Citigroup CEO Jane Fraser expects a recession in 2023. So does JPMorgan Chase CEO Jamie Dimon. Even Treasury Secretary Janet Yellen recently acknowledged that there's a real risk of a U.S. recession next year. 

Such concerns could be overblown. Then again, maybe they're not. What should investors do? You don't have to avoid stocks altogether. Here are three high-flying stocks to buy and hold if a recession is on the way.

1. Axsome Therapeutics

Biotech stocks often soar, regardless of what's going on with the economy. Axsome Therapeutics (AXSM 3.32%) is a great case in point. Its share price has more than doubled this year, with most of the gain coming in the fourth quarter.

Wall Street analysts don't think the nice run is complete. The consensus 12-month price target for Axsome reflects an upside potential of more than 30%. 

The impressive performance this year stemmed, in large part, from Axsome winning U.S. Food and Drug Administration (FDA) approval for Auvelity for treating major depressive disorder. Look for Auvelity's sales to pick up strongly in 2023.

Axsome also could have more good news on the way. The company expects to file for FDA approvals of AXS-07 in treating migraine and AXS-14 in treating fibromyalgia next year. It also should announce results from a late-stage study of AXS-12 in treating narcolepsy in the first half of 2023. These potential catalysts make Axsome a top stock to buy now and hold, whether or not a recession comes.

2. Eli Lilly 

Eli Lilly (LLY -2.63%) stock hasn't doubled this year like Axsome. However, the big pharma stock is up more than 30% during an especially challenging macro environment. 

At first glance, you might wonder why Lilly's shares have performed so well. The company reported year-over-year revenue growth of only 2% in its latest quarter. Sales for six of the top products in Lilly's lineup fell by double-digit percentages.

However, savvy investors know that Lilly's future looks very bright. Mounjaro is off to a great start with its U.S. launch in treating type 2 diabetes. The drug should have even greater prospects if it wins approval as an obesity treatment.

Lilly also awaits U.S. and European regulatory approvals of lebrikizumab in treating atopic dermatitis. It has promising late-stage Alzheimer's disease candidates with donanemab, lecanemab, and remternetug.

The company's fortunes hinge on its new drugs and its pipeline much more than they do on the economy. With a good chance of key regulatory approvals on the way, Lilly is an ideal stock to own while riding out a recession.

3. Vertex Pharmaceuticals

Vertex Pharmaceuticals (VRTX 0.20%) stock has soared more than 40% year to date. The big-biotech's cystic fibrosis (CF) franchise, led by Trikafta/Kaftrio, continues to enjoy strong momentum. Since Vertex markets the only therapies that treat the underlying cause of CF, its business isn't threatened by the prospects of a recession.

But CF is only the start for Vertex. The company, along with its partner CRISPR Therapeutics, should be in good shape to win regulatory approvals for exa-cel next year in treating sickle cell disease and beta-thalassemia. Vertex is also gearing up for a potential commercial launch in the near future for non-opioid pain drug VX-548, which is in late-stage testing.

Looking out a little further, Vertex has two other late-stage programs with blockbuster-sales potential. The triple-combo of vanzacaftor/tezacaftor/deutivacaftor could be the company's best CF therapy yet. Inaxapalin has the potential to become the first approved drug to treat the underlying cause of APOL1-mediated kidney disease. 

Last but certainly not least, Vertex could be on track to develop a cure for type 1 diabetes. The company is already evaluating one program in early-stage clinical studies. It hopes to soon advance an even better alternative to clinical testing in the not-too-distant future.

With Vertex's strong CF franchise and promising pipeline, it's absolutely not too late to buy its stock.