Management also cited the impact of U.S. generic entries, including Entresto, Promacta, and Tasigna, which entered the U.S. market mid-2025. Narasimhan said Q4 sales were also affected by gross-to-net dynamics and Entresto’s loss of exclusivity.In the fourth quarter, sales declined 1% while core operating income rose 1%. Kirsch said results were “a little bit noisy” due to U.S. R&D-related adjustments that had a positive impact in Q4 2024 and a negative impact in Q4 2025, “mostly on generic brands.” Excludi ...