HealthSpan Partners, an affiliate of the nonprofit Bon Secours Mercy Health, is taking Surgery Partners private at an enterprise value of about $5.7 billion including debt. Shareholders other than Bain Capital receive $23.50 a share in cash, a 49% premium to the last close, while Bain affiliates, which own about 39%, exchange their shares for equity in the acquirer. Surgery Partners runs ambulatory surgery centres and surgical hospitals in orthopaedics, spine, cardiology, gastroenterology and ophthalmology, with more than 200 sites in 30 states, about 5,000 affiliated physicians and $3.31 billion of 2025 revenue, Reuters and Becker’s report. HealthSpan is funding the deal with cash and new debt, and closing is expected in the first quarter of 2027.

Bain tried to take Surgery Partners private last year and was rebuffed, Reuters reports. It now keeps its stake and lets a hospital system pay the premium.

The price is about 1.7 times 2025 revenue for a business that moves procedures out of the hospital, bought by a hospital system. Reuters notes that Ascension bought AmSurg for $3.9 billion earlier this year, and Mizuho’s Ann Hynes sees overlap only in Ohio and Kentucky and no meaningful FTC risk. Surgery Partners alone is 92% of the week’s $6.16 billion upfront, and the fourth week running in which the largest cheque bought a healthcare business with no molecule attached, after Option Care, Xodus Medical and QIAGEN. The deal ends a two-year strategic review that drew several bidders.

RadNet is acquiring ONRAD, which provides 24-hour teleradiology, onsite diagnostic and interventional radiology, medical directorship and billing services to hospitals, practices and imaging centres, for $350 million in cash and 5 million RadNet shares at closing. ONRAD can earn up to $210 million more if it reaches target 2027 EBITDA, payable in cash, stock or both at RadNet’s election. RadNet expects $190 million to $200 million of revenue and $60 million to $65 million of adjusted EBITDA in the first year, from more than 130 contracted radiologists serving more than 225 hospital facilities in 26 states, and closing in early 2027.

RadNet did not put a value on the 5 million shares, so ONRAD ranks here on its $350 million of cash. The earnout is 37.5% of the disclosed total.

RadNet is buying radiologists. ONRAD takes an outpatient imaging company into hospital-based professional services, where the constraint is staff, and the earnout keeps $210 million tied to how well that staff performs in 2027. With Surgery Partners, the two largest cheques bought surgeons and radiologists: $6.05 billion, 98% of the upfront. Davion Healthcare paid mostly in its own stock for two smaller deals, $22.5 million of the $25 million for Humaskan’s WoundSkan and Spektra intellectual property and $5.5 million of the $13.5 million for Healthcare Stat Homecare, at an agreed $13 a share.

BioMarin licensed worldwide rights outside Korea to HM15421/GC1134A from GC Biopharma and Hanmi Pharm on 29 October, a long-acting recombinant alpha-galactosidase A given under the skin and in a Phase 1/2 trial in Fabry disease. BioMarin pays $70 million upfront, and the two companies are jointly eligible for up to $405 million in development and commercial milestones plus tiered royalties. BioMarin takes over all development after the Phase 1/2, and the candidate received FDA orphan drug designation in 2024.

BioMarin bought Amicus and Galafold for about $4.8 billion in December 2025. This licence is for the Fabry patients Galafold cannot treat.

CEO Alexander Hardy framed the deal as reaching patients beyond those with mutations amenable to Galafold, the oral chaperone BioMarin gained with Amicus, and the candidate could be the first subcutaneous enzyme replacement therapy in Fabry. Drug deals put $70.2 million of separable upfront on the table, 1.1% of the week’s total, counting TME Pharma’s €150,000 exclusivity fee. Across the seven deals that disclosed both upfront and total, 91% was paid at signing; without Surgery Partners it was 42%.

Audax Biosciences granted Astellas an exclusive worldwide option on DAX-044, an IL-12 antibody-cytokine fusion built on its AVIKINE technology to keep IL-12 activity in the tumour, for $285 million combining the upfront and a future option exercise payment that is not guaranteed, plus up to $1.05 billion in milestones and double-digit royalties. The Melbourne company will fund development into a Phase 1 starting in 2027 and can co-fund and co-promote in Australia and New Zealand. Ferring is acquiring Gameto, whose Fertilo uses stem cell-derived ovarian support cells to mature eggs outside the body for IVF, for up to $1.38 billion; BioPharma Dive reports that the upfront was not disclosed and the rest depends on milestones.

Audax’s $285 million would rank third this week if it were all upfront. Because it includes an option payment that may never be made, it stays out of the ranking.

Both buyers are paying for stage risk in different ways. Astellas is buying an option on a preclinical cytokine in a class that systemic toxicity has held back, while Ferring is buying a cell-based fertility product already cleared in Australia and parts of Latin America and in Phase 3 in the US, BioPharma Dive reports. The two account for 29% of the week’s disclosed value and none of its separable upfront. Processa granted Generian an option on an oral macrocyclic peptide FcRn antagonist, an oral rival to injectable FcRn drugs, with no terms.

US WorldMeds acquired Orbus Therapeutics for an undisclosed upfront, milestones and royalties on US sales, taking the glioma programme for eflornithine, the molecule it already sells as Iwilfin in high-risk neuroblastoma. Orbus’s Phase 3 STELLAR in 343 patients showed no overall survival difference, but in 196 patients with IDH-mutant grade 3 astrocytoma under the 2021 WHO classification, median survival was 34.9 months against 23.5 (HR 0.64), with grade 3 or worse hearing impairment in 24% against none. US WorldMeds will take that subgroup to FDA, where the programme holds Breakthrough Therapy designation.

MiMedx settled an infringement claim with a non-exclusive patent licence worth $25 million, paid as $5 million a year for five years.

TME Pharma took €150,000 for six months of exclusive negotiation with TMS Co. over NOX-A12; the near-term payments of about €10 million and more than €100 million in milestones are non-binding, so they stay out of the totals. Thirteen of 22 deals released no terms, including Aptar Pharma’s purchase of Pulmotree and its Kolibri mesh nebuliser, Adalvo’s purchase of Enzene’s romiplostim biosimilar and AstraZeneca’s AI toxicology collaboration with Tremont AI.