Gilead (GILD) Q3 2026 Earnings: Biktarvy Drives 18% HIV Growth

Gilead Sciences (GILD) Q3 2026 earnings showed faster HIV treatment demand, which answered the earlier question about the quality of its growth. Gilead released its results for the third quarter of 2026 (ended September 30) on October 29, 2026, in an earnings press release and on its earnings call [1][2]. Four questions were open before the report: whether Biktarvy growth would hold once inventory and pricing effects faded, whether Yeztugo could grow without cannibalizing Descovy, whether Trodelvy could offset the decline in cell therapy, and whether profit and cash would recover after the company's large acquisitions.

All four areas moved in a positive direction this quarter, with clear limits. Third-quarter sales included a larger-than-usual channel inventory build, and the company gave no new Yeztugo persistence figure. Gilead also quantified, for the first time, the effect of the Medicare price set for Biktarvy from 2028. The company's view that it can still grow in 2028 depends on new products that have yet to deliver.

Gilead is a biopharmaceutical company built mainly on HIV medicines. In 2025, HIV product sales were $20.752 billion, or 72% of product sales, including $14.334 billion from the treatment drug Biktarvy [3]. Its pre-exposure prophylaxis (PrEP) products, which people without HIV take to prevent infection, include daily oral Descovy and Yeztugo, an injection given once every six months.

Biktarvy accelerates and HIV sales rise 18%

Third-quarter HIV growth was well above the level implied by the company's earlier guidance. HIV sales were $6.249 billion, up 18% year over year, and base business sales, which exclude the COVID-19 drug Veklury, were $8.203 billion, up 16% [1]. Gilead's August guidance implied second-half growth of roughly 7%-9% for HIV and roughly 4%-6% for the base business [4]. Gilead has now raised its full-year base business guidance to $30.7-$31.0 billion and its full-year HIV growth outlook to about 12% [1][2].

Biktarvy growth sped up, and market share data support the demand picture. Biktarvy sales were $4.059 billion, up 10% year over year, compared with 7% growth in the second quarter [1][5]. The company said Biktarvy's U.S. treatment market share reached an all-time high of 53%, and that the HIV treatment market has shown signs of stabilization [2]. This indicates that second-quarter growth did not rely only on inventory and price.

Part of the growth came from inventory that will not repeat. The company said third-quarter HIV inventory was higher than usual, that Biktarvy's sequential growth came first from inventory, and that it anticipates a smaller fourth-quarter inventory build than in past years; it did not quantify the inventory contribution [2]. Based on the guidance, fourth-quarter base business growth would slow to roughly 5%-9% year over year [1][3].

Revenue growth also restored profit and cash after the acquisitions. The third-quarter non-GAAP operating margin was 50.2%, and SG&A expenses rose 14%, which the company attributed to HIV promotion, legal expenses and performance-linked compensation [1][2]. Operating cash flow was $5.0 billion, and cash, cash equivalents and marketable debt securities reached $6.4 billion at September 30, compared with about $3.2 billion at June 30 [1][6]. This improvement shares its source with revenue growth and also includes profit from the inventory build.

PrEP and oncology: prior view holds

PrEP and oncology performed well, but the results are not yet enough to confirm the earlier view. Yeztugo sales were $305 million, and Descovy sales were $1.046 billion, up 49%, with no sign of substitution; Descovy growth came mainly from price and inventory [1]. Trodelvy sales rose 42% to $506 million, while cell therapy sales fell 18% to $355 million [1].

New focus: Biktarvy's 2028 Medicare price cuts revenue by about $1.5 billion

The Medicare price for Biktarvy is now set, and the company has quantified the impact for the first time. Biktarvy was selected for Medicare price negotiation in January 2026 [7]. In October, the Centers for Medicare and Medicaid Services set the price at $2,600 per 30-day supply, about 38% below list price, effective January 1, 2028 [1][2]. Gilead's preliminary estimate is that the new price will reduce 2028 Biktarvy net revenue by about $1.5 billion, including related effects in Medicaid, 340B and other channels [2].

That impact equals about 5% of 2025 product sales, and because HIV drug margins are very high, the hit to operating profit would be close to the same amount [3]. Gilead anticipates that 2028 total HIV revenue, total product sales and earnings per share will still exceed 2027 levels. That view depends on new products such as Bixlenvo and a once-weekly oral regimen, and the company does not yet report Bixlenvo sales separately [1][2].

Conclusion

This report strengthens the case for Gilead's growth, profit conversion and cash generation, but the third-quarter inventory build will unwind in the fourth quarter. The longer-term pressure is the 2028 Biktarvy Medicare price. The next tests are whether Biktarvy keeps growing once inventory builds shrink, whether the company discloses Yeztugo persistence again, and whether it revises the $1.5 billion estimate.

Sources

[1] GILD 8-K filed 2026-10-29 · Q3 2026 earnings release (EX-99.1), 2026-10-29, 8-K, https://www.sec.gov/Archives/edgar/data/882095/000088209526000037/exhibit991earningspressrel.htm

[2] GILD Q3 2026 earnings call 2026-10-29 · transcript, 2026-10-29, earnings call transcript, drillr://earning_call_summary/GILD/2026-10-29

[3] GILD 10-K filed 2026-02-24 · FY2025 product sales by franchise, 2026-02-24, 10-K, https://www.sec.gov/Archives/edgar/data/882095/000088209526000006/

[4] GILD 8-K filed 2026-08-04 · August 2026 full-year guidance, 2026-08-04, 8-K, https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0000882095&type=8-K

[5] GILD 10-Q filed 2026-08-06 · Q2 2026 revenues by product, 2026-08-06, 10-Q, https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0000882095&type=10-Q

[6] GILD 8-K filed 2026-08-04 · cash, operating cash flow and capital return, 2026-08-04, 8-K, https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0000882095&type=8-K

[7] GILD 10-K filed 2026-02-24 · IRA Medicare negotiation of Biktarvy, 2026-02-24, 10-K, https://www.sec.gov/Archives/edgar/data/882095/000088209526000006/