Clayton, Dubilier & Rice and McKesson are taking Option Care Health private for $32.05 a share in cash, a 37% premium to the 5 October close and an enterprise value of $5.8 billion. CD&R will own about 51% and McKesson about 49%, investing about $1.4 billion, backed by about $2.87 billion of equity commitments and up to $3.15 billion of debt financing. Fierce Healthcare reports that Option Care serves more than 308,000 patients a year across all 50 states with about 5,000 clinicians, on more than $5.6 billion of 2025 net revenue. Closing is expected in the first half of 2027.

The week’s largest cheque bought 5,000 clinicians and an infusion network. No molecule changed hands.

The structure says more than the price. The agreement includes a framework for McKesson to buy CD&R’s interest later, so a drug distributor has a staged route to owning the infusion provider outright, with private equity carrying half the cost until then. McKesson’s oncology and multispecialty unit grew 31% to $48.4 billion in 2025, largely on acquisitions. For rare and specialty launches that depend on home infusion, distribution and the site of care are moving under one owner, and at about one times revenue the price is a services multiple for what is really control of the channel.

Shionogi is acquiring IntraBio for $2 billion upfront, taking Aqneursa (levacetylleucine), approved in the US and EU for the neurological manifestations of Niemann-Pick disease type C and in the US for ataxia in ataxia-telangiectasia. The same molecule, IB1001, is in clinical programmes in CACNA1A-related disorders, GM2 gangliosidosis including Tay-Sachs and Sandhoff disease, and spinocerebellar ataxias. Fierce Pharma, working from Shionogi’s disclosures, puts IntraBio’s 2025 sales at around $68 million. Closing is expected between November and December 2026.

About 29 times trailing sales, for a second label that is weeks old and a third still in Phase III.

The price is for the labels still to come. The A-T approval logged in NeuroPulse Week 38 rested on a 73-patient crossover study, and IB1001-304 in CACNA1A disorders, a population Fierce Pharma puts at about 30,000 in the US, was due to complete enrolment this month. Shionogi is buying a molecule that keeps collecting rare neurology labels, and it bolts onto the rare disease unit Shionogi built around Radicava, bought from Tanabe Pharma for $2.5 billion in April. NPC itself is filling up: two drugs are approved, and Rafael plans an NDA for Trappsol Cyclo in Q4 after missing its pivotal primary.

Viatris is acquiring Pacira BioSciences through a tender offer at $36.50 a share in cash, a 44.8% premium and an aggregate equity value of about $1.65 billion, funded mainly from cash with the rest from short-term borrowings. Pacira brings Exparel, a liposomal bupivacaine for postsurgical pain, and Zilretta, an extended-release triamcinolone injection for osteoarthritis knee pain. It reported about $746 million in revenue and $177 million in adjusted EBITDA for the 12 months to 30 June 2026, and Viatris calls the deal immediately accretive. Closing is expected by the end of 2026.

Viatris paid about 2.2 times revenue for two products it can sell now. Shionogi paid about 29 times for labels it expects to add.

With Option Care and IntraBio, the three takeovers put $9.45 billion on the table at closing, 92% of the $10.23 billion upfront disclosed this week. The multiples run from about one times revenue for an infusion services business, to about 2.2 times for two patent-protected pain products, to about 29 times for a rare disease drug still adding indications. All three bought revenue already on the books; the multiple tracked how much of the value still depended on new labels. Week 39 paid 34% at signing; this week, with the takeovers, paid 80%.

Alentis Therapeutics granted CSL worldwide rights to co-develop and co-commercialise lixudebart, a claudin-1 antibody in a Phase II trial in ANCA-associated vasculitis with rapidly progressive glomerulonephritis, for $355 million upfront, up to $1.2 billion in commercial milestones and 45% of global profits. Alector licensed AL-050, a preclinical brain-penetrant GCase enzyme replacement therapy for Parkinson’s disease, to Genentech for $100 million upfront and up to $1.17 billion in milestones, keeping its blood-brain barrier platform. Biohaven granted Ono Pharmaceutical its MoDE IgG degraders, led by Phase III BHV-1300 in Graves’ disease, in Japan, South Korea, Taiwan and ASEAN for $80 million upfront, $20 million on a milestone expected within a year and royalties of about 20%. Asieris licensed Cevira, a photodynamic drug-device treatment for cervical precancerous lesions, to Theramex in Europe, Australia, New Zealand and Turkey for $15 million upfront against more than $250 million.

Ono paid 80% at signing for a Phase III asset in one region. Genentech paid 8% for a preclinical one worldwide.

Upfront share tracks stage and scope, and the profit split carries the rest. CSL’s disclosed milestones are all commercial, so Alentis is paid for the development risk it keeps through its 45% profit share. Alector’s $100 million compares with $138.7 million in cash at the end of September, according to Fierce Biotech, and moves its runway guidance from at least through 2027 to into 2029. Roche also took molecular glue degraders from Hangzhou Defand for under $10 million upfront against up to $1 billion, a deal reported by Endpoints News and confirmed by neither company.

Ultragenyx agreed on 6 October to sell the rare pediatric disease priority review voucher it received on 19 August with the approval of Genglycos in glycogen storage disease type Ia, for $210 million in cash at closing. Its 8-K discloses that a 2018 patent licence entitles the NIH to 20% of gross proceeds, which leaves Ultragenyx about $168 million. SRX Global agreed to buy CERo Therapeutics, developer of the Phase I cell therapy CER-1236 in haematological cancers, for $1.0 million in SRX stock, forgiveness of a secured note with $8.25 million in outstanding principal plus interest, and about $1.56 million in assumed liabilities, with a 30-day go-shop from signing on 6 October.

SRX bought CERo’s senior secured debt on 31 August and agreed to buy the company with it five weeks later.

That is a creditor taking the asset: the consideration goes to CERo’s holding company, the filing commits no distribution to its stockholders, and the go-shop is the only test of whether anyone will pay more. Nine of 21 deals released no terms. The one to follow is Qilu, which licensed its pembrolizumab biosimilar to Cipla for the US in September and this week gave Orion exclusive European rights for a profit share and undisclosed milestones, placing a Keytruda biosimilar in both major markets while it is still in development. Lundbeck sold its Padova API plant to Flamma and ALZpath widened its pTau217 licence with Quanterix, both without numbers.