Gilead Sciences makes medicines that treat serious diseases, mainly HIV, hepatitis, and cancer. Most of its products are pills or injections that patients take every single day, or in some cases every six months, for the rest of their lives. That is the core of the business: patients need to keep refilling their prescriptions, which means Gilead collects revenue from the same customers over and over again. In 2025, the company sold more than 25 approved therapies across more than 35 countries, generating $29.4 billion in total revenue. HIV medicines alone accounted for $20.8 billion of that, making them by far the engine of the whole operation. The diagram below traces where the money goes.
Five years of financial data tell a story of a business that is stable but not dramatically growing. Revenue went from $27.3 billion in 2021 to $29.4 billion in 2025, a modest climb over that period. The middle years were essentially flat, with 2023 revenue at $27.1 billion, slightly below the 2021 level. The real acceleration only appeared in 2024 and 2025, driven mostly by stronger HIV drug sales.
Gross margin, which measures how much money is left after making the drugs, has stayed consistently high across all five years, running between 75% and 79%. That tells you the products themselves are profitable. The bigger question is what happens after those profits, because Gilead spends heavily on research and on buying other companies to find its next set of drugs. Free cash flow, which is the cash left over after capital spending, was $10.8 billion in 2021, dipped to $7.4 billion in 2023, then recovered to $10.3 billion in 2024 before settling at $9.5 billion in 2025. The dip in the middle years corresponded with heavy spending on acquisitions and research programs.
Net debt has been falling steadily, from $21.4 billion in 2021 down to $16.7 billion in 2024, before ticking back up slightly to $17.4 billion in 2025 after increased share repurchases and investment spending. The overall direction has been positive: the company is carrying less debt than it was four years ago, while still funding a large research pipeline and paying dividends.
Gilead's oncology business is the part of the company still finding its footing. Cell therapy sales (Yescarta and Tecartus combined) fell 7% to $1.8 billion in 2025, as competitors gained ground. Trodelvy, a breast cancer drug, grew 6% to $1.4 billion, but two major clinical trials for Trodelvy in lung cancer failed to meet their goals in 2024, forcing the company to write down the value of that program by $4.2 billion. A further $590 million write-down followed in 2025 on a hepatitis drug called bulevirtide, after new competitive data weakened its expected market. These write-downs did not affect cash, but they are a reminder that drug development bets do not always pay off.
The risks Gilead faces are specific and documented. The most immediate is concentration: HIV drugs make up roughly 71% of total product sales. If those products lose market share to generic versions or newer competitors, the whole financial picture changes. New U.S. government rules allow Medicare, the government health insurance program for older Americans, to negotiate lower drug prices directly with companies starting in 2026. That kind of pricing pressure is already visible in the numbers. Gross-to-net deductions, the gap between what Gilead charges and what it actually receives after rebates and government discounts, rose from 38% of gross sales in 2024 to 41% in 2025. That is money that never reaches Gilead's accounts.
Manufacturing adds another layer of risk specific to the cell therapy business. Yescarta and Tecartus are made using a patient's own cells, collected at specialized treatment centers, engineered in Gilead's labs, and shipped back. Any disruption to that chain, whether at a manufacturing site or at a collection center, can mean a patient does not get treated. The company also relies on suppliers outside the United States for raw materials, and proposed U.S. laws could restrict access to some of those suppliers.
Veklury, the COVID-19 treatment remdesivir, is already illustrating what happens when a product's moment passes. Sales dropped 49% to $911 million in 2025 as COVID-19 hospitalization rates fell. That is a large and fast decline for a product that was contributing nearly $1.8 billion just one year earlier. The company has acknowledged it expects Veklury sales to continue falling in 2026.