On February 4th, before the U.S. market opened, Novartis AG (NVS.US) released its fourth-quarter 2025 financial results. The earnings report indicated that Novartis's Q4 revenue reached $13.34 billion, a 1.4% year-over-year increase but falling $740 million short of expectations; non-GAAP earnings per share were $2.03, surpassing expectations by $0.03. Novartis anticipates a profit decline this year, attributing it to increased competition from generic drugs affecting some of its blockbuster medicines, such as the heart failure treatment Entresto. The company stated on Wednesday that its core operating profit, at constant exchange rates, might decrease by a low single-digit percentage. Sales are projected to achieve low single-digit growth. With Entresto and other established best-sellers facing pressure from generic competitors, CEO Vas Narasimhan's strategy focused on innovative drugs will be put to the test this year. Novartis is launching a new pill for autoimmune skin diseases and is poised to release crucial data from experimental therapies targeting conditions like heart disease and multiple sclerosis. To fuel growth, Vas Narasimhan is also actively pursuing deals. Last September, Novartis agreed to acquire the U.S. biotech firm Tourmaline Bio to gain access to a promising therapy that reduces systemic inflammation, a major contributor to cardiovascular disease. Subsequently, in October, the company sealed its largest acquisition deal in over a decade, agreeing to buy Avidity Biosciences for up to $12 billion, which has developed several potential blockbuster drugs. Novartis has recently resolved some uncertainties regarding the future of its operations in the United States, the world's largest pharmaceutical market. Similar to its domestic rival Roche Holding, the Swiss company reached an agreement with the Trump administration before Christmas, securing protection from new industry regulations, including potential tariffs, by committing to price reductions. Novartis has pledged to establish seven new manufacturing facilities in the U.S., as part of its $23 billion plan to expand manufacturing capacity in the country. The majority of this investment will be concentrated on radioligand therapies.