Why J&J thinks its new psoriasis pill could be one of its biggest drugs ever
Johnson & Johnson is counting on its newly launched psoriasis pill to become its next cash cow. Investors want to know if it can live up to the hype. Icotyde went to market after the Food and Drug Administration approved it in mid-March for moderate to severe plaque psoriasis. The once-a-day drug is the first and only oral treatment targeting the same IL-23 receptor as popular injectables, including J & J’s Tremfya, which is also indicated for psoriatic arthritis, ulcerative colitis, and Crohn’s Disease. IL-23 inhibitors, which include AbbVie’s Skyrizi, are biologic medications used to treat chronic inflammatory diseases. “Icotyde has the potential to be one of our largest products ever,” Johnson & Johnson CEO Joaquin Duato said on the April earnings call. Together, J & J is aiming for Tremfya and now Icotyde to shore up its immunology portfolio and to replace and exceed the waning sales of Stelara, which topped out in 2023 at nearly $11 billion in annual revenue. Stelara lost exclusivity last year, paving the way for biosimilars to enter the market. It is estimated to pull in just $2.36 billion this year, and less and less in the years to come. Tremfya sales have steadily climbed since peak-Stelara — from $3.15 billion in 2023 to an estimated $7.13 billion for 2026. It’s too early to tell how much Icotyde will add to the mix, but J & J said last month when it reported first-quarter earnings that roughly 1,500 prescriptions have been written in less than 30 days. J & J, which is also studying Icotyde for Crohn’s disease and ulcerative colitis, sees the new pill as a much-needed alternative. Tremfya and Icotyde are what Duato called a “complementary category-shaping portfolio” to address different patient needs and preferences within the psoriasis market. Topicals have historically been the first line of care for many patients before the shots. J & J estimates about 8 million people in the U.S. have plaque psoriasis. “We know there are so many patients that keep cycling and cycling and cycling on topical therapies,” the head of J & J’s pharmaceutical unit, Jennifer Taubert, said on the April earnings call. Now, she said, recent changes to prescribing guidelines make it easier for those patients to become eligible for systemic and advanced therapies. “So we think Icotyde fits right in this sweet spot as that first systemic choice.” Bank of America analyst Jason Gerberry questioned whether the convenience of a pill is strong enough to become the standard. “The value proposition isn’t entirely obvious given how far behind the IL-23 biologics are,” he told CNBC. “Some would argue you’d rather take a quarterly injection than you would take a pill every day, especially if you’ve gotten used to taking biologics,” as is the case for a large number of existing patients with psoriasis. The skepticism isn’t necessarily new. Gerberry highlighted Sotyktu as a key comparison. The drug was Bristol Myers Squibb ‘s first oral TYK2 inhibitor, green-lighted by the FDA for the treatment of moderate to severe plaque psoriasis back in September 2022. It failed to generate significant traction, underscoring how difficult it has been for pill-based psoriasis treatments to gain traction against biologics. “At some point, investors are going to want to see that this can be a drug that can live up to the large peak sales potential,” said Gerberry, who has a hold equivalent rating on J & J and a $254 price target. Leerink analyst David Risinger said in a CNBC interview that payer access, or the process of securing insurance coverage and reimbursements, is critical to new drug adoption, and Icotyde is no different. “We want to see that J & J achieves widespread payer access by this summer,” Risinger said. J & J is running a program to help patients pay for Icotyde. Rival shots Tremfya and Skyrizi cost around $100,000 a year. “We are anticipating Icotyde’s uptake to be in patients that are new to therapy that may otherwise consider a less effective psoriasis pill,” Risinger said last week, directly mentioning Sotyktu and Amgen ‘s Otezla. Leerink upgraded shares of J & J on Wednesday and lifted its price target to $265 from $252, implying about 17% upside from Friday’s close. Risinger now projects Icotyde sales reaching $10.5 billion in 2032, well ahead of the Wall Street consensus of $7.4 billion. Reaching its full sales potential will require Icotyde to secure approvals for additional conditions such as Crohn’s disease and ulcerative colitis, which fall under the umbrella of inflammatory bowel disease. IBD proved to be 75% of Stelara’s sales, Duato said in January, and Tremfya’s use for these conditions has accelerated its growth. The same could eventually be true for Icotyde. In his upgrade, Risinger said the “massive opportunity” of IBD should be unlocked in 2028 for Icotyde. “There’s still an underestimation of the potential of Icotyde in psoriasis, psoriatic arthritis, and IBD,” Duato said on the April earnings call. Bottom line Johnson & Johnson has gotten off to a strong start in 2026 — delivering a beat-and-raise quarter led by its most important growth medicines. The potential of Icotyde in the coming months and years, and a critical milestone that could pave the way for FDA approval of J & J’s investigational Ottava robotic surgery system, are some of the exciting things on the horizon. Robotic surgery has long been dominated by Intuitive Surgical ‘s da Vinci systems. Shares of J & J have gained up 9.55% year to date compared to the 8.2% advance in the S & P 500 . That’s quite good when considering that healthcare is the second-worst sector in the S & P 500 this year — down 6.5%. Only financials, down 6.8%, is down more. The not-so-good news is that J & J has gone the wrong way since we initiated the stock on April 8 at just under $240. We have bought on the way down to improve our average cost basis and currently sit on an unrealized loss of 3.2%. Johnson & Johnson is a high-caliber name known for its consistent delivery of strong earnings and forecasts, even as the broader pharma sector remains out of favor amid Wall Street’s rotation into artificial intelligence plays tied to the data center boom. J & J generated about $94 billion in sales in 2025, with roughly two-thirds coming from its pharmaceutical division, known as Innovative Medicines, and the other third from its medical products segment, known as MedTech. Executives have recently been adamant that they have a “line of sight” to double-digit revenue growth by the end of the decade. We’re willing to be patient. We have a $265 price target on Johnson & Johnson with a buy-equivalent 1 rating. (Jim Cramer’s Charitable Trust is long JNJ. 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