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Tax reform passed into law in the US did not translate into the dramatic growth expected in biopharma merger and acquisitions (M&As) in 2018. Acquirers may also have been more reserved than predicted, choosing a wait-and-see approach with regard to how critical the US administration would be towards the pharmaceutical industry. Nevertheless, there were still big deals, and now that some of these transactions — including the major vertical integrations in the health-care services sector of CVS and Aetna, and Cigna and Express Scripts — have cleared key regulatory hurdles, buyers in 2019 may be more inclined to return to the table. Bristol-Myers Squibb’s US$74 billion takeover of Celgene (the fourth-largest pharma M&A ever), announced in January 2019, may be a harbinger.