceutical industry's steeper patent cliffs in the next few years. Eliquis, the blood-thinning pill that brought in $14.4 billion in 2025 and is the company's single largest product, already faces generic challengers in Europe and will face them in the U.S. in 2028 under settlement agreements. Generic Pomalyst is expected to enter the U.S. market in early 2026. Generic Revlimid volume limits expired in January 2026, opening the door to full generic competition. These are not distant threats. They are already arriving.
Government price-setting adds another layer of pressure. The U.S. government announced a maximum price for Eliquis in the Medicare program starting January 2026. A government price for Pomalyst follows in January 2027. Orencia is next in line for 2028. The company also struck a separate agreement with the U.S. government in December 2025 to provide Eliquis for free to the Medicaid program starting January 2026 and to sell several other medicines at discounts of roughly 80% off list price for cash-paying patients. Additionally, royalty income of approximately $2.7 billion received in 2025 is expected to shrink significantly because major royalty streams from Keytruda and Tecentriq are set to end by December 31, 2026.
The Growth Portfolio is genuinely growing. Breyanzi, a complex cell therapy for certain blood cancers, grew 82% in 2025 to $1.4 billion. Camzyos, a heart drug for a condition called obstructive hypertrophic cardiomyopathy, grew 77% to $1.1 billion. Reblozyl, which treats anemia in patients with certain blood disorders, grew 31% to $2.3 billion. Opdivo, the flagship cancer immunotherapy, grew 8% to $10.0 billion and keeps receiving approvals for new cancer types. These are not small numbers. But the legacy drugs being lost generated billions more. The math requires the growth side to accelerate even faster than it already has.
The pipeline behind today's Growth Portfolio includes over 45 assets in development. BMS is working on next-generation cancer cell therapies, a new class of drugs called protein degraders, and radiopharmaceuticals that deliver radiation directly to tumors. It entered a collaboration with BioNTech in 2025 to co-develop pumitamig, a drug that targets two cancer pathways at once. A cardiovascular drug called milvexian is in late-stage trials in partnership with Johnson and Johnson. A new schizophrenia drug, Cobenfy, launched in late 2024 and is in early commercial stages. These programs represent the next generation of products BMS is counting on. But drug development fails far more often than it succeeds. The company's own filings note that approximately 93% of small molecule drugs that enter early-stage trials never reach approval.