That the pharmaceutical sector is undergoing considerable structural change is now something of a truism. Certainly, there have been numerous mergers and acquisitions, as well as a multitude of smaller companies entering the market over the last few years. And there is increasing interdependency between the large and small players. But what impact will these structural changes ultimately have on the shape of the sector? The outcome is far from clear. However, a new publication from the UK Office of Health Economics (OHE) suggests that the relationship between big pharma and biotech companies is at the heart of the changes.1And according to one of the authors, a combination of business and societal trends might undermine big pharma's traditional profitability.