The New Drug Modalities 2026 report builds on our 2023, 2024, and 2025 analyses to provide a perspective on the evolving biopharmaceutical landscape. As in prior years, we track progress across the major novel modalities in terms of the number of products, pipeline revenue, and deal activity. Our goal was to determine which modalities industry analysts consider to be progressing most rapidly and which hold the greatest promise.
This year’s report includes a new feature: an analysis of the new-modality landscape by company size. By mapping public companies that have new-modality-focused pipelines and their market capitalization, we were able to make three assessments: which modalities are concentrated among small-cap innovators versus diversified large-cap companies; the modalities in which large pharma has already placed its bets and those it is still considering before undertaking further development; and where there is the greatest potential for future M&A activity.
In addition, we categorize modalities and, as in previous reports, track pipeline size and value to reflect a multispecific modality within antibodies (including the previously tracked bispecifics) and added a modality in radiotherapeutics.
A Plateau in New-Modality Pipeline Value
The value of the 2026 new-modality pipeline was roughly flat year-over-year, while the value of the conventional-therapy pipeline posted its strongest growth in the history of our analysis. As a result, the total five-year forward pipeline value rose to $347 billion in 2026, up from $330 billion in 2025, but the composition shifted. (See Exhibit 1.) New modalities accounted for 57% of forward pipeline value, down from 60% the prior year, with conventional therapies recovering to 43%.
The value of the conventional-therapy pipeline grew by approximately $18 billion, which was driven by new products and revised analysts’ forecasts for a variety of small-molecule products for obesity, oncology, cardiovascular, and rare diseases.
The value of the new-modality pipeline, meanwhile, held steady at $198 billion; approximately $40 billion of growth in pipeline value was offset by analysts’ downward revisions to their forecasts for several products. The single largest reduction was in the forecast for CagriSema after its pivotal Redefine 1 trial delivered weight loss below analysts’ expectations. In BCG’s 2025 report, CagriSema was one of the top ten products by forecasted 2030 revenue.
Eight of the top ten biopharma products sold in 2026 are new modalities, a result that is consistent with our 2025 findings. However, the rankings have shifted. (See Exhibit 2.) Mounjaro rose from third to the top position propelled by continued gains in market share in obesity and obstructive sleep apnea. Zepbound nearly doubled its projected revenue from 2025, moving from tenth place to fifth, and Skyrizi climbed from fifth place to third on the strength of market share gains and label expansion into inflammatory bowel disease.
The five-year outlook has also shifted. Analysts now expect seven of the top ten products in 2031 to be new modality drugs; last year, they projected nine such drugs in 2030. Two conventional small-molecule products, Foundayo and Rinvoq, entered this list in 2026. At the same time, Keytruda and Wegovy fell out of the top ten, driven by the forecasted loss of exclusivity and exposure to Inflation Reduction Act (IRA) pricing.
A Diverging Modality Landscape
As we’ve done previously, this year we tracked modality growth by the number of pipeline products as well as by projected pipeline and marketed value. (See Exhibits 3 and 4.)
Antibodies: Maturing, Not Stagnating
Antibodies, the largest modality category, experienced continued robust growth through commercial maturation in monoclonal antibodies, expansion from Chinese and South Korean players in antibody-drug conjugates, and new launches in multispecific antibodies.
- Monoclonal Antibodies. The monoclonal antibody (mAb) pipeline remains the largest among the new modalities. Its forward pipeline value (Phase 1 through Phase 3) declined, while the forward value of marketed mAbs grew by $24 billion. The shrinking pipeline value is a sign of commercial maturation, with several high-value mAbs—including Viridian Therapeutics’ Lumvoa for thyroid eye disease—recently receiving FDA approval.
- Antibody-Drug Conjugates. The size and projected value of the ADC pipeline has grown significantly over the past year. Of the 25 companies with the largest increase in ADC pipeline size, 17 are based in China and four in South Korea. The largest product growth (15 to 35 products) comes from LigaChem Biosciences in South Korea, while product growth in Western ADC pipelines is concentrated in the portfolios of established players (for example, Pfizer’s Seagen and AbbVie’s ImmunoGen).
- Multispecific Antibodies. This year, we expanded the bispecific category to also include trispecifics and multispecifics. The modality’s forward pipeline value was essentially flat at roughly $6 billion; nearly all of the modality’s growth came from newly marketed products. The largest single driver of value was Summit Therapeutics and Akeso’s ivonescimab (a PD-1 and VEGF bispecific), which was filed with the US Food and Drug Administration (FDA) in January 2026.
Proteins and Peptides: Broadening Beyond Diabetes and Obesity
The number of recombinant proteins continues to grow, with the forward pipeline and marketed value rising at a 15% CAGR. GLP-1 products now account for roughly half the modality’s projected value but only a small fraction of its product count, and our analysis indicates that GLP-1 product counts grew year-over-year even as their aggregated forecast value declined by 7%.
The decline was driven by three factors: CagriSema’s forecast revision; semaglutide’s exposure to price negotiations under the US IRA and anticipated loss of exclusivity, both of which analysts have begun to build into semaglutide forecasts; and intensifying competition from oral GLP-1 agonists. These pressures are partly offset by continued indication expansion that is broadening the GLP-1 opportunity into cardiovascular risk reduction, chronic kidney disease, obstructive sleep apnea, MASH, and neurodegenerative indications such as Alzheimer’s disease.
Non-GLP-1 recombinant products, by contrast, grew in both count (+9%) and forward value (+22%). This growth is diversified across therapeutic areas, including oncology and systemic anti-infectives, and largely concentrated in immunoglobulin products.
Cell Therapies: Contrasting Outcomes
The cell therapy pipeline continues to target the hematology space with promising results, while expanding into solid tumors and spaces outside of oncology such as autoimmune diseases.
CAR-T. CAR-T therapies saw additional commercial validation. Most notably, Gilead Sciences and Arcellx’s anitocabtagene autoleucel (anito-cel), a BCMA-directed therapy for relapsed or refractory multiple myeloma, had its BLA accepted by the FDA in February 2026.
At the same time, the modality’s overall clinical-phase forward pipeline value declined, which appears to be driven by the financing and prioritization pressures affecting smaller developers. Caribou Biosciences undertook a significant workforce reduction in 2025 and discontinued several earlier-stage products in order to concentrate resources on its two lead allogeneic products
TCR-T, CAR-NK, TILs, and Stem Cell. These emerging cell therapy modalities continued to show stagnant or declining forecasted value, reflecting the commercialization and financial headwinds that have weighed on the broader cell therapy field. Despite some successes and growth in the number of pipeline assets, the forward value of the four modalities together has remained relatively flat since we started tracking it in 2020.
TCR-T’s projected pipeline value declined as TScan Therapeutics halted its Phase 1 solid-tumor product in November 2025 and cut 30% of its workforce to refocus on its hematologic-malignancy candidate.
CAR-NK continued to face headwinds. Prompted in part by disappointments in oncology trials, the pipeline has pivoted toward autoimmune diseases. For example, Nkarta refocused its lead NKX019 product on lupus and other autoimmune indications after the results of its NKX101 trial for acute myeloid leukemia.
The tumor-infiltrating lymphocyte (TIL) therapy’s forward value remains almost entirely tied to Iovance Biotherapeutics’ Amtagvi (lifileucel), with approval in Australia in June 2026 and filings underway in the UK and European Union. Iovance is also advancing lifileucel into new indications, including non-small cell lung cancer; its forecast was modestly trimmed on slower-than-expected commercial uptake, reflecting the manufacturing complexity and cost that continue to constrain individualized TIL therapy.
Stem cell therapies, by contrast, retained modest momentum, anchored by Mesoblast’s marketed remestemcel-L-rknd franchise and its late-stage candidate Revascor in Phase 3 for heart failure.
Gene Therapies: Editing Advances and Augmentation Plateaus
Gene editing is among the fastest-growing modalities, with a 21% CAGR in forward value and a growing number of clinical-phase products. Intellia Therapeutics’ lonvoguran ziclumeran (or lonvo-z) initiated a rolling BLA submission to the FDA in April 2026 for hereditary angioedema. If approved, lonvo-z would be the world’s first in vivo CRISPR-based gene-editing therapy to reach the market. Beam Therapeutics’ base-editing products, including Beam-302 for alpha-1 antitrypsin deficiency, have the highest revenue forecasts of all clinical-phase products.
Gene augmentation saw clinical-phase forward pipeline value continue to grow, driven by Neurogene’s NGN-401 for Rett syndrome, Candel Therapeutics’ GliAtak for glioma, and Solid Biosciences’ SGT-003 for neuromuscular and neurological diseases. This growth was offset by a decrease in five-year forecasted marketed value driven by Elevidys (delandistrogene moxeparvovec-roki) for Duchenne muscular dystrophy following a 2025 safety hold and label restrictions.
Nucleic Acids: Growing Pipelines Beyond mRNA
Nucleic acid modalities have continued their divergent paths. DNA and RNA therapies and RNAi are rapidly growing, while the postpandemic contraction in mRNA continues.
- DNA and RNA: DNA and RNA therapies remained one of the fastest-growing modalities, with an increase in the number of Phase 3 products by roughly two-thirds in a single year. Three cohorts drove the expansion: established Western pure-plays, large pharma platforms, and Chinese biotechs. Forward pipeline value growth was driven by increased confidence in late-stage products, including ProQR Therapeutics’ AX-0810 targeting cholestatic diseases and Dyne Therapeutics’ Dyne-101 for myotonic dystrophy.
- RNAi: RNAi forward pipeline value was nearly flat, while forward marketed value grew from $11.5 billion to $16.9 billion. The largest driver was Alnylam Pharmaceuticals’ Amvuttra, which was approved for ATTR cardiomyopathy, a label expansion beyond the original polyneuropathy indication.
- mRNA: The mRNA pipeline continued its postpandemic contraction, with its forward pipeline value for Phase 1 through Phase 3 falling sharply. Forward marketed value fell as well, as postpandemic demand normalized. However, there has been positive momentum with Moderna’s mFlusiva becoming the first mRNA seasonal influenza vaccine approved and Intismeran autogene (Merck and Moderna) becoming the first mRNA cancer vaccine to achieve positive Phase 3 results in melanoma.
Radiopharmaceuticals: Quickly Expanding
Radiopharmaceuticals, a newly tracked category this year, posted the highest overall CAGR by product count of any modality, reflecting a wave of clinical, marketed, and dealmaking activity. The radiopharmaceuticals category spans radiotherapeutics, which delivers a therapeutic radiation dose, and radiodiagnostics, companion imaging agents used to identify patients whose tumors express the relevant target. Most radioligand therapies are delivered via small-molecule or peptide-targeting vectors, though a smaller subset of therapies is delivered via antibodies.
Commercial growth in radiotherapeutics was driven by marketed products such as Novartis’s Pluvicto, which had a label expansion to earlier in the prostate cancer treatment pathway. The near-term clinical calendar is equally active, extending to the more potent next-generation alpha-emitters: ITM Isotope Technologies’ ITM-11 (a lutetium-177 therapy for neuroendocrine tumors) and Convergent Therapeutics’ Conv01-α (an actinium-225 therapy for prostate cancer) both carry FDA decision dates in the second half of 2026.
Other New Modalities
Oncolytic viruses showed a pronounced shift from clinical to marketed value. Replimune’s Tudriqev for melanoma became the second oncolytic virus approval, and CG Oncology’s cretostimogene grenadenorepvec initiated a rolling BLA submission to the FDA in November 2025 for high-risk Bacillus Calmette Guerin-unresponsive NMIBC. Microbiome therapies and PROTACs remain nascent, with little pipeline value forecasted.
Antibodies and China-Originated Assets Anchor Deal Activity
Acquisition and licensing activity is a useful barometer of where large biopharma companies see value. From 2023 through 2026 year-to-date, the top 20 biopharma companies spent roughly $290 billion on new-modality deals. (See Exhibits 5 and 6.) In the second half of 2025 and through May 2026, new-modality deal activity totaled $127 billion across 50 deals.
Antibody platforms continue to anchor the deal landscape. Antibodies command the largest share of deal value. The largest transactions since last year’s report include Novartis’s $12 billion acquisition of Avidity Biosciences and Eli Lilly’s $8.8 billion collaboration with Innovent Biologics. There has also been a continued string of smaller deals, including Boehringer Ingelheim’s $1.3 billion deal with Simcere and Sanofi’s $1.2 billion deal with Kali Therapeutics. In multispecifics, AbbVie’s $5.6 billion early-stage licensing agreement with RemeGen represents the majority of deal value for the year. ADC activity was led by Gilead’s $5 billion acquisition of Tubulis, expanding its solid-tumor ADC platform.
China remains a primary source of licensed assets. China-originated assets represented roughly 50% of the top 20 biopharma 2026 year-to-date new-modality deal value, up from 40% last year.
Late-stage M&A commands a premium. Many of the largest acquisitions concentrated on assets at or near clinical or commercial validation. The largest such M&A transactions of 2026 to date are Gilead’s $7.8 billion acquisition of Arcellx for its anitocabtagene autoleucel (or anito-cel) CAR-T product for multiple myeloma, AbbVie’s acquisition of Apogee Therapeutics for $10.9 billion, and Lilly’s acquisition of Centessa for $7.8 billion.
The Potential Future Landscape of New-Modality M&A
This year, we identified companies that have at least 50% of their pipeline and marketed products in new modalities. Then we grouped them into four market capitalizations tiers. (See Exhibit 7.)
Further analysis of the market-cap categories showed a clear maturation arc along three dimensions: the clinical phase of the lead asset, the concentration of value in that lead asset, and modality breadth. In the first tier, $225 million to $1 billion, the typical company has a single asset in a single modality, and the asset is often in the clinical phase. The median company derives nearly 100% of its 2031 forecasted pipeline value from one lead product. More than one-third of these companies operate in just one modality.
The typical company in the second tier, $1 billion to $5 billion, has at least one asset that is in a more advanced clinical phase. In these companies, the median lead product has progressed to Phase 3, the majority of forward pipeline value is in the top asset, and the focus is on one or two modalities. The key shift in this tier is not diversification but the advancement of the lead asset toward registration.
Beyond antibodies and proteins and peptides, most new modalities cluster in small-cap companies, with cell and gene therapies overwhelmingly a small-company phenomenon. Roughly 35 companies that are focused on cell and gene therapies are below $1 billion in market capitalization, and only 5 have market capitalization over $5 billion. This pattern indicates, in part, why acquisitions often occur at the $1 billion to $5 billion clinical-inflection point: the window to acquire cell- and gene-therapy platforms at attractive valuations is concentrated at the clinical phase. Gilead-Arcellx, Lilly-Verve Therapeutics, and Bristol Myers Squibb-Orbital all closed in roughly this range.
The third tier, $5 billion to $20 billion, marks an inflection point. The lead product is typically marketed and companies have more diversified pipelines across multiple new modalities.
The fourth tier, over $20 billion, is defined by breadth and de-risked, on-market revenue. Every company has multiple modalities and a marketed lead asset. The exceptions in this tier are argenx and Alnylam, both of which have reached their large scale while having their business anchored to new modalities.
This year’s analysis marks an inflection point in the new-modality story. Conventional therapies, led by oral metabolic drugs, recovered lost ground. Antibodies continue to anchor the new-modality industry in both pipeline and deal activity, although their growth increasingly reflects commercial maturation rather than pipeline expansion. Nucleic acids are building a credible second commercial wave, and cell and gene therapies continue to advance unevenly, with gene editing reaching a watershed even as gene augmentation plateaus. For acquirers, the new size-based lens makes plain that pure-play innovation sits in small, single-asset companies and that scaling requires progression through clinical phases as well as expansion into a breadth of modalities.
The authors would like to thank BCG colleagues Carl Brown and Alizeh Maqbool for their contributions to this article.
