Deals · Research note · 20 Oct 2026
Shionogi's $2 billion for IntraBio: the Medicaid line behind one rare-disease drug
On 5 October 2026 Shionogi agreed to pay an upfront USD 2.0 billion for IntraBio Inc, whose only marketed drug is Aqneursa (levacetylleucine). Public Medicaid claims records held in Svatantra.ai's signal database show that state Medicaid programs reimbursed 463 prescriptions of Aqneursa in calendar 2025, for $19.36 million before rebates, about $41,806 per prescription. This note sets out the deal terms as Shionogi printed them, the quarterly claims series, how Aqneursa's cost per prescription ranks among 37,042 drug codes, which states the claims came from, and what the public record cannot show.
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Every number, and where it comes from
The first five figures in the note.
The full table has 18 rows. Each figure is as published on the date shown, with its denominator.
| Figure | What it measures | Source |
|---|---|---|
| 463 | Prescriptions of Aqneursa (NDC 83853010101) reimbursed by state Medicaid programs in calendar 2025, national total rows (state XX), fee-for-service plus managed care. The Q1 2025 fee-for-service national row is suppressed and omitted | Svatantra.ai signal database, count at 16 Oct 2026 (CMS State Drug Utilization Data 2025) |
| $19,356,135.79 | Total amount reimbursed for those 463 prescriptions, before Medicaid rebates. Medicaid share $18,702,690.56; non-Medicaid share $653,445.23 | Svatantra.ai signal database, count at 16 Oct 2026 |
| $41,806 | Total amount reimbursed per prescription, 2025: $19,356,135.79 / 463 = $41,805.91. Author's arithmetic | Derived from Svatantra.ai signal database, count at 16 Oct 2026 |
| 38,220 and 82.5 | Units reimbursed in 2025, and units per prescription (38,220 / 463). Author's arithmetic | Derived from Svatantra.ai signal database, count at 16 Oct 2026 |
| 97, 163, 170, 163 | Prescriptions per quarter, Q2 2025 to Q1 2026, national rows, both plan types summed. Author's arithmetic from published rows | Derived from Svatantra.ai signal database, count at 16 Oct 2026 |
13 more figures in the PDF, each with its source.
Sources
9 primary releases.
- Centers for Medicare & Medicaid Services, State Drug Utilization Data 2025, national total rows (state XX) for NDC 83853010101 (AQNEURSA, labeler IntraBio Inc) (File modified 13 July 2026; rows checked 16 October 2026)Verbatim rows: Q1 FFSU suppression_used=true; Q1 MCOU prescriptions 33, total 1264504.78, Medicaid 1264504.78; Q2 FFSU 36, 1454153.49, 1395177.93; Q2 MCOU 61, 2416559.79, 2316942.59; Q3 FFSU 79, 3288367.91, 3196467.73; Q3 MCOU 84, 3530837.46, 3413044.04; Q4 FFSU 69, 3020119.38, 2922717.47; Q4 MCOU 101, 4381592.98, 4193836.02.data.medicaid.gov
- Centers for Medicare & Medicaid Services, State Drug Utilization Data 2026, national total rows (state XX) for NDC 83853010101 (AQNEURSA) (File modified 10 July 2026; rows checked 16 October 2026)Verbatim rows: Q1 2026 FFSU prescriptions 93, units 7728.000, total 4017756.66, Medicaid 4017744.66; Q1 2026 MCOU prescriptions 70, units 6076.000, total 3160527.34, Medicaid 2874948.28. 25 rows in all for this NDC: 20 states plus XX.data.medicaid.gov
- Centers for Medicare & Medicaid Services, Medicaid State Drug Utilization Data field descriptions (Accessed 16 October 2026)"For any data where NDCs are aggregated (e.g. National Totals) the state code is \"XX\" to represent multiple states." "data that are less than eleven (11) counts are suppressed." Total Amount Reimbursed: "This total is not reduced or affected by Medicaid rebates paid to the state."cms.gov
- Centers for Medicare & Medicaid Services (data.medicaid.gov), State Drug Utilization Data 2025, dataset metadata (Modified 13 July 2026)"Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies". Download: https://download.medicaid.gov/data/sdud2025_updatedjuly2026.csvdata.medicaid.gov
- Shionogi & Co., Ltd., Shionogi Continues Rare Disease Expansion With Planned Acquisition of IntraBio Inc. (5 October 2026)"an upfront consideration of USD 2.0 billion payable to IntraBio shareholders". IntraBio FY2025/12 net sales USD 67,867 thousand; FY2024/12 USD 3,535 thousand; FY2025/12 operating loss USD (35,292) thousand. "approved by the FDA in September 2024 for neurological manifestations of Niemann-Pick disease Type C (NPC)". A-T approval 18 September 2026. Completion "Scheduled between November 2026 and December 2026 (planned)".shionogi.com
- Cleary Gottlieb, Shionogi to Acquire IntraBio (6 October 2026)Agreement signed 5 October 2026; IntraBio to become "a wholly owned subsidiary of Shionogi Inc."; "subject to customary closing conditions".clearygottlieb.com
- Fierce Pharma, Shionogi strikes $2B deal for IntraBio hot off FDA label expansion (5 October 2026)IntraBio described as the Austin, Texas-based, privately held commercial biotech; the deal to be run through Shionogi Inc., the US subsidiary. Context only; figures in this note come from Shionogi's release.fiercepharma.com
- NeurologyLive, FDA Approves Levacetylleucine for Ataxia-Telangiectasia (18 September 2026 (updated 24 September 2026))"The approval marks the first FDA-approved treatment indicated specifically for A-T". Levacetylleucine "previously received approval in September 2024 for neurological manifestations of Niemann-Pick disease type C."neurologylive.com
- Svatantra.ai, Signal database (16 October 2026)Counted: CMS State Drug Utilization Data rows for NDC 83853010101 (Aqneursa, IntraBio Inc), national total rows (state XX) for 2025 and Q1 2026, fee-for-service plus managed care; state-level rows for the same NDC to count reporting and unsuppressed states; and, for the ranking, every drug code's unsuppressed 2025 national rows summed across quarters, total amount reimbursed divided by prescriptions. Files held: 5,308,547 rows (2025) and 1,287,884 rows (2026), matching the CMS API. Counts at 16 October 2026.svatantra.ai