Bristol's $2.4 billion buyout of Medarex in 2009 yielded value equivalent or greater to that realized in larger M&A transactions signed that year, such as Pfizer/Wyeth, Merck/Schering-Plough and Roche/Genentech. The deal made BMS a leader in immuno-oncology and by most accounts is the highlight of the pharma's "string of pearls" strategy.

The success of gastrointestinal drug pantoprazole has turned mid-sized Altana into one of Europe's fastest growing pharmaceutical companies. By re-investing the proceeds from pantoprazole into its own R&D, Altana now has two late-stage follow-ons--ciclesonide and roflumilast--with similar potential to pantoprazole. Rather than simply out-licensing these compounds to larger players, Altana wants a more active role alongside its partners in marketing and selling its own drugs, hoping thereby to establish itself internationally.

AstraZeneca appears to have navigated the integration process without much of the turmoil seen in other mergers. As part of that integration, the company created a new, centralized sales and marketing infrastructure intended to transform two mid-size European companies into a commercial global power. That new organization will soon confront the company's most immediate challenge: dealing with the genericization of the world's biggest drug, Prilosec. Whether AstraZeneca can meet that challenge will turn largely on the extent to which two late-stage drug candidates, Nexium and Crestor, can fill the Prilosec void. They'll require a commercialization effort far beyond that attempted by the former Astra or Zeneca.

A few years ago, generics looked unstoppable; today, pricing's reached suicidal levels. As for generic substitution, patients would rather fight than switch.