⚠ Botox Joins the Medicare List in 2028Moderate threat

AbbVie (ABBV) — threat to the moat

From 2028 the government will set the Medicare price of Botox, a $3.8 billion drug with no biosimilar.

The Medicare selections are moving to AbbVie's larger drugs. In January 2026 Botox was selected as one of fifteen medicines subject to government-set prices in Medicare Parts B and D beginning in 20281. Botox Therapeutic sold $3,769 million in 2025, up 14.8%2.

Government-set Medicare pricesImbruvicafrom 2026Vraylarfrom 2027Linzessfrom 2027Botoxfrom 2028Selected products, 2025 salesabout $11.2bnAbbVie Form 10-K FY2025; sales calculated
Four drugs, three years.

Botox is a biologic with no biosimilar and a large Medicare population for its neurological uses. The government price removes the pricing power that exclusivity would otherwise protect.

Vraylar and Linzess follow in 20273. Together with Imbruvica, the selected products sold about $11.2 billion in 20254, about 18% of revenue5.

Botox differs from a pill in one way that matters. As a physician-administered biologic it has been protected by manufacturing complexity as well as patents, and a government price removes the benefit of that protection for Medicare patients without any competitor arriving. The Parts B and D selection covers exactly the channel through which most therapeutic Botox is paid6.

Botox Therapeutic's growth after 2028 is the test. Continued growth would mean volume outweighs the price cut; a decline would mean the government has taken the drug's best years.

References
  1. ReportedIn January 2026 Botox was selected as one of fifteen medicines subject to government-set prices in Medicare Parts B and D beginning in 2028.
    AbbVie Form 10-K for fiscal 2025 - Item 1A risk factors, patents and exclusivity, government pricing and legal proceedings. — FY2025 · publ. 20 February 2026 · source ↗
  2. ReportedBotox Therapeutic sold $3,769 million in 2025, up 14.8%.
    AbbVie Form 10-K for fiscal 2025 - Item 7 MD&A: net revenues by product and region, and rebates. — FY2025 · publ. 20 February 2026 · source ↗
  3. ReportedVraylar and Linzess follow in 2027.
    AbbVie Form 10-K for fiscal 2025 - Item 7 MD&A: net revenues by product and region, and rebates. — FY2025 · publ. 20 February 2026 · source ↗
  4. Moat Explorer calcTogether with Imbruvica, the selected products sold about $11.2 billion in 2025, about 18% of revenue.
    Moat Explorer calculation from AbbVie's reported product revenue and financial statements ($ millions unless stated). Therapeutic areas 2025: immunology 17,562 + 8,304 + 4,540 = 30,406; neuroscience 3,621 + 3,769 + 1,271 + 1,036 + 482 + 381 + 207 = 10,767; oncology 2,869 + 2,792 + 690 + 271 + 33 = 6,655; aesthetics 2,602 + 993 + 1,265 = 4,860; eye care 493 + 410 + 197 + 1,009 = 2,109; other key products 1,317 + 1,512 + 907 = 3,736; all other 2,627; eye care and other products 2,109 + 3,736 + 2,627 = 8,472; total 61,160. 2024: immunology 11,718 + 5,971 + 8,993 = 26,682; neuroscience 8,999; oncology 6,555; aesthetics 5,176; eye care and other 2,242 + 3,648 + 3,032 = 8,922. 2023: 7,763 + 3,969 + 14,404 = 26,136; neuroscience 7,717; oncology 5,915; aesthetics 5,294; eye care and other 2,415 + 3,806 + 3,035 = 9,256. 2022: 5,165 + 2,522 + 21,237 = 28,924; neuroscience 6,528; oncology 6,577; aesthetics 5,333; eye care and other 2,701 + 3,854 + 4,137 = 10,692. Growth 2025: immunology 30,406 / 26,682 - 1 = 14.0%; neuroscience 10,767 / 8,999 - 1 = 19.6%. Immunology and neuroscience 30,406 + 10,767 = 41,173, 41,173 / 61,160 = 67.3%. Immunology share 30,406 / 61,160 = 49.7%. Skyrizi + Rinvoq: 5,165 + 2,522 = 7,687 (2022); 7,763 + 3,969 = 11,732 (2023); 11,718 + 5,971 = 17,689 (2024); 17,562 + 8,304 = 25,866 (2025); H1 2026 9,988 + 4,644 = 14,632; Q2 2026 5,505 + 2,525 = 8,030, 8,030 / 16,990 = 47.3%; 2026 plan 21.5 + 10.1 = 31.6 bn. Shares of revenue 7,687 / 58,054 = 13.2%; 11,732 / 54,318 = 21.6%; 17,689 / 56,334 = 31.4%; 25,866 / 61,160 = 42.3%. Humira: 4,540 / 21,237 - 1 = -78.6%; share 8,993 / 56,334 = 16.0% (2024), 4,540 / 61,160 = 7.4% (2025). Rebates: 65.1 / 61.16 = 1.06; 65.1 / 18.8 = 3.5 times (2019-2025) against net revenues 61,160 / 33,266 = 1.8 times; gross sales 61.2 + 65.1 = 126.3 bn, 126.3 / 61.2 = 2.1 times; managed care 22,307 / 61,160 = 36.5%; Medicaid and Medicare 21,283 / 61,160 = 34.8%; payers 22,307 + 21,283 = 43,590, 43,590 / 61,160 = 71.3%. Geography: US 46,603 / 61,160 = 76.2%; international 14,557 / 61,160 = 23.8%. Gross margin 2025 (61,160 - 18,204) / 61,160 = 70.2%. Government-set price products, 2025 sales: 2,869 + 3,621 + 907 + 3,769 = 11,166, 11,166 / 61,160 = 18.3%. Goodwill and intangibles 35,640 + 52,641 = 88,281, 88,281 / 133,960 = 65.9%. Eye care share 2,109 / 61,160 = 3.4%; aesthetics share 4,860 / 61,160 = 7.9%. Net debt 30 June 2026: 62,481 + 8,341 - 6,569 = 64,253; net debt / operating cash flow 64,253 / 19,030 = 3.4 years. Free cash flow 2025: 19,030 - 1,214 = 17,816; dividends paid 11,657 / 17,816 = 65.4%; operating cash flow / dividends 19,030 / 11,657 = 1.6; dividends declared / net earnings 11,819 / 4,226 = 2.8; dividends per share 6.65 / 1.75 = 3.8 times (2014-2025). Free cash flow yield 17,816 / 468,500 = 3.8%; free cash flow per share 17,816 / 1,771 = 10.06. 2026 adjusted EPS guidance midpoints: (14.37 + 14.57) / 2 = 14.47; (13.96 + 14.16) / 2 = 14.06; (14.08 + 14.28) / 2 = 14.18; (13.91 + 14.11) / 2 = 14.01; (13.87 + 14.07) / 2 = 13.97. Ubrelvy and Qulipta Q2 2026 392 + 350 = 742; 2025 1,271 + 1,036 = 2,307. Skyrizi share 17,562 / 61,160 = 28.7%. Juvederm 993 / 1,428 - 1 = -30.5%. Aesthetics 4,860 / 5,176 - 1 = -6.1%. Gross margin 2023 (54,318 - 20,415) / 54,318 = 62.4%. Skyrizi + Rinvoq 2021 2,939 + 1,651 = 4,590; 2022 7,687 / 21,237 = 36% - therapeutic-area totals, growth and rebates. — 2015-2026 · publ. September 2026 · source ↗
    Method: Arithmetic on figures reported in AbbVie's Forms 10-K, 10-Q, results releases, the Q4 2025 call and market data; operands shown in the source line.
  5. Moat Explorer calcTogether with Imbruvica, the selected products sold about $11.2 billion in 2025, about 18% of revenue.
    Moat Explorer calculation from AbbVie's reported product revenue and financial statements ($ millions unless stated). Therapeutic areas 2025: immunology 17,562 + 8,304 + 4,540 = 30,406; neuroscience 3,621 + 3,769 + 1,271 + 1,036 + 482 + 381 + 207 = 10,767; oncology 2,869 + 2,792 + 690 + 271 + 33 = 6,655; aesthetics 2,602 + 993 + 1,265 = 4,860; eye care 493 + 410 + 197 + 1,009 = 2,109; other key products 1,317 + 1,512 + 907 = 3,736; all other 2,627; eye care and other products 2,109 + 3,736 + 2,627 = 8,472; total 61,160. 2024: immunology 11,718 + 5,971 + 8,993 = 26,682; neuroscience 8,999; oncology 6,555; aesthetics 5,176; eye care and other 2,242 + 3,648 + 3,032 = 8,922. 2023: 7,763 + 3,969 + 14,404 = 26,136; neuroscience 7,717; oncology 5,915; aesthetics 5,294; eye care and other 2,415 + 3,806 + 3,035 = 9,256. 2022: 5,165 + 2,522 + 21,237 = 28,924; neuroscience 6,528; oncology 6,577; aesthetics 5,333; eye care and other 2,701 + 3,854 + 4,137 = 10,692. Growth 2025: immunology 30,406 / 26,682 - 1 = 14.0%; neuroscience 10,767 / 8,999 - 1 = 19.6%. Immunology and neuroscience 30,406 + 10,767 = 41,173, 41,173 / 61,160 = 67.3%. Immunology share 30,406 / 61,160 = 49.7%. Skyrizi + Rinvoq: 5,165 + 2,522 = 7,687 (2022); 7,763 + 3,969 = 11,732 (2023); 11,718 + 5,971 = 17,689 (2024); 17,562 + 8,304 = 25,866 (2025); H1 2026 9,988 + 4,644 = 14,632; Q2 2026 5,505 + 2,525 = 8,030, 8,030 / 16,990 = 47.3%; 2026 plan 21.5 + 10.1 = 31.6 bn. Shares of revenue 7,687 / 58,054 = 13.2%; 11,732 / 54,318 = 21.6%; 17,689 / 56,334 = 31.4%; 25,866 / 61,160 = 42.3%. Humira: 4,540 / 21,237 - 1 = -78.6%; share 8,993 / 56,334 = 16.0% (2024), 4,540 / 61,160 = 7.4% (2025). Rebates: 65.1 / 61.16 = 1.06; 65.1 / 18.8 = 3.5 times (2019-2025) against net revenues 61,160 / 33,266 = 1.8 times; gross sales 61.2 + 65.1 = 126.3 bn, 126.3 / 61.2 = 2.1 times; managed care 22,307 / 61,160 = 36.5%; Medicaid and Medicare 21,283 / 61,160 = 34.8%; payers 22,307 + 21,283 = 43,590, 43,590 / 61,160 = 71.3%. Geography: US 46,603 / 61,160 = 76.2%; international 14,557 / 61,160 = 23.8%. Gross margin 2025 (61,160 - 18,204) / 61,160 = 70.2%. Government-set price products, 2025 sales: 2,869 + 3,621 + 907 + 3,769 = 11,166, 11,166 / 61,160 = 18.3%. Goodwill and intangibles 35,640 + 52,641 = 88,281, 88,281 / 133,960 = 65.9%. Eye care share 2,109 / 61,160 = 3.4%; aesthetics share 4,860 / 61,160 = 7.9%. Net debt 30 June 2026: 62,481 + 8,341 - 6,569 = 64,253; net debt / operating cash flow 64,253 / 19,030 = 3.4 years. Free cash flow 2025: 19,030 - 1,214 = 17,816; dividends paid 11,657 / 17,816 = 65.4%; operating cash flow / dividends 19,030 / 11,657 = 1.6; dividends declared / net earnings 11,819 / 4,226 = 2.8; dividends per share 6.65 / 1.75 = 3.8 times (2014-2025). Free cash flow yield 17,816 / 468,500 = 3.8%; free cash flow per share 17,816 / 1,771 = 10.06. 2026 adjusted EPS guidance midpoints: (14.37 + 14.57) / 2 = 14.47; (13.96 + 14.16) / 2 = 14.06; (14.08 + 14.28) / 2 = 14.18; (13.91 + 14.11) / 2 = 14.01; (13.87 + 14.07) / 2 = 13.97. Ubrelvy and Qulipta Q2 2026 392 + 350 = 742; 2025 1,271 + 1,036 = 2,307. Skyrizi share 17,562 / 61,160 = 28.7%. Juvederm 993 / 1,428 - 1 = -30.5%. Aesthetics 4,860 / 5,176 - 1 = -6.1%. Gross margin 2023 (54,318 - 20,415) / 54,318 = 62.4%. Skyrizi + Rinvoq 2021 2,939 + 1,651 = 4,590; 2022 7,687 / 21,237 = 36% - therapeutic-area totals, growth and rebates. — 2015-2026 · publ. September 2026 · source ↗
    Method: Arithmetic on figures reported in AbbVie's Forms 10-K, 10-Q, results releases, the Q4 2025 call and market data; operands shown in the source line.
  6. ReportedThe Parts B and D selection covers exactly the channel through which most therapeutic Botox is paid.
    AbbVie Form 10-K for fiscal 2025 - Item 7 MD&A: net revenues by product and region, and rebates. — FY2025 · publ. 20 February 2026 · source ↗
Sources
Generated September 25, 2026