VC Bob Nelsen argues that even if large pharma companies appropriate ideas or gain leverage over US biotech, their financial success is ultimately beneficial. Profitable pharma companies must deploy massive cash reserves, much of which flows back into the biotech ecosystem through M&A, funding the next generation.

The nature of biopharma M&A changed dramatically in a year. After a period with no deals over $5 billion, there are now seven or eight such transactions, reflecting a pivot by large pharma to acquire de-risked assets with large market potential to offset looming patent expirations.

The key risk facing biomedical innovation is not just policy chaos, but the normalization of political and ideological influences on science-based regulation. This includes CEOs negotiating prices with the president and FDA enforcing pricing policies, breaking long-standing norms that separated science from politics.

Major pharmaceutical companies are now willing to deploy the "nuclear option" of pulling planned R&D investments to express displeasure with national drug pricing policies. This tactic, seen in the UK, represents a direct and aggressive strategy to pressure governments into accepting higher prices for innovative medicines.

Historically a Democratic focus, drug pricing policy has been co-opted by Republicans, making it a bipartisan political issue. This alignment creates a stable policy overhang and sustained uncertainty around pricing and innovation, deterring generalist investors regardless of which party is in power.

The biotech industry is entering a paradoxical period. Financial markets show signs of recovery with rising follow-ons and potential IPOs, suggesting a bear market end. However, this optimism is contrasted by significant uncertainty and political turmoil at key US agencies like the FDA and NIH, creating a challenging operating environment for innovation.

Competitive bidding wars for biotech companies are not isolated incidents. They are a clear indicator of heightened market aggression and the intense pressure large pharmaceutical firms feel to acquire assets and drive growth ahead of major patent expirations.

After years of policy debates, biotech investors have become desensitized to drug pricing headlines. While this supports current market resilience, it creates a potential blind spot, as a truly significant policy change could catch the market off-guard and cause a sharp correction.

CEOs are in an awkward position, supporting the administration in public but asking Congress not to codify the Most Favored Nation drug pricing policy. They fear legislation would create a permanent, stricter, and more broadly applied version than their private deals with the White House.