The top players in pharma know how to adapt. After M&A, selloffs, cost cuts and therapeutic rejigs, the companies on this list may largely wear the same names, but none entered it looking exactly as they did for last year’s edition.

Whether because of buyouts or reorgs or both, companies atop the rankings this year generally have a strong presence in cancer, but immunology and rare diseases are also strongholds. Takeda gained its place on the list thanks to a Shire buyout that added rare diseases to its broader lineup.

Vaccines are important, too: Companies with leading vaccine outfits all made the top 10. Cell and gene therapies continue making advances across the industry, including at Novartis and Roche.

New launches played a big role as usual, as the individual company profiles show. And at companies with particularly tough patent losses—Pfizer, for instance—newer meds have shown they’re more important than ever.

Meanwhile, pricing pressure remains an industrywide issue, but maybe less so than experts predicted in 2020. Despite this being an election year in the U.S., the COVID-19 pandemic has changed much about the world. Drug pricing talk doesn’t get as much traction in Washington, D.C., compared with years past.

Looking forward, global economies are relying on the pharmaceutical industry to produce solutions, and many of the companies on this list are involved in the race for vaccines and drugs. We’ll continue tracking their performance—and potential advances in COVID-19—as the year plays out.

Some notes: Though BMS closed its Celgene deal in late 2019, it won’t leap ahead in our rankings till next year, when the combined company’s 2020 numbers are in. AbbVie is set to jump in the rankings as well, thanks to its massive purchase of Allergan, provided the deal closes later this year as scheduled.