Monday, February 23, 2026
Written By Param Malik, Editor-in-Chief
The obesity war has a new leaderboard, and the "Grand Bargain" between the White House and Big Pharma just got an expiration date. From multi-billion dollar M&A moves in cell therapy to a complete recasting of the nation's vaccine advisory panel, the sector is moving at a breakneck pace as we enter March.
The signals are clear: dominance is being challenged, and the regulatory guardrails are being rebuilt in real-time.
Let’s dive in.
Last Week in Biotech, Pharma & Finance
The Obesity Crown Shifts: In a daring head-to-head trial (REDEFINE 4), Eli Lilly’s Zepbound outperformed Novo Nordisk’s highly anticipated combo, CagriSema. Zepbound hit 25.5% weight loss compared to CagriSema’s 23%. While CagriSema is still a potent clinical asset, the "best-in-class" title remains firmly with Lilly, sending Novo’s shares tumbling 15% on the news.
M&A Surge:
Gilead & Arcellx: Gilead is doubling down on cell therapy with a $7.8 billion acquisition of its partner Arcellx. The prize is anito-cel, a multiple myeloma CAR-T that Gilead hopes will revitalize its oncology portfolio and challenge incumbents like Carvykti.
GSK & 35Pharma: GSK committed $950 million to acquire Canada’s 35Pharma. The deal centers on a selective activin signaling inhibitor for pulmonary hypertension that notably offers "fat-selective" weight loss as a metabolic differentiator.
More News:
The "Grand Bargain" Expiration: Recent SEC filings from Gilead and Merck have revealed the fine print of the administration's "Most Favored Nation" (MFN) deals. The tariff exemptions and pricing concessions are locked in for only three years. This creates a massive 2029 "fiscal cliff" for pharma, setting up a high-stakes renegotiation or a return to aggressive trade war tactics.
Cigna’s Vertical Expansion: Cigna’s Evernorth quietly completed the acquisition of CarepathRx, a specialty pharmacy providing infusion services to nearly 10% of U.S. hospitals. This move deepens the vertical integration of the "Big Three" PBMs/insurers into the actual delivery of complex hospital medications.
RFK Jr.’s New Guard: Health Secretary Robert F. Kennedy Jr. has appointed two new members to the Advisory Committee on Immunization Practices (ACIP): Dr. Sean Downing and Dr. Angelina Farella. These appointments come as the panel prepares for a rescheduled March meeting to investigate COVID-19 vaccine injuries and long COVID.
Hospital Dominance in 340B: A new report from the Berkeley Research Group highlights that large tax-exempt hospitals now capture nearly half of all claims for top cancer therapies through the 340B discount program. The program has ballooned into an $81 billion engine, with critics arguing it incentivizes shifting care to more expensive hospital settings to maximize markups.
SCOTUS vs. Tariffs: The Supreme Court struck down the administration’s emergency global tariffs. The ruling specifically invalidates levies deployed under the IEEPA (International Emergency Economic Powers Act), though industry-specific Section 232 probes remain in play. The immediate fallout? A sharp presidential rebuke and a promise to pivot to a new 10% global tariff mechanism. For pharma, the question is leverage: without the immediate threat of IEEPA tariffs, will the "voluntary" $600B investment pledges from the top 17 drugmakers remain on track?
New FDA drug approvals?
This Week: Yes.
Yuviwel (navepegritide): Approved on 2/27/2026. Ascendis Pharma secured an accelerated nod for this once-weekly treatment to increase linear growth in pediatric patients (2+) with achondroplasia. It is the first once-weekly CNP therapy, significantly reducing the treatment burden.
Loargys (pegzilarginase-nbln): Approved on 2/23/2026. Immedica Pharma scored an accelerated approval for hyperarginemia (Arginase 1 Deficiency). This is a major win for the company after a four-year regulatory journey that included a prior refusal-to-file.
The Latest from Healthcare Insights
Here's what we're writing about at healthcarein.org:
What’s on Our Mind for the Next Two Weeks
This Week (March 2): The Post-Negotiation Reality Now that the February 28 Medicare deadline has passed, the industry's focus shifts from "legal defense" to "portfolio optimization." We are watching for a surge in orphan drug filings as companies look for regulatory loopholes to protect margins against future negotiation cycles.
Next Week (March 9): The New ACIP Paradigm With RFK Jr.’s handpicked panel set to meet, we are preparing for a fundamental shift in how the CDC recommends—and insurers cover—immunizations. Any move to de-list or re-categorize major vaccines will trigger immediate ripples in the public health capital flows we’ve been tracking.
The Week Ahead
March 2 (Today): UroGen Pharma (URGN) & uniQure (QURE) report Q4 earnings. Watch UroGen for updates on their urothelial cancer launch.
March 3: Zymeworks (ZYME) & Xeris Biopharma (XERS) report earnings.
March 5: CMS Open Door Forum. Expect the first public hints regarding the implementation of the freshly signed Medicare Part D agreements.
March 6: PBM Transparency Deadline. Watch for any last-minute filings related to the Department of Labor's transparency rule.
Takeaways
The narrative of "Big Pharma vs. The Government" is evolving into "Big Pharma Within The Government." Whether it’s the MFN deals having a three-year "fuse" or Cigna swallowing hospital pharmacy chains, the boundaries between payer, provider, and policymaker are blurring. The winners are the companies that can navigate a landscape where a Supreme Court ruling can vaporize a trade strategy overnight.
Stay curious, stay sharp, and we will see you in seven days.
With gratitude and resolve,
The Healthcare Insights Team
Reach out to us by email at [email protected].
