HIV still infects about 1.2 million people a year, there’s no cure, and in sub-Saharan Africa women and girls account for 63% of new infections. Daily prevention pills work, but only if you take them every day. Two shots a year change that. Gilead Sciences (GILD) makes these shots, called lenacapavir and sold in the US as Yeztugo.
Which brings us to pharma, the hardest sector for us at GoodStocks. Drug companies earn money when people are sick, and the price shareholders seek can keep a medicine from those who need it. Yet new drugs cost billions to develop, and that money is only spent when entrepreneurs and investors can expect a satisfactory return. So we’ve chosen not to skip pharma. We look for drugmakers that deliver competitive returns without putting their medicines out of reach for everyone but the wealthy.
Gilead is the first pharma company to clear that bar, with caveats we’ll lay out openly. Its core business just grew 16% in a quarter, the fastest pace in more than a decade, and the stock trades at all-time highs. Gilead and its partners plan to reach 3 million people in the poorest countries with lenacapavir by 2028, supplied at no profit.
The return case
Strip out deal charges and Gilead expects $8.75 to $9.10 in earnings per share this year, with HIV sales growing 18%. Add a 1.9% dividend and management’s guidance for higher earnings even in 2028, and our base case is about 8% a year. If upcoming drug approvals land, we see 12% to 15%, and about 21% if everything goes right.
The impact case
In a trial of 5,338 young women in South Africa and Uganda, none of those receiving lenacapavir (Yeztugo’s active ingredient) got HIV. Gilead sells it at no profit to countries supported by the Global Fund, which aims to reach 3 million people by 2028.
Gilead, based in Foster City, California, is the world’s leading HIV drugmaker. Biktarvy, a once-a-day pill, holds 53% of the US HIV treatment market and sold $4.1 billion last quarter. In prevention, the Descovy pill and the Yeztugo shot together hold half the US market. Outside HIV, the breast cancer drug Trodelvy grew 42% and the liver drug Livdelzi is ramping fast. The cell therapies Yescarta and Tecartus are the soft spot, down 18% on competition.
The moat is deep. HIV treatment is lifelong, patients rarely switch a regimen that works, and Biktarvy’s US patent protection now runs into 2036.
Gilead’s profits nearly vanished in 2024, rebounded to a 29% net margin in 2025, and turn into a loss in 2026. The cause is accounting. When Gilead buys a company whose drugs aren’t approved yet, US rules make it expense most of the purchase price immediately. In 2024 that meant a $3.9 billion charge for CymaBay plus a $4.2 billion write-down on a lung cancer program, which cut earnings per share to $0.38. In 2026 it’s $12.4 billion for four deals, led by Arcellx and its myeloma cell therapy. That’s why the trailing price-to-earnings ratio reads a meaningless -47x. The business underneath generated $5.0 billion of operating cash in the third quarter alone.
HIV sales hit $6.25 billion last quarter, up 18%, the fastest since 2018. Yeztugo sold $305 million, up 31% on the prior quarter. Gilead has raised its 2026 sales guidance three times, now to $31.0 to $31.3 billion. Ziggma’s Growth sub-score of 93 reflects that.
At $169.73, Gilead trades at about 19x this year’s underlying earnings. Sales are valued at 6.0x, well above the five-year average of 3.8x, and Ziggma’s Valuation sub-score sits at a modest 34. Strong Profitability (89) and Financial Health (91) carry the overall Ziggma Score to 96.
Analysts’ average target is $175, just 3% above today’s price. We wouldn’t read too much into it. Targets tend to trail a rally: the consensus sat near $158 this summer, when the stock was in the $130s. The stock hit its first record highs in about a decade this year and is up roughly 44% since October 2025. So we did our own math.
Each scenario takes Gilead’s earnings per share in 2028, applies a price-to-earnings multiple, and adds about $6.50 in dividends over two years. All returns are measured from today’s $169.73.
| Scenario | 2028 earnings per share | Multiple | 2028 share price | Yearly return |
|---|---|---|---|---|
| Bear | $9.50 | 15x | $143 | about -6% |
| Base | $10.00 | 19x | $190 | about 8% |
| Best | $11.00 | 22x | $242 | about 21% |
The base case is simple. Earnings grow about 6% a year, in line with one consensus estimate of $10.00 for 2028, and investors keep paying today’s 19x. That’s a fair return with no help from the pipeline, but nothing to get excited about.
The best case needs two things at once. First, earnings have to climb about 10% a year, to $11 by 2028. That takes Yeztugo compounding past $1 billion, approval of the myeloma therapy anito-cel (the FDA decides by December 23), a once-weekly Yeztugo pill (decision due February 2, 2027) and a faster ramp for Trodelvy in first-line breast cancer. The quieter lever is moving HIV patients onto Gilead’s newer long-acting drugs before Medicare’s lower Biktarvy price kicks in.
Second, investors have to pay 22x for those earnings. That only happens if the market stops treating Gilead as an HIV franchise facing a price cut and starts seeing a growth company with a runway well past 2028. A once-yearly prevention shot, now in development, is the strongest argument for that.
The bear case is the mirror image: approvals slip, the Biktarvy cut bites harder than expected, and the multiple falls back toward the mid-teens.
Medicare’s negotiated price for Biktarvy, 38% below list, will cut about $1.5 billion from 2028 revenue. Deal spending pushed cash down to $6.4 billion and added $4.1 billion of debt, so these purchases have to pay off. Management expects last quarter’s helpful pricing and inventory effects to fade. At 19x earnings, a stumble would cost more than it did a year ago, when the stock traded near 13x.
The earnings side of the best case looks reachable, since most of the catalysts land in the next three months and Gilead has raised guidance three times this year. The higher multiple is harder after a big rerating. If the approvals land and the multiple holds, we’d expect 12% to 15% a year. The two FDA dates are the ones to watch.
Our pharma test asks four questions. Does the company save or improve lives at scale? Does it avoid price gouging? Does it run real access programs for people who can’t pay? And is it free of serious controversy? Gilead passes the first and third clearly. It gets mixed marks on the second, which is why its Impact Score is a solid 69 and not higher.
Many people on daily prevention pills miss doses, and the young women at highest risk are often the least able to take a pill every day without being noticed. Lenacapavir removes that hurdle with one shot every six months.
Gilead, the US government’s PEPFAR program and the Global Fund aim to reach 3 million people in high-risk, low-income countries with lenacapavir through 2028, with Gilead supplying it at no profit. Six generic makers hold royalty-free licences for 120 countries, at a target price of $40 a year, with large-scale generic supply expected in 2027. The rollout is real: by July 2026, nearly 66,000 people across nine African countries had started on it.
Biktarvy keeps the virus suppressed in about 430,000 Americans with one pill a day, which also stops it from spreading. Operations score well too: Gilead’s Climate Action score of 85 reflects an emissions path in line with 1.5°C of warming and 64% renewable energy.
Gilead’s own staff do well, with a Fair Labor score of 73 helped by an employee rating of 3.80 out of 5 and a gender equality score of 86. CEO pay, at 97 times the median worker’s, scores a middling 50.
Gilead’s US list prices are high. Biktarvy lists near $61,000 a year and Yeztugo at $28,218. List prices overstate what many patients pay: about half of Americans on Gilead’s HIV drugs get them through federal and state programs at steep discounts, and uninsured patients can apply to get them free. Medicare, barred from negotiating drug prices until 2022, has now set a Biktarvy price 38% below list, starting in 2028. Still, the high prices bite. In 2026 the AIDS Healthcare Foundation blamed Gilead’s prices for straining Florida’s HIV drug assistance program, which put 11,500 people at risk of losing coverage until the state found $31 million in stopgap funding. Middle-income countries outside the licensing deal, much of Latin America among them, still lack affordable access. These issues drive Gilead’s Accountability score of 35, and we’ll be watching both.
See Gilead’s full Ziggma Stock Score and Impact Score
Compare GILD’s fundamentals and impact data with every stock you own.
See GILD’s full Ziggma analysisGilead shows that pharma can belong in a values-aligned portfolio if you look closely. A twice-yearly shot that stops HIV is on its way to 3 million people in the poorest countries, while the company behind it grows at its fastest pace in a decade. The US pricing record keeps us honest about the trade-offs. Behind the messy accounting sits a strong business with high single-digit return potential, and that earns Gilead its place in the GoodStocks universe. To see how it would fit with what you already own, run it through Ziggma’s Portfolio Optimizer.
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