Merck has made a change, recently announcing adjustments to its pharmaceutical business organizational structure and confirming a new head of the business.

This organizational restructuring, ostensibly a rearrangement of business lines, is actually aimed at addressing the impending patent cliff for Keytruda and defending its position as the leading oncology drug.

01

Announcement of important adjustments

Originally, Merck's organizational structure was divided into two main segments: human health (i.e., pharmaceutical business) and animal health. The human health business included nine sub-segments: oncology, vaccines, hospital emergency care, cardiovascular, metabolic and respiratory, virology, neuroscience, immunology, metabolism, and others.

Merck has now restructured its human health business, consolidating its previously fragmented business lines into two strategic clusters: Oncology and Specialty (Specialty Drugs), and General Drugs and Infectious Diseases. This signifies that Merck is reshaping its market competitiveness through resource focus and synergistic effects.

This new round of organizational restructuring marks a new stage in Merck's human health business, characterized by intensive management. This involves optimizing operational efficiency through consolidation of similar items, achieving in-depth optimization of the business landscape, and refocusing on core competitiveness.

For example, Merck categorized its new pulmonary arterial hypertension drug Winrevair (sotecept) and diabetes drugs JANUVIA/JANUMET (sitagliptin + metformin) into its Specialty, General and Infectious Diseases division, which also oversees its vaccine business. In 2025, the JANUVIA/JANUMET series, along with the rapidly growing Winrevair and the 21-valent pneumococcal conjugate vaccine Capvaxive, are projected to contribute a combined $4.746 billion in revenue, becoming a powerful weapon in the face of the Keytruda patent cliff.

It is clear that this organizational restructuring is not a simple departmental merger, but a strategic refinement of existing business assets, reshaping the original business segments into more competitive strategic units.

In line with the major overhaul of its organizational structure, Merck also made precise moves at the senior management level to ensure that professionals do what they do best.

On one hand, Jannie Oosthuizen, who previously led Human Health's US market, was brought to the forefront as Executive Vice President and President of Oncology Business and International Operations. With the new organizational structure designating "oncology" as a core engine, Jannie Oosthuizen, with her extensive marketing experience, shoulders the dual responsibility of "maintaining the existing market share" and "expanding territory" : safeguarding Keytruda's core business and replicating the success of the US market globally to accelerate the global expansion of the oncology segment.

On the other hand, Merck poached Brian Foard from rival Sanofi to oversee its specialty drugs, generic drugs, and infectious disease businesses. The brilliance of this arrangement lies in its "integration": previously, Merck's vaccines, hospital emergency care, and cardiovascular metabolic businesses operated independently, while Brian Foard at Sanofi had simultaneously managed multiple areas including immunology, neurology, oncology, and rare diseases. This "cross-therapeutic area coordination capability" is precisely what Merck currently lacks most.

This transformation not only involves business lines, but Merck has also established a "strategic hub"—a brand-new strategic access, policy and communications department , headed by former Chief Marketing Officer Chirfi Guindo as Executive Vice President.

This reveals Merck's deeper considerations: to cope with the Keytruda patent cliff, simply adjusting the business structure is not enough. It is also necessary to create synergy between market access, policy, communication, and sustainable development in order to cope with the complex global payment environment, especially the drug price reform in the United States, thereby clearing external obstacles for global expansion in the post-Keytruda era.

02

"Top Cancer Patient" Launches Defensive Battle
Merck has listed "oncology" as one of its core engines in its new organizational structure, mainly because the oncology business is its revenue pillar and "cash cow" business.

In 2025, Merck's oncology business achieved revenue of $35.425 billion, maintaining a steady growth momentum (an 8% year-on-year increase), accounting for 61% of the company's pharmaceutical revenue. In particular, Merck firmly holds the top spot in global pharmaceutical giants' oncology revenue in 2025 with an absolute leading advantage, becoming the only pharmaceutical company with annual oncology revenue exceeding $30 billion.

However, Merck's position as the "top oncology company" is being challenged.

On one hand, the patent cliff for Keytruda, the former "global drug king," is looming. Keytruda contributes nearly 90% of Merck's oncology revenue and almost half of Merck's total revenue (48.73%). Even if Keytruda reaches Merck's projected peak of $35 billion in 2028, its sales growth has gradually slowed, reaching $31.68 billion in 2025, a 7% year-on-year increase, falling below double digits for the first time.

On the other hand, competitors are keeping up , with AstraZeneca and Johnson & Johnson securing the second and third positions in global pharmaceutical giants' oncology revenue in 2025, achieving revenues of $25.619 billion (+14%) and $25.38 billion (+22%) respectively, both achieving double-digit growth.

In particular, AstraZeneca's oncology business has a relatively balanced revenue structure. The top two products, osimertinib and durvalumab, generated revenues of $7.254 billion and $6.063 billion, respectively. Olaparib, acomitinib, and Enhertu (trastuzumab) each contributed more than $2.7 billion in revenue. Except for olaparib, the other products all maintained double-digit growth.

Looking back at Merck, its oncology performance currently relies primarily on Keytruda (pembrolizumab), as well as the two blockbuster drugs Lynparza (olaparib) and Lenvima (lenvatinib), which contribute a portion of the alliance revenue. Additionally, Welireg (bezutefan), a rare disease drug for advanced renal cell carcinoma, is projected to achieve a 41% year-on-year revenue increase to $716 million in 2025, demonstrating its potential to become a blockbuster drug; Reblozyl (rotexip), a novel anemia drug for treating myelodysplastic syndromes (MDS), will contribute $525 million in alliance revenue.

To maintain its leading position in the oncology field, Merck has adopted an offensive-defense strategy, launching a deep defensive battle around the "life cycle of Keytruda" : on the one hand, changing the dosage form of Keytruda and expanding its indications, and on the other hand, building a moat through combination therapy regimens, including combination with ADC drugs, KRAS G12C inhibitors, and mRNA tumor vaccines.

Especially in the ADC field, Merck has built a rich ADC product pipeline, covering targets such as Nectin-4, TROP2, B7H3, HER3, and Claudin18.2. The pembrolizumab + ADC combination solution currently under development is very promising.

03

Future growth prospects

In addition to oncology, Merck is also deploying its resources in non-oncology fields, laying the foundation for growth in the post-Keytruda era.

Previously, Merck stated at the 2026 JPM conference that "new drug-driven revenue is expected to exceed $70 billion by 2030, with ten projects including Winrevair, MK-1406, and Ifinatamab deruxtecan contributing 70% of the target revenue."

Winrevair (Sotecept) is a new pulmonary arterial hypertension (PAH) drug acquired by Merck for $11.5 billion through its acquisition of Acceleron. It was approved by the FDA in March 2024 and sold $1.443 billion in 2025, quickly becoming a "blockbuster drug" in just two years.

Currently, Winrevair has several clinical trials underway, including for the treatment of conditions such as post-capillary and pre-capillary pulmonary hypertension (CpcPH) arising from heart failure with preserved ejection fraction (HFpEF). Analysts predict that Winrevair's peak sales could exceed $5 billion.

In its new organizational structure, Merck has listed "infectious diseases" as one of its core engines, demonstrating its emphasis on this field. Currently, Merck's most promising infectious disease drug is MK-1406 (CD388), a potential first-in-class long-acting antiviral drug, with analysts predicting peak annual sales could exceed $5 billion.

MK-1406 was acquired by Merck in November 2025 through its $9.2 billion acquisition of Cidara Therapeutics. It can prevent influenza A and B and is expected to be administered once per quarter . It is currently undergoing a phase III study for the prevention of influenza complications.

Positive topline results from the Phase 2b NAVIGATE clinical trial showed that a single injection of CD388, in healthy, unvaccinated adults, protected against symptomatic influenza for up to 76% of subjects over 24 weeks compared to placebo , and was well-tolerated with no observed safety issues.

Merck stated that MK-1406 is expected to be a significant growth driver over the next decade, and it also expands and enhances the company's respiratory product portfolio and R&D pipeline.

In the respiratory field , Merck also spent $10 billion to acquire Verona Pharma and obtain the world's first PDE3/4 inhibitor ensifentrine (Ohtuvayre) for the treatment of the large number of patients with chronic obstructive pulmonary disease (COPD).

It is estimated that 390 million people worldwide suffer from COPD. Ensifentrine, as the first novel inhaled drug with a mechanism of action for treating COPD in over 20 years, has enormous commercial potential. Analysts predict that Ensifentrine's peak sales could reach $4 billion.

In addition, Merck has several other potential blockbuster drugs in its pipeline, including the TL1A monoclonal antibody PRA023, the long-acting RSV monoclonal antibody Clesrovimab (MK-1654), the personalized neoantigen tumor vaccine mRNA-4157/V940, the oral cyclic peptide PCSK9 inhibitor Enlicitide (MK-0616), and the novel LSD1 inhibitor Bomedemstat.

04

Conclusion

Through this sweeping organizational change, Merck has completed a profound evolution from the inside out in order to achieve a smooth transition between old and new growth drivers.

Driven by both "maintaining the core oncology business" and "cultivating non-oncology growth curves," Merck's future growth story will no longer be limited to Keytruda.

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