What Could Go Wrong At Gilead From Here?

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Management says Gilead Sciences (GILD) is growing faster than it has in years, but a price the company does not get to set poses the biggest risk to that growth. Sales excluding Veklury rose 16% from a year earlier in the third quarter of 2026. Investors now have a large gain to protect after the stock returned 47.4% from its October 30, 2025 close to November 2, 2026, compared with 11.8% for the S&P 500. Who is setting that price, and on which drug?

Gilead Faces A Lower Medicare Price For Biktarvy

CMS sets the Medicare price for Biktarvy, Gilead’s largest product. During its October 29, 2026 earnings call, management said the agency set the drug’s Medicare price at $2,600 per 30-day supply, or about 38% below the list price.

Executives have already estimated the financial impact. They expect Biktarvy revenue to fall in 2028 from 2027, and put the net impact of the lower price at about $1.5 billion in 2028. That figure covers Medicare as well as the spillover into Medicaid, 340B and other U.S. payer segments. Management said most of it comes from Medicare but provided no split, calling it still very early.

How Big Is Biktarvy For Gilead?

Biktarvy accounted for $14.3 billion of sales in fiscal 2025, out of $29.4 billion in total company revenue. Biktarvy’s growth slowed to 6.8% that year, down from 13.3% in fiscal 2024. During the third quarter of 2026, sales of the drug rose 10% from a year earlier to $4.1 billion, helped partly by inventory dynamics that management expects to normalize by year-end.

Measured against that base, the $1.5 billion management expects to lose in 2028 equals about a tenth of what Biktarvy sold in fiscal 2025.

Gilead stock sits close to its high for the past year, closing at $170.33 on November 2, 2026, 0.2% below its highest close of that period. The shares trade at 6.8 times sales, compared with 3.3 times for the S&P 500. A price-to-earnings ratio is not meaningful because Gilead lost money over the last twelve months. That loss came from a single quarter: Gilead lost $10.5 billion in the second quarter of 2026 and made money in the other three. Management said that quarter carried $11.2 billion of acquired research costs, mainly from its purchases of Arcellx and Tubulis.

How Worried Should Gilead Holders Be?

The Medicare price poses a real risk to Gilead, but not an immediate one. The revenue loss lands in 2028, and management expects total HIV revenue to grow in 2028 from 2027 on growth from other HIV products. The company also expects total product sales and earnings per share to grow in 2028. Those figures remain forecasts, not results. Management also said it expects very strong margins in 2027 and for the foreseeable future.

With the stock near its high, holders have a lot riding on that offset holding. When Gilead next reports, expected in February 2027, sales of its other HIV products will be the figure to watch.

Does This Mean You Should Act On GILD?

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