Last Week Tonight in BioPharma: March 20th - 27th
The first edition of a new weekly offering for BPS subscribers - hope you enjoy it!
So I am trying something new. I’ve been working on a more news-focused weekly post that all subscriber levels can have access to. There are a dozen or so news roundups that summarize the big stories in BioPharma for the week. Several on substack from other writers and plenty more all over the internet. I didn’t want this to be another one of those.
I really like the format John Oliver uses for his hit satirical news comedy show Last Week Tonight. The first half of his show usually reflects back upon the last week in the news, with Oliver delivering the comedic angle of all the crazy shit happening in our world.
I wanted to create something digestible and reflective like that, that also could serve as a vehicle to provide my unique perspective on the week in Biopharma. The format below is what I came up with. I am hoping to crank these out each week and have these in your in box on Sundays, while you are getting your ducks in a row for your Monday meetings. I envision this series being available to both free and paid subscribers, with paid subscribers continuing to get my regular deep-dive content.
These posts will have three sections with roughly three things in each bucket that caught my attention:
Press Release Decoder: going beyond the company speak, reading between the lines, thinking about what isn’t being said, to illustrate the strategic implications of a company’s moves that don’t make it into the press release
Connecting the Dots: looking at stories that are either about the macro or from the mainstream news and how they may impact BioPharma
Follow the Money: quick takes on some key deals that were struck and what they mean for those companies, their competitors, or the sector at-large
I’ll keep iterating on this “Last Week Tonight” series with the hope of it getting better and more useful to you. You might see new sections beyond these initial three or slight tweaks, so please bear with me. Any feedback you have is welcome!
As always, if you are getting value out of my content and you want to take it to the next level, please consider becoming a paid subscriber 🙏🏾
📡 PRESS RELEASE DECODER
Going beyond the press release
Rhythm Pharmaceuticals — Imcivree (Setmelanotide) Approved for Acquired Hypothalamic Obesity: A First-in-Class Rare Disease Win
Source: BioPharma Dive | Date: March 23, 2026
The FDA approved setmelanotide (Imcivree) for adults and children 4 and older with acquired hypothalamic obesity (AHO), a condition caused by hypothalamic brain injury — making this the first-ever approved therapy for AHO. The Phase 3 TRANSCEND trial demonstrated approximately 18 percentage points greater weight loss versus placebo, leveraging the drug’s MC4R agonism mechanism, which is mechanistically distinct from GLP-1 receptor agonists. Analysts project a $1B+ market opportunity across an estimated 2,000–10,000 diagnosed U.S. patients; consensus 2026 estimates for the new indication sit at ~$40M, and RYTM shares rose approximately 6% on the news.
BPS’ Take: RYTM 0.00%↑ has really created a beachhead in rare obesities prosecuting a single MOA across multiple drugs in its pipeline. While it is dwarfed by the broader GLP-1-focused obesity population, adding up these rare obesity markets, as RYTM has done, can amount to sizable market potential over time in a relatively low-competition arena. They’re a solid example of how building a rare disease business can still be right at the intersection of patient-impact and market opportunity. They’ve been a popular buyout target off and on over the years, and if they are able to prove that rare obesities can be a blockbuster set of indications, larger players were be interested.
Corcept Lifyorli (Relacorilant) + Nab-Paclitaxel — FDA Full Approval for Platinum-Resistant Ovarian Cancer: First SGRA Crosses the Finish Line
Source: FDA.gov / Fierce Pharma | Date: March 26, 2026
The FDA granted full approval to relacorilant (Lifyorli) combined with nab-paclitaxel for platinum-resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer — making it the first FDA-approved selective glucocorticoid receptor antagonist (SGRA) for any oncology indication. This decision came after a prior Complete Response Letter for the drug in hypercortisolism (due to hypertension AEs) and arrived ahead of schedule, placing Corcept in a competitive position against the entrenched ovarian cancer standard of care with no existing SGRA-class competition in the market. The approval validates a mechanism that had previously been considered commercially speculative and opens a new drug class in a space where options remain limited for platinum-resistant patients.
BPS’ Take: Going from seeing the door shut on one approval and winning another in a major indication is quite the victory. There was certainly negative sentiment swirling about the ovarian cancer approval in the wake of the CRL, but this is a great example of how the benefit-risk of a drug changes based on the indication. The FDA essentially said: "We can't approve this for 10,000 rare disease patients with hypertension concerns." But then said: "We absolutely can approve it for 50,000+ PROC patients where a 4-month OS extension is meaningful and safety profile is acceptable." LIFYORLI enters platinum-resistant ovarian cancer (PROC) as a potentially broad-based option in a market that has become fragmented by therapies biomarker-driven sub-groups (folate receptor alpha, HRD). Folate-receptor alpha targeting ADCs, like ELAHERE, are probably most under threat by this new approval, as LIFYORLI can address the entire PROC population and not just the FR-alpha high group.
🌐 CONNECTING THE DOTS
When the mainstream meets biopharma and vice versa
Trump’s MFN Drug Pricing Policy: The Fine Print Reveals a Framework Designed to Raise Foreign Prices, Not Lower U.S. Costs
Source: STAT News | Date: March 24, 2026
An HHS official disclosed to congressional Republicans that the Most Favored Nation (MFN) drug pricing framework is explicitly designed to allow manufacturers to “price wherever you want” in the U.S. so long as they do not underprice American consumers in foreign markets — a framing that inverts the popular understanding of MFN as a cost-reduction tool. Sixteen major drugmakers have already reached agreements under the framework, and the 3-year deal terms may expire before many affected drugs even launch in foreign markets. The revelation suggests MFN is being operationalized as a foreign price-raising mechanism rather than a domestic price-control tool.
BPS’ Take: For biopharma manufacturers, this reframing of MFN is commercially significant: if the policy succeeds in elevating ex-U.S. prices toward U.S. reference levels, it could partially neutralize one of the sector’s greatest structural headwinds — international price arbitrage — while leaving U.S. pricing power intact.
RFK Jr. Signals FDA Will Legalize ~14 Restricted Peptides, Opening Gray-Market Therapies to Compounding Pharmacies
Source: Politico / NPR | Date: March 22–26, 2026
On Joe Rogan’s podcast (late February), HHS Secretary Robert F. Kennedy Jr. declared himself “a big fan” of peptides and signaled that the FDA will reclassify approximately 14 of 19 peptides currently on the agency’s restricted list — including BPC-157, ipamorelin, and MOTS-c — back to legal compounding status within weeks. Kennedy frames the move as reversing what he calls an “illegal” 2023 Biden-era reclassification that he argues drove patients toward black-market suppliers and overseas manufacturers. If enacted, compounding pharmacies would be permitted to produce these peptides under state pharmacy boards, potentially legitimizing a market currently worth billions in gray-market sales and moving human-use peptide treatments from research-labeled products to pharmaceutical-grade compounded drugs.
BPS’ Take: The argument from compounders and RFK allies is somewhat logical: people are already using these peptides (often sourced from China and sold illicitly), so legitimizing pharmaceutical-grade compounding is harm reduction. Most peptides (BPC-157, CJC-1295, AOD-9604) that are super popular in the man-o-sphere ack rigorous human clinical trial data and have theoretical safety risks (cancer from growth hormone peptides, organ damage, immune reactions). The logic of green-lighting a lot of these vs. not federally legalizing other drugs we actually do have a lot of clinical research on is missing me, but that is a rant for another day. Back to peptides - we already have really poor regulation of the supplements market, and these peptides have been hawked with specious claims by social media influencers even before this ruling. Bad news. Letting companies like HIMS, who have demonstrated a penchant to fastpass medicines to patients and disregard all kinds of laws in the process is a really dangerous thing. The decision also creates some odd competitive pressure on Novo Nordisk and Eli Lilly’s GLP-1 business. If these other peptides are legalized, telehealth platforms like HIMS (which acquired a peptide facility in early 2025) can now manufacture and market these other peptides as alternative weight loss drugs (that don’t have the backing of “evil big pharma”) and potentially blunt GLP-1 sales (while also potentially harming patients). No formal FDA rule change has occurred yet, despite RFK’s announcement, the move remains at the intention/negotiation stage.
💰 FOLLOW THE MONEY
Deals, dollars, and what they signal
Merck & Co. Acquires Terns Pharmaceuticals for $6.7B — A Clear Post-Keytruda Signal in Hematology
Source: STAT News / Reuters / BioPharma Dive | Date: March 25–26, 2026
Merck will acquire Terns Pharmaceuticals at $53.00 per share in an all-cash transaction valued at approximately $6.7B in equity ($5.7B net of cash), with TERN-701 — an oral allosteric BCR::ABL1 TKI in Phase 1/2 development for chronic myeloid leukemia via the CARDINAL trial — as the primary asset driving the deal. Terns stock had surged approximately 6x over the prior six months, reflecting the market’s growing conviction in TERN-701’s potential best-in-class profile, and analysts are already flagging the possibility of rival bids. The acquisition deepens Merck’s hematology pipeline at a pivotal strategic moment as the company faces the looming patent expiration of Keytruda, its $25B+ blockbuster PD-1 inhibitor.
BPS’ Take: To be honest with you, CML was really off my radar. When I first started working in heme/onc I was told by my seniors that it was a solved problem. I was mostly under the impression that patients were rather well managed on the existing set of generic TKIs, notably GLEEVEC. But Terns’ story is a great example of how Oncology markets can turn into chronic disease markets. Even though patients can live a full life with existing treatments, there is still a risk of mutation driven relapse but also accumulation of toxicity from AEs over time. This explains why companies are willing to pay for "me-too" assets in diseases that looked "solved." The market isn't really about cure innovation anymore in these spaces, it's about managing a patient population with chronic disease. CLL could be headed that direction, or perhaps is already there, with how strong the BTK inhibitor class has been and is becoming. In oncology efficacy usually outweighs safety, but when efficacy tops out, it creates more room for companies to differentiate on safety, tolerability, and convenience which is where Terns and Novartis’ asciminib come in. On the Merck side of the coin, they clearly don’t feel like they’ve enough to fill the Keytruda patent cliff yet, so much so that they are interested in getting into heme/onc. I wonder if other high unmet need heme/onc areas like AML, MDS, and MF are on the table for them too.
Gilead Sciences Acquires Ouro Medicines for Up to $2.18B — Second Major Deal in Five Weeks as Autoimmune Pivot Accelerates
Source: BioPharma Dive / Reuters / WSJ | Date: March 23–24, 2026
Gilead will acquire Ouro Medicines for $1.675B upfront plus up to $500M in milestones, with the key asset being gamgertamig (OM336), a BCMA/CD3 bispecific antibody targeting autoimmune diseases; Galapagos co-finances 50% of the deal and receives Ouro assets and employees in exchange for up to 23% royalties, while Gilead retains global commercialization rights. The transaction follows Gilead’s $7.8B acquisition of Arcellx in February 2026 — making this the company’s second significant deal in approximately five weeks. Together, the two deals further Gilead’s efforts to diversify beyond their commercial dominance in HIV and growing Oncology business into auto-immune.
BPS’ Take: I guess the GLPG 0.00%↑ team finally has a product to develop? A savvy move by the GILD 0.00%↑ folks to get Galapagos to pay for half this drug in this co-financing architecture. I guess you could argue this was Gilead’s money all along, since they own ~25% of Galapagos, have two board seats, and also gave them ~$4B upfront many moons ago when the two companies struck their fruitless R&D collaboration. Tomato, tomahto. Galapagos basically feels like Gilead’s EU R&D hub and if OM336 continues to look promising, it may just make mathematic sense for Gilead to acquire the remaining 3/4ths of the company vs. paying the 23% royalty.
Novartis Acquires Excellergy for Up to $2B — Second Major Deal in One Week as Allergic Disease Strategy Accelerates
Source: Reuters | Date: March 27, 2026
Novartis will acquire Excellergy for up to $2B in upfront and milestone payments for Exl-111, an anti-IgE biologic with longer half-life and tighter receptor binding than Xolair, targeting allergic diseases including potential food allergy applications. The deal marks Novartis’s second multi-billion-dollar acquisition in one week following the $3B Pikavation/Synnovation deal announced March 20, with close expected in H2 2026 pending regulatory clearance.
BPS’ Take: NVS 0.00%↑ snuck this in on a Friday, but I thought this was far more interesting than the Pikavation deal they did earlier in the week. Novartis now joins Regeneron REGN 0.00%↑ and GSK 0.00%↑ (via the RAPT acquisition) as squarely targeting the Allergy space using an immune-mediated approach. All three companies are deploying quite different strategies (GSK has a better XOLAIR, REGN is combining a BCMAxCD3 with DUPIXENT, and this EXL-111 basically sequesters IgE) so it will be quite the race to watch to see which therapeutic approach wins out. Allergy treatment and prevention are massive market opportunities, and we shouldn’t be surprised if other Big BioPharma players move into this space via deals. The immune reset read-through from antibody based therapies in autoimmune diseases is real, and this area is a high priority for the current HHS administration to boot, meaning if you’re a drug developer, you may get the FDA red carpet treatment (vs. the unpredictable 180s we’ve been accustomed to with this administration).
Hope you enjoyed this first edition of “Last Week Tonight in Biopharma”. As this gets going a bit more, please send through any constructive feedback.