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After years of breakneck growth, healthcare marketing agencies are finally slowing down.

For four consecutive years, the top 100 collectively reported a double-digit increase in revenue.

Until 2024.

And growth rates didn’t experience a small decline, but a sharp drop-off. For last year’s Agency 100, MM+M calculated agencies in the top 100 grew at a clip of 11.6% to $11.5 billion in revenue. In 2024, MM+M estimates the total revenue for the top 100 at $12 billion, which translates to just 4.3% growth. 

While revenue did increase across the industry, head count did not. In fact, total employment didn’t even stay stagnant as MM+M reported in 2024. It decreased 3.0% from an estimated 57,200 employees to 55,400 employees.

Since the Great Resignation, agencies have been under pressure to do more with less — and 2024’s numbers suggest that pressure may finally be catching up with them. One way agencies are relieving that pressure is via ramped capabilities with AI, which is automating processes, speeding up concepting and saving time and effort in numerous other ways.

Every year, MM+M measures the industry’s progress, tracking the 100 largest healthcare agencies in the U.S. and evaluating their growth in revenue, head count, diversity and more. MM+M surveyed more than 125 agencies, asking them to share the challenges they face and shifts they’ll navigate.

Navigating tariffs, pricing and growth

Agencies filled out this survey during Q1 2025, well before President Donald Trump’s declared tariffs that targeted specific countries, made threats for pharmaceutical tariffs or released his plan for favored-nation pricing. 

Even before those events unfolded, agencies were weary of pricing’s impact on the work they do and ultimately how budgets could shrink.

Of the 127 agencies that responded to the survey, more than half (54%) viewed pricing as a challenge or significant change, which is up from 46% last year. To boot, 83% of agencies expect pricing to be an increased concern for clients.

Pricing issues may cause pharma budgets to shrink, and 72% of agencies expressed concern about evaporating spending pools. Surprisingly, agencies are slightly more optimistic about overall budgets than last year when the 2024 survey revealed 80% of agencies considered shrinking budgets a challenge or significant challenge. 

The slight uptick in optimism might be helping relieve some of the pressure on new business pipelines. In 2023, 64% of agencies felt replenishing the new business pipeline represented a challenge or significant challenge. In 2024, it’s down to 60%.

Despite concerns over their new business pipelines, agencies still grew in 2024. The industry has held steady for several years now in terms of organic versus growth from new clients. In 2024, agencies reported organic growth accounted for 61% of their revenue gains and this year, it nudged upward to 63%. 

And in a year in which growth moderately slowed down across the industry, managing growth isn’t as much of a concern within the industry — 11% viewed it as a significant concern in 2023 versus just 4% in 2024. 

Investment in talent

Slower growth and investment in AI led to an overall reduction in head count among the top 100 agencies. Notably, nearly one in five growing agencies still trimmed staff — signaling that profitability now trumps expansion. The trend accelerated in 2024 because about one in seven agencies cut employees despite revenue growth in 2023.

Agencies reported less stress around recruiting talent. Three years ago, 47% of respondents said the talent pipeline was a significant concern. After dropping to under 5% last year, it stayed there this year, and only 45% said it’s a challenge compared to 50% of agencies last year.

Following the Trump administration’s attacks on diversity, equity and inclusion, this has also become less of a priority. Only 22% of respondents considered it a challenge, down from 33% the prior year.

AI and raising standards

The underlying theme to nearly every conversation reporters and editors had with agencies in the top 100 was AI. Every agency has a solution and the leaders of nearly every firm spoke with confidence about how they’re handling the implementation of the single most revolutionary technology in decades. 

The survey tells a somewhat different story: About 60% of agencies find managing AI’s impact a challenge, and half of agencies are having trouble keeping pace with innovation. However, the industry is gaining confidence overall in its ability to stay on top of AI, as 80% said AI was a challenge in 2023. 

AI’s made targeting more precise, enabling pharma marketers to reach HCPs and patients more effectively. Agencies are able to generate more content, as well. Combine these two impacts of AI, and it’s clear why agencies reported on the survey that they are certain clients will be demanding more personalized experiences and better content. While agencies consistently echoed sentiments of thinking of patients first, they’ll also be more focused on payers this year.

Pharma’s sales force is reemerging after years of dormancy. After years of declining investments in field reps during the pandemic, MM+M’s Healthcare Marketers Trend Report 2025 found that trend reversing. Agencies backed that up in the A100 survey, as nearly half of agencies in 2023 thought sales reps’ impact would decrease. In 2024, only 35% believe their impact will drop. 

Overall, the healthcare marketing industry finds itself at a crossroads in 2025. After years of rapid growth, 2024 marked a turning point — one defined by slower revenue increases, shrinking head counts and heightened pressure to deliver more with less. As AI reshapes how agencies and their clients operate, the sector is leaning into innovation while recalibrating its priorities. Talent concerns have faded, DEI has lost momentum and clients are demanding more value and personalization than ever before. 

* Revenue and head count totals are based on data submitted by companies as part of MM+M’s annual agency review. Survey data are supplemented by estimates made by the MM+M data team, and include numbers from firms not yet founded in 2023 or whose revenue estimates were not finalized until this feature went to press. Revenue and employment numbers for parent companies and certain network-owned firms were accounted for to prevent double-counting in these totals. 

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From the June 01, 2025 Issue of MM+M - Medical Marketing and Media