Healthcare companies have revved the deals engine back into high gear.

Takeda Pharmaceutical’s possible acquisition of Shire, with its market value of $45 billion, would boost the sector’s year-to-date dollar total for deals to well above $200 billion, the most for a first quarter in at least a dozen years. Announced healthcare transactions have already reached about $156 billion this year, according to data compiled by Bloomberg.

Just this week, British drugmaker GlaxoSmithKline agreed to buy Novartis’s stake in their consumer-health joint venture for $13 billion, days after abandoning pursuit of a similar unit put on the block by Pfizer. Now, Takeda is considering its biggest takeover ever, a bid for Shire that could propel the Japanese company into the ranks of the world’s top drugmakers.

After facing uncertainties in 2017, pharma companies can benefit from an improved tax landscape in the U.S. and the receding threat of significant action on drug pricing, said Alan Montgomery, co-head of pharmaceuticals and healthcare at Herbert Smith Freehills, a firm specializing in corporate law.

“That, combined with the fact that many companies in the sector still need to build their pipelines and deliver top line growth, we believe, will continue to drive M&A activity for pipeline and marketed products this year,” he said in an email.

Among the biggest beneficiaries of this deal-making bonanza are Lazard, Morgan Stanley, Centerview Partners and JPMorgan Chase, according to the data compiled by Bloomberg.

In January, U.S. biotech Celgene struck one of its largest deals ever with the $9 billion acquisition of biotechnology firm Juno Therapeutics. That was shortly after it agreed to buy Impact Biomedicines for at least $1.1 billion. Sanofi Chief Executive Officer Olivier Brandicourt has stitched together more than $15 billion in deals this year with the acquisitions of Bioverativ and Ablynx.

Beyond drugmakers, health insurance and services providers have also been active. Cigna agreed this month to buy Express Scripts for $54 billion in cash and stock, another move toward consolidation between health insurers and the companies that oversee patients’ drug benefits.

“The fundamentals are there. Debt is freely available to fund ambitious M&A, confidence is riding high, and the balance has tipped in favor of taking action for fear of missing out,” said Christopher Sullivan, a partner at London-based Clifford Chance, who specializes in cross-border private equity transactions. While the year should remain strong, “headwinds include ever greater politicization of merger control and foreign direct investment regimes which heighten execution risk.”

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