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Lilly is buying a company a week. That is not hyperbole. Since February, Lilly has announced five acquisitions: Orna Therapeutics ($2.4B, in vivo CAR-T, February), Centessa Pharmaceuticals ($7.8B, narcolepsy, March), Kelonia Therapeutics ($7B, in vivo CAR-T, April 20), CrossBridge Bio ($300M, dual-payload ADC, April 22), and now Ajax Therapeutics ($2.3B, blood cancer, April 27). Total: approximately $19.8B. CNBC noted that Lilly also acquired Scorpion Therapeutics earlier this year, which would push the total even higher. The Ajax deal adds a first-in-class Type II JAK2 inhibitor to Lilly's blood cancer portfolio. All currently approved JAK2 inhibitors for myelofibrosis (ruxolitinib, fedratinib, pacritinib, momelotinib) bind the Type I conformation. Patients who develop resistance to Type I inhibitors have limited options. AJ1-11095 binds the Type II conformation, designed to deliver deeper disease control and overcome Type I resistance. Phase 1 began in late 2024 and proof-of-concept data are expected later this year. Meanwhile, the Regeneron MFN deal closes a chapter. All 17 companies the White House targeted last July have now signed. The deals cover 86% of the branded drug market. Regeneron was the last holdout. The practical impact on drug prices remains debated (critics note Medicaid already pays less than Medicare and private insurers), but the political signal is unmistakable: the tariff framework forced voluntary compliance from every major pharma company. 👉 Read Full Analysis

Lilly Acquires Ajax Therapeutics for Up to $2.3B, Its Fifth Deal of the Year LLY

What Happened: Eli Lilly announced a definitive agreement on April 27 to acquire Ajax Therapeutics, a privately held biopharmaceutical company developing next-generation JAK inhibitors for myeloproliferative neoplasms (MPNs). The total deal value is up to $2.3B in cash, including an upfront payment and milestone payments upon clinical and regulatory achievements. Ajax is based in Cambridge, Massachusetts, and New York. Close expected in the coming months.

The Asset: AJ1-11095 is a first-in-class, once-daily oral Type II JAK2 inhibitor currently in Phase 1 (AJX-101 trial, NCT06343805) in patients with myelofibrosis who have previously been treated with a Type I JAK2 inhibitor. Unlike all approved JAK2 inhibitors (ruxolitinib, fedratinib, pacritinib, momelotinib), which bind the Type I conformation of JAK2, AJ1-11095 was designed to bind the Type II conformation. This unique binding mode is intended to deliver deeper and more durable disease control and provide a treatment option for patients who develop resistance to existing therapies. Dose selection for future registrational development is expected in 2026.

Executive Impact: Lilly Oncology president Jacob Van Naarden said: "We look forward to the presentation of clinical proof-of-concept data later in 2026, rapidly advancing AJ1-11095 into registrational clinical trials, and using our expertise in blood cancer to hopefully deliver another important new medicine to patients and hematologists." Lilly's 2026 M&A total now stands at approximately $19.8B across five announced acquisitions:

Fierce Biotech called it "Lilly's run of near-weekly acquisitions" and noted the pace "shows no sign of letting up." The strategic logic is consistent: Lilly is building a diversified oncology, cell therapy, and neuroscience franchise to extend growth beyond its GLP-1 dominance.

Regeneron Signs MFN Deal, Completing All 17 White House Agreements REGN

What Happened: Regeneron signed a Most-Favored-Nation pricing agreement with the White House on April 23, becoming the 17th and final major pharmaceutical company to do so. The deal was announced in an Oval Office ceremony. Regeneron was the last holdout among the companies targeted by the administration in letters sent last July.

The Deal Structure: Regeneron agreed to lower Medicaid prices on all current and future drugs to MFN levels. Praluent (cholesterol) will be listed on TrumpRx at $225, down from $537 (58% reduction). All new Regeneron medicines will receive MFN pricing for U.S. patients. Regeneron committed billions in U.S. manufacturing investment as part of the agreement. The company will also provide Otarmeni (gene therapy for genetic hearing loss, approved the same day under CNPV) at no cost to U.S. patients.

Executive Impact: With all 17 companies signed, the MFN initiative now covers approximately 86% of the branded drug market, according to the White House. The full list: Pfizer, AstraZeneca, EMD Serono, Eli Lilly, Novo Nordisk, Amgen, Bristol Myers Squibb, Boehringer Ingelheim, Genentech, Gilead Sciences, GSK, Merck, Novartis, Sanofi, Johnson & Johnson, AbbVie, and Regeneron. STAT called it the close of "the first round of drug price negotiations." Critics note that the deals primarily affect Medicaid pricing (which is already deeply discounted) and TrumpRx listings (which reach a limited patient base), while Medicare and private insurance, where most spending occurs, are not directly covered.

Ligand Acquires XOMA Royalty for $739M LGND | XOMA

Ligand Pharmaceuticals announced a definitive agreement to acquire XOMA Royalty for approximately $739M in cash ($39/share, roughly 3% premium). The deal adds more than 120 treatments to Ligand's portfolio, including seven marketed products with royalty streams from Roche's Vabysmo, Servier's Ojemda, and Zevra's Miplyffa. At peak, Ligand expects Vabysmo royalties worth $37.5M annually. The combined company will hold economic rights to more than 200 drugs in development or on the market. Ligand raised its 2026 revenue outlook to $270M to $310M (from $245M to $285M) and expects the acquisition to be immediately accretive. XOMA shares rose 9.7%.

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Five acquisitions in under three months. Nearly $20B in total committed capital. Two in vivo CAR-T platforms (Kelonia + Orna). A narcolepsy franchise (Centessa). A dual-payload ADC platform (CrossBridge). And now a first-in-class blood cancer drug (Ajax). No other large pharma company has executed this volume of dealmaking in this compressed a timeframe in 2026.

The bull case: Lilly has the balance sheet, the commercial infrastructure, and the therapeutic area expertise to integrate all five. GLP-1 revenues provide an enormous cash generation engine. Each acquisition targets a different therapeutic area (autoimmune, oncology, narcolepsy, blood cancer), reducing integration complexity since the teams do not overlap. Lilly Oncology president Van Naarden is executing a coherent oncology build across cell therapy, ADCs, and now targeted small molecules.

The bear case: five integrations in parallel is unprecedented for any pharma company. Kelonia and Orna are both early-stage platforms that may take years to generate revenue. Centessa's cleminorexton must compete with Takeda's oveporexton. Ajax is Phase 1 with no proof-of-concept data yet. And all of this is happening while Lilly simultaneously launches Foundayo, its most important new product in years. Execution risk is not zero.

The question Lilly will answer tomorrow on the Q1 call: is there a sixth deal coming, or is the company shifting to integration mode?

Myelofibrosis is a rare, chronic blood cancer in which scar tissue builds up in the bone marrow, disrupting normal blood cell production. Current treatment relies on JAK2 inhibitors (ruxolitinib is the standard), but many patients eventually develop resistance or lose response.

AJ1-11095's differentiation is structural. Type I JAK2 inhibitors bind the active conformation of the kinase. Type II inhibitors bind the inactive conformation, a fundamentally different binding mode that may overcome the resistance mechanisms that limit current therapies. If proof-of-concept data later this year show meaningful responses in patients who failed Type I JAK2 inhibitors, Ajax would be the first validated therapy for this resistant population.

The myelofibrosis market is dominated by ruxolitinib (Incyte/Novartis) and represents a multi-billion dollar opportunity. A Type II inhibitor that addresses the resistance population could capture a significant share. But this is Phase 1 with no clinical data yet. Lilly is paying $2.3B for a preclinical thesis that has not been proven in humans. The data later this year will determine whether this was a visionary acquisition or an overpay.

All 17 companies have signed. What do the deals actually do?

What they cover: Medicaid pricing aligned to lowest prices in comparable developed nations. Selected drugs listed on TrumpRx at discounted prices. U.S. manufacturing commitments totaling hundreds of billions.

What they do not cover: Medicare Part D pricing (separate from MFN, governed by IRA negotiations). Private insurance pricing (not addressed). The vast majority of U.S. drug spending flows through Medicare and private insurance, not Medicaid.

The real impact: The MFN deals are politically significant but economically modest for most companies. Medicaid represents roughly 20 to 25% of U.S. drug revenue for large pharma, and Medicaid rebates already bring net prices well below list. The TrumpRx portal reaches a limited patient base. The administration gets headlines. Pharma gets tariff relief. The structural economics of U.S. drug pricing remain largely unchanged. The bigger question is whether the administration uses the MFN framework as a foundation for broader pricing reform, including Medicare and private insurance, or whether this is the end point.

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