Summary
Eli Lilly and Gilead Sciences have each completed multiple acquisitions since the start of 2026, making this one of the most active years for pharma M&A since at least 2018. Lilly has acquired five companies since January — four of them in the space of six weeks — across oncology, immunology, and neuroscience. Gilead closed three significant deals, including a $7.8 billion acquisition of Arcellx in multiple myeloma. The strategy, which Lilly describes as “land grab” M&A, involves acquiring assets before late-stage clinical data is available — accepting higher uncertainty in exchange for lower entry prices.
Access Impact
Acquiring before Phase 3 results lowers the entry price but does not lower the commercial risk embedded in the asset. It transfers that risk to the acquirer, who must now navigate HTA, payer negotiations, and reimbursement decisions without the evidence base those bodies will ultimately evaluate. In the current environment, three factors amplify that exposure. First, M&A activity is concentrated in adjacent therapeutic areas — particularly cell therapy, antibody-drug conjugates, and JAK inhibitors — where multiple assets from different acquirers are simultaneously approaching regulatory submission. The relative cost-effectiveness position of any one asset will be evaluated against a competitive landscape that is still forming at the time of acquisition. Second, the pricing environment has shifted materially: the Trump administration’s Most Favored Nation approach, new pharmaceutical tariffs, and Medicare pilot programs set to begin in October 2026 introduce reimbursement variability that is difficult to model using historical precedent alone. Third, faster deal cadences reduce the time available for market access diligence — precisely the analysis that matters most when evidence is incomplete. A deal thesis that does not separately quantify market access probability conflates clinical potential with commercial access — a distinction that HTA bodies and payer committees will enforce, regardless of what was assumed at signing.
Comparator Appropriateness
Early acquisitions in competitive indications — multiple myeloma, myelofibrosis, antibody-drug conjugates — face comparator landscapes that will evolve between deal signing and HTA submission. The comparator assumed in the acquisition model may not be the one HTA bodies apply at the time of review.
Evidence Quality and Robustness
Pre-data acquisitions carry inherent evidence risk. HTA bodies evaluate head-to-head data, patient-relevant endpoints, and follow-up duration — none of which is finalized at deal close. Gaps in the evidence base translate directly into uncertainty in the HTA recommendation, regardless of the strength of early-stage signals.
Budget Impact and Resources
Portfolio-level acquisition strategies across adjacent therapeutic areas create additive budget exposure across health systems. Payer willingness to fund multiple new therapies simultaneously in the same disease area is rarely modeled at the individual asset level — and almost never at the portfolio level.
Risk Signal
2026’s M&A pace is accelerating. Deal timelines are compressing. The assets being acquired are earlier-stage. Each of these factors increases the distance between what an acquirer assumes about market access and what payers and HTA bodies will actually accept. That distance is not closed at approval. It is closed — or not — at reimbursement.
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Explore 450+ independent assessments: https://mararating.com/mara-ratings-list Source: https://www.biopharmadive.com/news/lilly-gilead-lead-pharmas-deal-merger-drug-acquisition/819676/