Sugammadex Generics Wipe $353M Off Merck’s Bridion in One Quarter

Merck & Co., Inc. sold $497 million of Bridion (sugammadex) in the second quarter of 2026. One quarter and four US generic launches later, it sold $144 million, and the sugammadex generics that took the business are selling vials for a fraction of what the brand charged.

That is the patent cliff in its cleanest form: a $1.6 billion US hospital market repriced in one summer. The interesting question for anyone buying or selling sugammadex is who ends up holding the margin that Merck just lost.

How sugammadex generics emptied Merck’s Bridion line in one quarter

Merck reported third-quarter results on October 29. Bridion came in at $144 million against $439 million a year earlier, down 67%, and the company put the decline on “generic competition following loss of market exclusivity” in the US. Three months earlier the picture was the opposite: Q2 Bridion sales rose 8% to $497 million on higher US demand and net pricing.

The switch flipped at the end of July. Gland Pharma reported FDA approval of its sugammadex injection around July 29 and said it launched the same day through a marketing partner. Lupin followed with its own approval and launch on August 1, Glenmark Pharmaceuticals announced a “Day 1 launch” on August 2, and Dr. Reddy’s Laboratories rolled out its version by August 4, describing itself as the first to introduce a generic Bridion. Everyone arrived with the same two presentations, 200 mg/2 mL and 500 mg/5 mL vials. Four companies, one starting gun, and more than one claim to have crossed the line first.

The prize looked big on paper. Gland, citing IQVIA, sized US Bridion sales at about $1.6 billion for the 12 months to April 2026, and Glenmark quoted the same figure for the year to May. For Merck, Bridion was a $1,841 million product worldwide in 2025, according to its annual 10-K.

Bridion is not the only Merck product going through this. Sitagliptin exclusivity in the US ran through May 2026 under patent settlements, per the same 10-K. In Q3, Januvia fell 51% to $186 million and Janumet fell 20% to $194 million.

The vial price fell almost 17-fold. Sales fell 3.5-fold

The quarterly sequence tells the story better than the year-on-year number. Bridion was still growing in spring, then lost $353 million of quarterly sales in a single reporting period. And Merck’s $144 million is a worldwide figure, so the US piece is smaller still.

Bridion went from its best quarter to less than a third of it in three months.

Source: Merck Q2 2026 (August 4, 2026) and Q3 2026 (October 29, 2026) earnings releases. Worldwide sales.

Now look at the price side. Richard Novak, medical director of a multispecialty surgery center in Palo Alto, wrote on October 7 that his facility paid $160 for a 200 mg sugammadex vial before generics and $9.50 as of July 2026, a 94% drop. That is one buyer, not a market index, and you should treat it as a data point rather than a benchmark. It is still a 16.8× price cut on the most common presentation.

Put those rows together and the shape is clear. A nearly 17-fold vial discount at one center, against a 3.5-fold drop in the brand’s sales, means generic volume is moving at commodity prices. My read is that most of the $1.6 billion is not changing hands between Merck and four Indian generic houses. A large part of it is simply disappearing from the invoice.

Hospitals keep the savings, Merck writes the check

The clear winners are the buyers in the operating room. Novak’s own argument is that at $9.50 the old cost case against routine sugammadex use falls away, so expect usage to rise. For a drug given at the end of surgery to reverse rocuronium or vecuronium, that is a volume story, not a value story.

Merck pays the most visible bill. Bridion lost $295 million year on year and Januvia and Janumet together lost $244 million, a combined $539 million of Q3 sales. That is 1.19 times the $454 million Keytruda added over the same period. The growth engine is now working mostly to cover the products falling off the cliff.

The generic entrants sit in the middle. They get volume and shelf space in hospital contracts, and they also get a price war on day one, with at least four companies chasing the same group purchasing contracts. Gland’s model is telling: it makes the product and sells through a partner, so its margin depends on its manufacturing cost, not on brand pricing. In a market priced like this, the low-cost API and the sterile fill line are where the money is decided.

We made a similar point about semaglutide in September, when Medicare paid up to 17× India’s price for the same molecule. Sugammadex shows what happens once that gap closes in the US: the price collapses first and the supply chain has to catch up.

Merck’s side of the ledger: this was in the 10-K

The fair counter-argument is that none of this hurt Merck where it counts. Total Q3 sales rose 5% to $18.1 billion, and the company narrowed its 2026 sales guidance to $66.8–67.3 billion, raising the midpoint. Bridion’s 2026 US expiry and the May 2026 sitagliptin date both appeared in Merck’s annual filing, so investors and planners had years of notice.

There is also a public-health case. A reversal agent that costs $9.50 instead of $160 is easier to use routinely, and that is the purpose of the Hatch-Waxman bargain: a period of brand pricing, then competition. Seen that way, a 71% sequential drop is the system working as designed. One surgery center’s invoice is also not the whole US market, and contracted hospital prices will vary widely.

I accept all of that. My point is narrower. When four injectable makers launch in the same week, the brand’s loss is predictable, but the generic makers’ economics are not, and that is exactly where sourcing teams carry the risk.

A patent cliff does not move the money to the generic maker. It moves the money to whoever can still make the molecule cheaply when the vial sells for $9.50.