The 2026 Top Company Observations

The top company reports reflect the concept behind the famous Charles Dickens quote, “It was the best of times, it was the worst of times…” The undertaking that begins at the end of May each year marks the summer for my colleagues and me. As a result of the journey, we emerge with a clearer picture of what’s happening within the industry (among the leaders, anyway), their clinical areas of focus, the slower-growth segments, and other insights. 

Fortunately, the issue has become less of a mountain to tackle with so many under each of our belts. Sam and I began doing them with the 2016 issue, and Mike was already writing them for several years before that. As a result, the task has become more enlightening than causing dread from the sheer size of it. So, without further ado, I share some thoughts I had while preparing and reviewing this year’s offering. 

A Shift in M&A Strategies

Years ago, my colleagues and I used to wonder what the “big announcement” was going to be. What was going to be the major acquisition in medtech that year on the scale of Medtronic/Covidien, BD/Bard, Abbott/St. Jude, and others. It seemed we always had one; sometimes two. It’s been a bit since that’s taken place. Instead, we’re wondering what major pieces are going to be sold off or spun out. 

Perhaps it was a natural evolution after so many mega-mergers. Companies are reassessing their core competencies and, following that review, splitting off certain segments or businesses. Typically, these represent slower growth areas, but they also may not fit with the company’s future vision for clinical care focus. As such, a number of Top 30 firms have shed or sold a piece of the company. Medtronic spun out its diabetes portion, MiniMed, to stand alone. J&J MedTech announced the divorce from its orthopaedics division, DePuy. Stryker sold its spine investment to Viscogliosi Brothers to create VB Spine. There have been other examples of this trend throughout the industry (Danaher, BD, Baxter, etc.). 

Is this a temporary move by these companies as they continue to absorb the large purchases of years ago and restructure their businesses as a result? Or will they continue to avoid the mega-buys in favor of smaller, more complementary acquisitions? These have most certainly remained a trend and, by all expectations, will continue to do so. 

Then there’s the exception that proves the rule—Boston Scientific. For as aggressive as the company has been (one of the most acquisitive organizations in the Top 30), executives seem to be remiss in selling off pieces of the business. Is this coming, or is the organization simply more strategic in its aggression? 

The mega-acquisition for Boston Scientific was all the way back in 2006 when it bought Guidant for $27 billion. It’s already divested disparate portions from that deal. However, perhaps the $1 billion-plus purchases of late will lead to the company following the rest of the industry in the years ahead. Penumbra (2026 for $14.5 billion), Axonics (2024 for $3.7 billion), and Silk Road Medical (2024 for $1.2 billion) may generate divestitures. We’ll have to wait and see what those executives decide. 

FTC’s Oversight

There may be another factor impacting the frequency of the mega-mergers. That is, the seemingly increased interest in medtech M&A from the Federal Trade Commission (FTC). There have been several high-profile situations where a deal was negated as a result of the agency investigating. For this year’s reports, the instances mentioned include Edwards’ attempted buy of JenaValve and Alcon’s interest in Lensar. (Alcon saw another deal fall through with Staar Surgical due not to the FTC, but rather from shareholder objections.)

AI’s Growing Influence

The use of artificial intelligence within medtech is not really a new trend, but it is still far from mature either. And there are several organizations within the Top 30 making significant investments in it and, as a result, incorporating it into many of the new product announcements made in the latest fiscal year. GE HealthCare arguably leads the industry as it’s achieved more regulatory authorizations for AI-enabled technologies than any other organization. Philips announced numerous product releases in 2025 with the software included. Siemens launched several devices with AI baked in, while also partnering with others to develop innovative solutions. And Danaher demonstrated its interest through an investment in an AI company—Innovaccer.

Sean Fenske, Editor-in-Chief
[email protected]