Industry Report: A Progress Check on Dealmaking, Access and Commercialization

As the pharmaceutical industry crosses the midpoint of 2026, the landscape is defined by an accelerating dealmaking environment, fast-moving shifts in how patients access and pay for therapies and a widening gap in patient affordability. Concluding its H1 Review/H2 Outlook series, Pharmaceutical Commerce checked back in with four experts spanning M&A, direct-to-patient commercialization, patient access and commercial strategy to see how the forecasts they made earlier this year have held up, and what can be expected in H2.

This report synthesizes those four perspectives to provide a comprehensive look at the trends defining H1 2026 for pharma and the challenges awaiting the industry in the final months of the year.

I. M&A and Dealmaking

The M&A environment has proven strong in 2026. Roel van den Akker, deals partner at PwC, says the sector is tracking 36 deals above $1 billion in enterprise value through the first six and a half months of 2026, with an aggregate value of roughly $140 billion across those transactions. Total M&A volume across the period, including smaller deals, comes to an estimated $160 billion to $165 billion, he says. Annualized, that puts the biopharma and services M&A market on pace to clear $300 billion, a level van den Akker calls, by historical standard, "very, very active."

The first-half surge tracks with figures from across the sector. PwC's own midyear outlook logged more than $65 billion in pharmaceutical and life sciences deal value in the first quarter alone, the strongest quarter since 2020, and the firm estimates more than $300 billion in branded pharma revenue is exposed to loss of exclusivity this decade.¹

Van den Akker attributes the activity to a mix of "fascinating science," widening pipeline gaps ahead of patent expirations and durable C-suite confidence backed by healthy balance sheets and ample dry powder. Coming into the year, several forecasts PC covered had projected that dealmaking would accelerate as patent cliffs pressured large-cap portfolios, with immunology and inflammation, targeted oncology, metabolic disease and RNA-based therapies flagged as the most likely hunting grounds. Van den Akker's read is that the data has largely borne that out, though he's also watching newer, less-anticipated structures take shape alongside it.

One development he flags as newer than expected is broader-based co-development and co-commercialization pacts between US multinationals and Chinese biotechs, a shift from the one-off in-licensing deals that used to be the default. Rather than simply licensing individual compounds, he says, companies are now striking co-development and co-commercialization structures that reflect the depth of clinical and scientific talent coming out of China. He's also watching the potential impact of artificial intelligence on drug discovery timelines, calling out its role in "drugging the undruggable" as a factor the market is still learning to price.

Capital markets have reinforced the deal activity rather than competed with it. Van den Akker points to a stronger IPO market in the second quarter than the first, with healthier valuations and larger ticket sizes, alongside a rising biotech sentiment index. The Dow Jones Biotech Index has also performed well, he notes, even as parts of the broader AI trade have come under pressure. He describes the policy backdrop as far calmer than the tariff and MFN pricing turbulence that weighed on 2025, with pharma looking comparatively stable as other political issues dominate the headlines. "Business has continued to perform, cash flows are good, balance sheets are strong, and science is progressing," he says. "I think that all points towards more M&A going forward." Looking to the back half, he sees little reason for the pace to slow, even if H1's rate of dealmaking may be difficult to fully replicate.

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