In our previous article, we explored the strategic imperative behind European healthcare and life sciences (HCLS) companies and investors targeting the U.S. middle market. We highlighted the compelling valuations and the U.S.’s enduring role as a global growth and innovation engine. This time, we turn to the “WHAT” and “HOW”—the concrete strategic opportunities that await European acquirers in the dynamic U.S. HCLS landscape. Join us as we delve into the specific avenues through which European firms can unlock substantial value, from accessing the world’s deepest HCLS market to leveraging its unparalleled innovation ecosystems and diverse patient populations.
Accessing the World’s Deepest Market & Robust Growth
The sheer scale of the U.S. HCLS market remains a potent magnet for international capital. Representing over 40% of total global health spending and nearly 50% of global biopharma sales, the U.S. presents an immense operational footprint and growth trajectory rarely matched. For European companies, an acquisition here is more than just an expansion; it’s an immediate leap into the largest, most commercially mature healthcare arena.
Despite some fluctuations in utilization rates, segments like Medicare Advantage continue to demonstrate robust growth, projected to expand by 5% annually through 2028. This provides a stable, expanding patient base for acquired entities, offering clear pathways for revenue generation and market penetration.
Tap into Dominant Biotech & Biopharma Innovation
The U.S. stands as the undeniable epicenter of biotech and biopharma innovation. Its vibrant ecosystems—think Boston/Cambridge, the San Francisco Bay Area, and the Research Triangle—are veritable hotbeds for pioneering clinical research, robust academic partnerships, and dynamic venture-backed startups. The biotech market alone is projected to grow from $1.74 trillion in 2025 to over $5 trillion by 2034, underscoring its explosive potential.
European acquirers can directly plug into these advanced networks, gaining access to cutting-edge R&D, intellectual property, and a pipeline of groundbreaking therapies. U.S.-based biopharmaceutical companies contribute 55% of global R&D investment, leading advancements in gene editing, mRNA vaccines, and precision medicine. Acquisitions provide a fast-track to these innovations, complementing Europe’s own scientific strengths. Budget related changes to government funding of HCLS research, will only increase the demand for private capital and keep downward pressure on valuations for earlier stage companies in the short term.
Leverage Advanced Digital & AI Integration
The rapid adoption of digital health technologies and artificial intelligence (AI) across the U.S. healthcare system presents another transformative opportunity. The global AI healthcare market is forecast to reach $110.61 billion by 2030, with North America holding the largest share and a high growth rate of 38.6% CAGR from 2025. This momentum translates into practical applications that European companies can acquire.
Over two-thirds of U.S. physicians utilized health AI in 2024, and 79% of healthcare organizations are actively integrating AI into their operations. This widespread adoption, from workflow optimization to predictive analytics and advanced diagnostics (with over 340 FDA-approved AI tools by 2025), offers European buyers a chance to acquire sophisticated digital capabilities, accelerating their own technological evolution and improving efficiency.
Access to Diverse Patient Populations for Clinical Advantage
The United States, with its highly diverse population, serves as an invaluable asset for clinical research and real-world data (RWD) generation. Acquiring a U.S. entity provides immediate access to a broad and varied patient base, crucial for conducting comprehensive clinical trials that reflect real world demographic variations. This diversity is vital for ensuring the safety and efficacy of new treatments across different genetic backgrounds, ages, and ethnicities.
Beyond traditional trials, the U.S. market’s extensive data infrastructure and growing emphasis on RWD allow for more robust post-market surveillance and the development of personalized medicine approaches. European firms can leverage this to refine therapies, expand indications, and accelerate market access.
Gaining A Foothold in a Mature, High-Value Commercial Landscape
- An acquisition in the U.S. offers European HCLS companies more than just innovation; it provides immediate entry into a mature, high-value commercial landscape. This includes established distribution networks, robust sales infrastructures, and direct access to a complex yet lucrative multi-payer reimbursement system. While navigating the distinct U.S. market access landscape can be challenging compared to European models, a well-executed acquisition provides a foundational platform from which to optimize commercial strategies and capture significant revenue streams. FDA has served as a quasi-Global Benchmark. U.S. FDA approvals often set the standard for global market entry. Acquisitions and licensing U.S. assets can streamline regulatory pathways in other regions and offer faster times to market utilizing the FDA’s relatively agile regulatory frameworks (e.g., accelerated approval, breakthrough therapy designation).
This integration allows European acquirers to bypass years of organic market development, capitalizing on existing brand recognition, patient relationships, and regulatory approvals. U.S. biotech attracts over 60% of global biotech VC funding, providing acquired firms with greater access to follow-on capital. The U.S. has a mature biotech capital market and companies are acquisition-ready or near IPO-stage, offering clear exit strategies. Companies with US based assets advancing under the FFDA regulatory process are more likely to obtain access to US based biotech VC funding. US VC’s may have a propensity to rely on FDA standards as a benchmark for clinical success globally and access to a robust US commercial market.
Connecting Opportunities: How These Elements Combine for European Buyers
The strategic opportunities in U.S. HCLS are synergistic. For instance, a European biopharma firm might acquire a U.S. biotech startup not only for its innovative pipeline but also for its access to a major U.S. innovation cluster, a diverse patient cohort for future trials, and an existing network for commercialization. This “string-of-pearls” approach—acquiring smaller, specialized companies to build a larger presence—has been a major driver of several recent major deals involving targeted acquisitions that fill specific capability gaps and accelerate growth.
Recent examples, such as Denmark’s Novo Holdings acquiring U.S. CDMO giant Catalent and Swiss Alcon’s acquisition of U.S. medtech firm Lensar, underscore this trend. These deals provide examples of European companies strategically investing in the US to gain manufacturing capabilities, innovative product lines, and direct market access.
Conclusion
The U.S. HCLS market presents unparalleled strategic opportunities for European companies and investors. Beyond the attractive valuations discussed in Article 1, the ability to directly access its vast market scale, dominant innovation ecosystems, advanced digital integration, and diverse patient populations offers a compelling “WHAT” for transatlantic M&A. This is not merely about expansion but about transformative growth and competitive advantage.
In our next article, we will delve into the “HOW” of successful transatlantic M&A, focusing on the critical talent edge and operational synergies necessary for seamless integration and long-term value creation.
This article explores the specific, high-value opportunities that may result from European HCLS companies developing the US presence and how they can drive value going forward.
About the Authors:
Nathan Cali is a Managing Partner at Noble Capital Markets with more than 18 years of Capital Markets experience. He has been a lead Managing Director/Head of the Healthcare and Life Sciences Investment Banking and Advisory franchise at NOBLE since 2017 and was previously a sell-side equity analyst for 9 years. Nathan is a Board Member of Precise Bio, a tissue engineering, biomaterials, and cell technologies company, including cardiology, orthopedics, and dermatology. He was previously a board observer of Eledon Pharmaceuticals (ELDN:NASDAQ, f.k.n.a. Anelixis Therapeutics, Inc.), a phase II biotechnology company. Prior to joining NOBLE, Nathan gained investment experience as a portfolio account analyst/manager at Franklin Templeton Investments. Nathan also currently holds series 7, 79, 86, and 87 FINRA designations.
Hinesh Patel, MCMI ChMC is a Partner in CNM LLP’s Los Angeles Office with over 20 years of experience in accounting. He leads and oversees the firm’s Accounting and Transaction Advisory practice. He brings a vast knowledge of US GAAP, technical accounting, and International Financial Reporting Standards (IFRS) reporting requirements to his role at CNM. Hinesh primarily focuses on technical accounting, IPO readiness, SEC reporting, and mergers and acquisitions. Prior to joining CNM, Hinesh worked as a Senior Manager at Deloitte with a primary focus in the technology, manufacturing, consumer business and entertainment industries for both public and private companies. He has assisted various companies through the IPO process and advised on a range of accounting services including technical accounting, financial reporting, and new business processes requirements.
Matthew (Matt) Podowitz is the founder and Principal Consultant of Pathfinder Advisors LLC, bringing experience on 400+ global M&A engagements to his clients. He specializes in the critical operational and technology aspects of M&A transactions, providing due diligence, carve-out, integration, and value creation services. Known for practical, actionable advice derived from extensive hands-on experience with healthcare and life sciences transactions, Matt helps companies, investment banks, and private equity firms navigate complex cross-border HCLS M&A through every step of the transaction lifecycle. Leveraging his perspective as a dual US/EU citizen, he provides seamless support for transactions in both markets. His background includes leadership roles at firms like Ernst & Young, Grant Thornton, and CFGI.
Chris Raphaely is the Co-Chair of Cozen O’Connor’s Health Care & Life Sciences Practice where he provides sophisticated transactional and regulatory counsel to an array of health care providers and investors in the health care industry. His practice focuses on mergers, acquisitions, and divestiture transactions for health care clients and the comprehensive regulatory schemes requisite to doing business in the health care space. Chris routinely handles matters involving payer negotiations, payment disputes and contract enforcement, accountable care organizations, management services organization, clinically integrated networks, value based payment arrangements, pharmacy benefit management and third party administrator contracts for self-insured employers, digital health, organizational and governance structures, HIPAA, information privacy and security, tax exemption, Stark Law, fraud and abuse matters, clinical integration, medical staff relations, facility and professional licensing, Pennsylvania’s Medical Marijuana Act, and general compliance. Prior to joining the firm, Chris served as the deputy general counsel to Jefferson Health System and general counsel to the system’s accountable care organization and captive professional liability insurance companies.