Two new proposed pharmaceutical acquisitions deals have been added this week, to a list of pharmaceutical industry mergers and acquisitions this year, that includes Pfizer’s $43 billion acquisition of Seagen and Amgen’s $27.8 billion buy of Horizon Therapeutics.

According to a report by Fiercepharma.com, Merck & Co. announced an agreement with Prometheus Biosciences and its bowel disease candidate in a $10.8 billion transaction earlier this month.

Then GSK announced offering $2 billion for Bellus Health to challenge its fellow pharma dealmaker in the cough market.

Moody’s Investor Services thinks these are just the start, with M&A activity expected to remain high over the next year to 18 months. Pharmas are trying to restock their pipelines due to approaching patent cliffs and long-term pricing pressure, Moody’s wrote in a sector commentary note.

Other Big Pharmas that are likely to strike include Bristol Myers Squibb, Royalty Pharma and Merck again, according to Moody’s. AbbVie, Biogen, Gilead, Pfizer and Viatris also have moderate potential for deals, the firm says, while Amgen, Eli Lilly, Johnson & Johnson and Regeneron are less likely.

The deals to come could be large. Moody’s thinks there is potential for acquisitions representing 10% or more of the acquirer’s market cap. That could come in one single deal or multiple over a short time frame.

Merck, even after the Prometheus buy, is looking to expand revenues beyond the blockbuster immunotherapy Keytruda.

“Although Merck’s tone appears to have recently shifted towards smaller-to-medium sized deals, we believe the company would opportunistically pursue a larger deal,” Moody’s wrote.

In January 2023 U.S. Senator Elizabeth Warren sent a letter to officials at the Federal Trade Commission (FTC) urging the agency to closely scrutinize two pending big pharmaceutical mergers: Amgen and Horizon Therapeutics, and Indivior and Opiant.

In the letter, the Senator expresses concern over the rampant consolidation in the pharmaceutical industry and its impact on drug affordability and access in the United States.

Her letter noted that in “recent decades, there has been extensive consolidation in the pharmaceutical industry, with the 60 most dominant pharmaceutical companies consolidating to a mere 10 firms between 1995 and 2015, leading to higher prices for American patients and decreased innovation. These corporate deals are bad for patients: prices for drugs sold by acquired companies increase at a faster rate than those sold by their non-acquired counterparts.”

A 69 page research study, – Mergers, Product Prices, and Innovation: Evidence from the Pharmaceutical Industry – which was last revised in February 2023, the authors from the University of Arizona and Stevens Institute of Technology examine changes in product prices and innovation around consolidation in the pharmaceutical industry.

They concluded that “pharmaceutical mergers are generally accompanied by increases in product prices particularly within uncompetitive product markets that experience further consolidation as a result of the merger.”

When they also examined innovation around mergers, they found that “any innovative activity is limited to labeling and manufacturing process changes, not new drug creation.”

They went to to say that thee “findings are inconsistent with synergistic gains being passed along to consumers through lower prices or better products.” And that their study “has implications for policymakers, who often claim ensuring affordable access to medication for constituents is a top priority.”

They claim that “one contributor to rising drug prices is recent consolidation in the pharmaceutical industry. Understanding the nature of competitive forces in this industry provides insights into how to better regulate this important industry and contain drug prices.”