The paper aims to demonstrate that biotech start-ups increasingly are choosing trade sales to large pharma or biotech players to move their drug discoveries into the marketplace. It draws on Bain & Company analysis to show that this can provide higher return on investments than an initial public offering, or IPO, once the traditional exit for entrepreneurs and venture capitalists (VCs), but now far less common, and in a shorter time. It argues that pharma companies, VCs and biotech firms need to adapt their approaches to this shift and identifies new priorities for each of these key actors in the sector.