Around 75% of all pharmaceutical research spending is by the very few largest companies, while around 66% of all new innovation is being carried out by many hundreds of smaller independent biotech startups and similar organisations. In many pharma companies most of their work is still driven by extending the functionality and patent protection of existing therapies.
Meanwhile it now costs over $800 million to bring a new drug to market, and can take 15 years. The entire model is becoming unsustainable. Expect significant reforms and changes in pharma structure over the next decade.