Healthcare (XLV) +2.4% was the best S&P sector, carried by large-cap pharma reporting before the open: Lilly +6.6% on its Q3 beat and third guidance raise, Merck +3.8% on a raised profit outlook. Biotech trailed the big caps (NBI +0.9%, XBI +0.2%, BBC (0.1%)), with Iovance and Coherus each down roughly 30% on early data.

Alphabet (12.6%), its worst day on record after a double miss and negative free cash flow, dragged the Nasdaq 100 (1.4%) and ended the S&P 500's three-day win streak at (0.3%); the Russell 2000 rose 1.0%. Q3 GDP ran at 3.4% annualized vs 3.1% expected, jobless claims fell to 194K, September PCE printed 3.6% y/y, the 10-year slipped 7bp to 4.98%, and the ECB held.

Q3 revenue rose 39% to $24.4B against ~$22.6B consensus, led by Mounjaro at $10.7B (+65%) and Zepbound at $5.4B (+49%). 2026 revenue guidance went to $91–92B from $85–87B, roughly $10B above the range Lilly set at the start of the year, while non-GAAP EPS guidance was trimmed to $35.00–36.00 on acquired IPR&D. LLY closed 6.6% higher.

Why it matters: The mix matters more than the beat. Volume grew 53% while realized price fell 15% worldwide and 29% ex-US, so Lilly is trading price for reach and still clearing consensus by about $1.8B. Medicare's GLP-1 Bridge has 500,000 patients on Lilly obesity drugs, 80% of them new to incretins, and ex-US tirzepatide grew 93% to $5.7B on self-pay demand. Novo has to chase that installed base with CagriSema and the Wegovy pill while Foundayo rolls into 40-plus markets. The risk is the one TD Cowen named: a stock re-rated on serial beats needs a new surprise once the upside runs out, and the EPS trim shows deal spending is already absorbing part of the windfall.

Source: Endpoints

More: Fierce Pharma; BioSpace; Endpoints

BioMarin took global rights outside South Korea to HM15421/GC1134A, a long-acting enzyme replacement therapy built for subcutaneous dosing, from GC Biopharma and Hanmi for $70M upfront, up to $405M in development and commercial milestones, plus royalties. The partners finish the ongoing global Phase 1/2 trial before BioMarin takes over development.

Why it matters: This is the other half of the $4.8B Amicus buy. Galafold, with $521.7M of 2025 sales, only works in amenable GLA variants, and William Blair puts the ineligible group at 60-70% of Fabry patients, the population Sanofi, Chiesi and Takeda serve with every-other-week infusions. A subcutaneous enzyme lets BioMarin compete for that majority on convenience rather than as a me-too. At $70M upfront for a Phase 1/2 asset with no clinical efficacy disclosed, the downside is capped; the bet is on a dosing interval the partners have not yet given. The real threat to the whole ERT model is PTC's ST-920 gene therapy, whose rolling BLA is due to complete this quarter.

Source: Fierce Biotech

More: MedCity News

The Labor Department finalized its PBM fee-disclosure rule. From 1 July 2027, PBMs serving large self-insured group health plans must disclose rebates, spread pricing and other drugmaker and supply-chain compensation at contract signing or renewal and every six months, and employers get annual audit rights. Officials estimate it covers 70-plus PBMs and 130,000 employers.

Why it matters: Express Scripts, Caremark and Optum Rx handle about 80% of US prescriptions, and their margins lean on rebate and spread economics employers could not see. Possible contract invalidation for non-compliance gives the rule teeth the earlier CAA reporting lacked. DOL pegs savings at $22B over a decade, small against the rebate pool, so the near-term hit lands on PBM negotiating leverage rather than earnings. Drugmakers lose some of the cover for high-list, high-rebate pricing, which helps brands already selling at lower net or direct to employers. PCMA calls the rule redundant and disputes DOL's authority, so expect a court fight before July 2027.

Source: STAT

More: Healthcare Dive

AstraZeneca's Q3 revenue rose 7% to $16.2B (vs ~$16.0B expected) and core EPS 19% at CER to $2.79 (vs $2.59), with oncology up 17% to $7.8B offsetting a 25% Farxiga slide to $1.6B on generics; 2026 guidance was confirmed and two early-phase prostate cancer programs were cut. — Fierce Biotech

Merck's Q3 sales rose 5% to $18.1B as Keytruda hit $8.6B (Keytruda Qlex $830M) and Winrevair nearly doubled to $694M; non-GAAP EPS guidance moved up to $2.77–2.82 net of Cidara and Terns charges, and management called 2027 another investment year. — Fierce Pharma

Bristol Myers beat Q3 consensus (revenue +7% to $13.1B vs $12.75B), edged 2026 revenue guidance to $49.75–50.25B, cut EPS guidance on a $1.65B acquired-IPR&D charge, and dropped Prothena-licensed PRX019 ($80M upfront in 2024) after Phase 1. — BioSpace

Alnylam's Q3 net product revenue rose 52% to $1.29B on Amvuttra at $1.13B (+65%); 2026 guidance of $4.7–5.1B was reiterated. — PR

Iovance and Coherus each fell roughly 30% on early data: lifileucel posted a 24.6% ORR (17/69) in previously treated non-squamous NSCLC, and tagmokitug plus toripalimab managed 16.7% (1/6) in second-line ESCC despite 75% (6/8) in first line. — Endpoints

Mevidalen, Lilly's D1 receptor modulator, was dropped in Alzheimer's after a Phase 2 that fell short of Lilly's internal bar. — Fierce Biotech

STAT flagged a previously undisclosed infection-related pause rule for Vertex's IgAN drug povetacicept, raising label questions ahead of its 30 Nov FDA decision. — STAT

Ono's endocannabinoid modulator ONO-1110 missed in all five Phase 2 trials; depression and social anxiety are dropped, while pain work in PHN, fibromyalgia and Hunner-type IC continues. — BioSpace

LENZ cut 75% of staff and changed CEOs alongside a disappointing Q3 update. — Fierce Pharma

Molecular Partners will lay off up to 44% of staff to focus its shrinking cash on a radiotherapy pipeline led by an early-phase small cell lung cancer candidate. — Fierce Biotech

Insmed posted $524.4M in Q3 revenue and raised 2026 guidance for Brinsupri and Arikayce. — PR

Flagship merged Cellarity, Etiome and Empress Therapeutics into AI drug-discovery company Etcelera, led by ex-Adaptimmune CEO Adrian Rawcliffe. — Endpoints

The UK pulled in £500M of biopharma investment pledges, led by Vertex, alongside its Autumn budget. — Endpoints

BioMarin / GC Biopharma + Hanmi: global ex-Korea licence to HM15421/GC1134A, a subcutaneous long-acting Fabry ERT in Phase 1/2; $70M upfront, up to $405M in milestones, plus royalties. — Fierce Biotech

Dren Bio raised an oversubscribed $350M (series undisclosed), co-led by Juvia Group and Lightspeed, for dibotatug (DR-01), a CD94-targeting depleting antibody in a registrational Phase 1/2 for LGLL and cytotoxic T-cell lymphoma; primary readout due in December, market target end-2027. — Endpoints

Bambusa (BBTX) priced an upsized IPO at the $16 midpoint, 10.56M shares for ~$168.9M gross (+1.58M-share option); BBT001 (IL-4Rα/IL-31) and BBT002 (IL-4Rα/IL-5) bispecifics are in the clinic; BofA, Evercore, UBS and Cantor; trades today, closes 2 Nov. — Fierce Biotech

Aspen Neuroscience (ASPE) priced at the $15 bottom of its range, selling 9.375M shares for ~$140.6M gross (+1.41M-share option), slightly fewer than planned; lead asset sasineprocel is an autologous iPSC-based cell therapy for Parkinson's; Leerink, Piper Sandler, Stifel, UBS and Oppenheimer; trades today. — PR

A small-molecule TREM2 agonist for Alzheimer's disease showed CNS penetration, target engagement and tolerability in preclinical work and phase 1. — Nature Medicine

In MASLD, multimarker non-invasive panels outperformed single markers in the prospective multicentre LITMUS diagnostic study. — Lancet