Where to List Your Biotech: A Strategic Guide for European Executives in 2025

The question of where to take a biotech company public has never carried higher stakes. In 2025, the transatlantic divide in biotech capital markets has widened dramatically: Nasdaq captured 98% of global biotech IPO capital through early December, while all European exchanges combined produced just one pure-play biotech listing.

For pre-IPO CEOs and CFOs navigating this landscape, the strategic calculus involves weighing the unmatched specialist capital and higher valuations of US markets against the lower costs, lighter regulatory burden, and faster timelines of European venues.

This guide provides an exhaustive analysis of every viable listing destination—from the dominant US exchanges through Europe's primary and secondary markets to Israel's unique dual-listing ecosystem—helping executives make informed decisions based on 2025 market realities rather than outdated assumptions.

The 2025 Market Reality: A Tale of Two Continents

The biotech IPO landscape in 2025 has been characterized by extreme geographic concentration. Through early December, North American exchanges recorded 9-15 biotech IPOs raising approximately $2.44 billion, while European markets effectively froze.

On Nasdaq, the largest 2025 biotech IPOs include MapLight Therapeutics ($296 million, CNS disorders), LB Pharmaceuticals ($285 million, schizophrenia), Metsera ($275 million, obesity), and Beta Bionics ($235 million, diabetes devices). The IPO window proved highly volatile—Q2 2025 recorded zero biotech IPOs, then activity resumed in September with LB Pharmaceuticals leading a modest reopening. Average deal size for substantial offerings exceeding $100 million reached approximately $200 million.

European markets have been effectively frozen. The UK has not seen a biotech IPO in over two years, extending to 12 consecutive quarters without a listing. France, Germany, the Nordics, and Benelux recorded no biotech IPOs in 2025. Switzerland's BioVersys (CHF 80 million, February 2025) stands alone—a Basel-based antimicrobial resistance company that SIX executives notably highlighted as "preferring an IPO at SIX Swiss Exchange to one overseas."

Even total European IPO volume declined 39% year-over-year to $9.4 billion, with biotechs described as "challenged" in EY's Global IPO Trends reports.

The US: Nasdaq Dominates Global Biotech Capital

For biotechs with Phase 2/3 assets seeking transformative capital, Nasdaq remains the clear destination. The exchange hosts approximately 600+ biotech companies with a combined market cap exceeding $1.1 trillion—representing 98% of US biotech listings. The Nasdaq Biotechnology Index includes 225-274 components with a $200 million minimum market cap threshold.

Why Nasdaq Commands the Premium

The US biotech investor ecosystem is unrivaled. OrbiMed Advisors manages over $19 billion across public and private healthcare investments. Perceptive Advisors manages approximately $8.5 billion. RA Capital specializes in evidence-based biotech investing. These funds dominate biotech financing globally, providing the specialist capital that European biotechs struggle to access domestically.

The "European discount" is not a myth—it is a documented, persistent gap that shapes listing strategy for every European biotech. According to Forbion's Managing Partner Sander Slootweg, valuations for earlier-stage biotechs are "significantly lower in Europe than in the US." This gap "has existed for decades."

Critically, US specialist funds primarily invest in European companies at the private/venture stage rather than in European public equities. As Slootweg noted, "We are not seeing a very strong influx of U.S. or Asian capital into Europe" at the public market level. Poor analyst coverage compounds the problem—European-listed biotechs receive significantly fewer sell-side analysts per company compared to US peers.

Nasdaq Listing Requirements

Nasdaq Capital Market (growth tier, most common for early biotech) requires $50 million market value under its Market Value Standard, with no revenue requirement. The higher-tier Nasdaq Global Select requires $160 million market cap under its Asset/Equity Standard. Both tiers mandate a minimum $4 bid price and 300+ shareholders. Initial listing fees range from $50,000-$295,000 with annual fees of $53,000-$193,000.

The regulatory burden is substantial. US-listed companies face SOX 404 compliance costs of $1.5-2.5 million annually for newly public biotechs, potentially doubling audit fees from approximately $500,000 to $1 million. The Emerging Growth Company (EGC) exemption provides five years of relief from SOX 404(b) auditor attestation—a critical consideration for cash-constrained biotechs.

Post-IPO Performance: Sobering Data

Investors and executives must reckon with sobering aftermarket data. 2024 biotech IPOs averaged a -52% return, dramatically underperforming the +16% average for all sizable IPOs that year, according to Renaissance Capital. Of 18 deals raising over $50 million, only two traded above their offer price—CG Oncology and ArriVent BioPharma. All biotech IPOs over the past five years average -41% returns.

Several high-profile 2024-2025 IPOs collapsed: BioAge Labs fell 77% after halting a Phase 2 trial; Alto Neuroscience dropped 70% when its depression drug failed efficacy; Septerna declined 47% after halting a Phase 1 trial just four months post-IPO. The failures underscore the elevated clinical risk inherent in biotech public market investing.

Early 2025 IPOs show improvement. Per Jefferies analyst Michael Yee, the first five 2025 biotech IPOs were trading +14% from deal prices on average, with three of five in positive territory. Metsera (weight loss) posted gains exceeding 52% post-IPO. The quality bar has risen dramatically—as Gunderson Dettmer partner Andrew Thorpe noted: "Phase 2 or Phase 3-ready assets have become the standard for IPO candidates."

Primary European Markets: Where Specialist Capital Exists

United Kingdom: AIM's Structural Challenge

AIM London stands out for minimal barriers: no minimum market cap, no revenue requirement, no free float threshold, and no trading history requirement. A Nominated Adviser (NOMAD) is mandatory. Total IPO costs typically reach £500,000 with approximately £100,000 annual maintenance—substantially below US levels.

However, AIM's challenge is structural: company numbers sit at their lowest in 20+ years, with 704 companies and £48 billion total market cap. Reform discussions include potential merger with the Main Market. The UK lists approximately 57 biotechs total, anchored by large pharma names like AstraZeneca (£180B) and GSK, but the exchange has gone 12 consecutive quarters without a new biotech listing.

For earlier-stage companies, AIM remains a viable interim public venue—build clinical track record, achieve milestones, then pursue Nasdaq dual-listing when data supports a larger raise. But executives should recognize that UK biotech investor depth has deteriorated significantly.

France and Euronext: Europe's Deepest Biotech Pool

Euronext (Paris, Amsterdam, Brussels, Milan, Dublin, Lisbon, Oslo) has developed one of the most dynamic biotech investor ecosystems in Europe. The exchange lists approximately 86 life science companies, of which 81 are SMEs and only 5 exceed €1 billion market cap—reflecting the concentration of smaller, growth-stage biotechs.

Euronext Tech Leaders now includes 110 companies with a combined market cap exceeding €1 trillion. The November 2025 launch of a Scale-Up Track specifically targets high-growth private companies preparing for public markets. The IPOready program has trained 1,000+ executives with 33 successful listings raising €1.6 billion.

Critically, 49% of Euronext's institutional investors are US-based—offering some transatlantic capital access without Nasdaq's regulatory burden. Listing costs run 2-5% of transaction value versus 10-15% in the US, with no SOX equivalent.

The proven "Euronext-first, Nasdaq-later" strategy has created European biotech success stories. argenx achieved an "immediate step up" in valuation after adding Nasdaq to its Euronext Brussels listing in 2017—the company now commands a $51 billion market cap. Galapagos, Ablynx, Cellectis, DBV Technologies, and Celyad all followed this pathway. Galapagos grew from a €44 million Euronext market cap to over €10 billion after Nasdaq dual-listing.

France lists approximately 41 biotechs with strong Euronext presence. For companies targeting European investors first while preserving optionality for US graduation, Euronext Paris represents the strongest European destination.

Switzerland: Life Sciences Credibility, Limited Activity

SIX Swiss Exchange operates the Stage Program (since 2016), providing mandated research coverage from Baader Helvea, UBS, and Zürcher Kantonalbank. The Sparks segment offers optimized trading for smaller market cap companies. SIX positions itself as "Europe's leading life sciences exchange," with over one-third of European life sciences market cap when including Roche (~$250B) and Novartis (~$200B).

The six-month Sparks IPO Academy trains scaleups on public market readiness. Listing requirements include 20% minimum free float with annual fees of CHF 6,000-50,000—competitive with other European venues.

Switzerland lists approximately 15-20 pure biotech companies beyond the pharma giants. BioVersys's February 2025 IPO (CHF 80 million) was Europe's only biotech IPO of the year—executives notably chose SIX over foreign alternatives, citing the life sciences ecosystem credibility. However, the limited biotech-specific IPO flow means fewer valuation comparables and thinner specialist investor attention compared to Euronext.

For Swiss-domiciled companies or those seeking association with the Roche/Novartis ecosystem, SIX provides a credible home. For others, the limited activity suggests Euronext or Nasdaq may offer better capital access.

Germany: Deutsche Börse's Biotech Gap

Germany lists approximately 23 biotechs, with market cap leadership driven by BioNTech (~$25-30B)—which notably chose Nasdaq, not Frankfurt, for its primary listing. Deutsche Börse's Scale segment mandates research coverage for all listed companies, addressing the analyst coverage gap that plagues small-cap biotechs.

However, German investors remain wary after past biotech busts. Many German biotechs have chosen foreign listings: CureVac, BioNTech, and ATAI Life Sciences all bypassed Frankfurt for Nasdaq. The pattern reflects deeper US biotech investor pools and higher valuations available in New York.

For German biotechs, the domestic exchange offers limited advantages over Euronext or direct US listing. The "Scale segment to Nasdaq" pathway is less proven than Euronext's track record.

Nordic Markets: Volume Without Scale

Sweden hosts approximately 79 listed biotechs—the largest count in Europe—concentrated on First North Growth Market. First North requires no minimum market cap, revenue, or track record, with a 10% minimum free float and mandatory Certified Adviser throughout listing.

Denmark contributes 15-20 biotechs anchored by Novo Nordisk ($435-540B, the world's most valuable pharma company by market cap) and Genmab (~$25B). The Nordic biotech ecosystem benefits from active retail investors and specialized local funds.

However, most Nordic biotechs are micro-cap to small-cap. The exchanges provide a viable stepping stone for earlier-stage companies, but the lack of large specialist biotech funds means limited capacity for substantial capital raises. Companies with global ambitions typically graduate to Nasdaq once clinical data supports larger offerings.

Secondary European Markets: Niche Applications

Netherlands: Europe's Strongest Secondary Hub

Euronext Amsterdam hosts approximately 47 biotech companies across the broader Euronext network, anchored by notable Dutch success stories within a dense life sciences cluster of ~2,000 companies within 120 miles of Amsterdam.

Key Dutch biotechs include argenx (autoimmune diseases, $51 billion, 8,174% growth since 2017), Pharming (~$600 million, rare diseases), uniQure ($3.5-4 billion, gene therapy), and Galapagos (€1.86 billion, oncology/immunology). The Dutch government has committed €1.3 billion to position the Netherlands as a global biotech leader by 2040.

Listing advantages include lower costs than Nasdaq (initial fees €100,000-125,500), a faster 4-6 month IPO timeline, flexible dual-class share structures, and access to 6,400+ institutional investors from 75 countries. However, Dutch venture financing shows a "winner-takes-all" dynamic—new company formation dropped from 48 biotechs in 2018 to just 12 in 2024.

For Dutch biotechs or those targeting European investors first, Amsterdam offers the strongest secondary market profile with a proven dual-listing pathway to Nasdaq.

Spain: Clinical Trial Hub, Limited Liquidity

Spain hosts 1,014 biotech companies generating €13+ billion in sector revenue (1.1% of GDP), supported by Europe's highest clinical trial participation rates. Major listed players include Grifols (IBEX 35, €7.21 billion revenue), PharmaMar (marine oncology), Almirall (dermatology), and Rovi (contract manufacturing).

BME Growth (formerly MAB) serves as the SME growth market with simplified requirements: €2 million minimum free float, 20+ minority shareholders, and 3-6 month listing timeline. The newer BME Scaleup segment removes even minimum free float requirements for very early-stage companies. Listing costs are competitive at €6,000 initial admission plus 0.05‰ of market cap.

AseBio Investor Day 2024 attracted 280 attendees and 70 investors from 55+ firms across 19 countries. However, REITs dominate BME Growth trading volumes, minimal recent biotech-specific IPOs have occurred, and few valuation comparables exist for biotech benchmarking.

For companies with Spanish commercial focus or leveraging the country's clinical trial infrastructure, BME offers a niche solution. For broader capital access, Euronext or Nasdaq provide superior alternatives.

Italy: Large Ecosystem, Limited Public Market

Italy hosts 5,869 biotech companies generating €53 billion annual turnover (~2% of GDP), yet public market biotech presence is surprisingly limited. Euronext Milan's main market lists established pharma/diagnostics players like DiaSorin (FTSE MIB, €7-8 billion, immunodiagnostics) and Recordati (rare diseases, listed since 1984).

Euronext Growth Milan hosts approximately 10-15 pure biotech companies including Cube Labs (life sciences venture builder, €34.1 million at 2023 listing). The segment offers a lighter regulatory path with 10% minimum free float and no minimum market cap.

Notably, Newron Pharmaceuticals, a leading Italian CNS biotech headquartered near Milan, chose the Swiss SIX Exchange over domestic markets—reflecting the pattern of sophisticated Italian biotechs seeking listings abroad for specialized investor access. PIR (Individual Savings Plans) provide meaningful retail liquidity since 2017, and the STAR Milan Conference attracts 44% foreign participation, but biotech-specific analyst coverage remains sparse.

Austria: Essentially Non-Viable

Vienna Stock Exchange lists essentially one biotech company—Marinomed Biotech (immunology/virology)—which underwent restructuring in 2024 and approved sale of its Carragelose division in December 2024. Despite 1,170+ life sciences companies generating €40 billion in sector revenue and a vibrant ecosystem at Vienna BioCenter, major Austrian biotechs choose foreign listings: HOOKIPA Pharma lists on Nasdaq, Valneva chose Euronext Paris.

Vienna's direct market plus segment offers very low costs (€5,000 initial, €1,000 annual) and €10 million minimum market cap guideline. However, the biotech investor base is extremely limited, and no new biotech IPOs occurred in 2024-2025. Not recommended for biotech IPOs.

Poland: CEE's Clear Leader

Warsaw Stock Exchange emerges as the clear CEE leader for biotech listings, hosting 15-20+ biotech/life sciences companies including notable success stories: Selvita (+846% since NewConnect debut, €100 million Menarini deal), Mabion (+475%, Novavax partnership for biosimilars), Celon Pharma (neurological/oncology), and Medicalgorithmics (cardiac telemetry, graduated NewConnect to main market).

The exchange launched the dedicated WIGmed Index in June 2024 covering biotechnology, pharma, medical equipment, and hospitals. NewConnect provides a proven SME stepping stone with simplified requirements and lower costs. Diagnostyka's February 2025 IPO (Poland's largest medical laboratory network, PLN 1.7 billion / ~$425 million raise, +23.8% first-day gain) demonstrates continued healthcare sector appetite.

Poland offers unique advantages: developed market status (FTSE Russell since 2018), PLN 2.3 trillion (~$633 billion) market cap making it CEE's largest exchange, and R&D cost advantages (1/5 to 1/7 of US competitors). Listing costs are competitive at ~PLN 30,000 (~$7,600) minimum plus 0.02% annual fees.

For CEE-based biotechs, Warsaw provides the most developed infrastructure with meaningful investor interest in healthcare.

Other CEE Markets: Not Recommended

Portugal offers negligible biotech public market presence—no significant public biotech companies exist on Euronext Lisbon, though private companies like Bial (largest Portuguese pharma) indicate an active private ecosystem. Companies typically seek acquisitions or foreign listings rather than domestic IPOs.

Israel: The Nasdaq Preference Model

Tel Aviv Stock Exchange hosts approximately 60 life sciences companies (including biotechs, medical devices, pharma, and holding companies like Clal Biotechnology), with 21 dual-listed on US markets. However, the most striking insight is Israeli biotechs' overwhelming preference for Nasdaq: 75% of Israeli biotech public capital has been raised on Nasdaq over the past decade, totaling $6.7+ billion.

Teva Pharmaceutical (NYSE/TASE dual-listed, ~$20-23 billion market cap) dominates, while other notable players include Kamada (plasma-derived products), Compugen (computational biology), Protalix (plant cell biologics), and RedHill Biopharma (GI diseases)—all dual-listed on Nasdaq/TASE. The ecosystem includes ~450 pharmaceutical companies, ~650 medical device companies, and ~700 digital health companies.

TASE recorded three consecutive years (2022-2024) without new biotech IPOs, while 4 Israeli biotechs raised ~$637 million on Nasdaq in 2024 alone. This preference reflects deeper US biotech investor pools, higher valuations, better analyst coverage, and proximity to US pharma partnership opportunities.

TASE's Dual-Listing Framework

TASE's dual-listing framework is notably streamlined—companies listed on eligible foreign exchanges (Nasdaq, NYSE, LSE, TSX) for 1+ year or with market value exceeding $150 million require no additional prospectus or disclosure obligations. This creates a 13-hour continuous trading window (Tel Aviv + US) and access to Israeli pension funds and institutional capital for follow-on offerings. Dual-listed companies constitute 40-60% of TASE's total market capitalization.

The Israeli Innovation Authority provides robust support including R&D grants (50-60% of costs), the new $30 million National Biotech Chip Lab, and €1.1 billion secured from EU Horizon Europe. TASE begins Monday-Friday trading in January 2026 (previously Sunday-Thursday), improving international accessibility.

Strategic insight for Israeli biotechs: Nasdaq remains the clear primary choice for significant capital raises. Pursue TASE dual-listing post-US IPO for Israeli institutional access, bond market participation (NIS 123.5 billion corporate bonds in 2024), and index inclusion benefits. TASE primary listing may suit pre-revenue companies that cannot meet Nasdaq thresholds.

Ireland: Corporate Domicile, Not Equity Venue

Euronext Dublin presents a paradox: Ireland hosts 9 of the world's top 10 pharma companies, employs 50,000+ in pharma/biotech, and generates €100+ billion in annual pharma exports—yet meaningful biotech equity listings are virtually absent. The exchange lists only ~20-37 equity companies total, with dominant sectors being building materials (CRH), gaming (Flutter), and food/pharma ingredients (Kerry Group, ~€14.8 billion market cap).

Most significant Irish-headquartered biotechs list on Nasdaq: Jazz Pharmaceuticals (Dublin HQ, Nasdaq primary), Prothena (~$442 million, neuroscience), Alkermes (CNS), and Horizon Therapeutics (acquired by Amgen for $27.8 billion in 2023). This reflects the standard pattern of Irish corporate domicile for tax efficiency combined with US capital markets for biotech capital access.

Ireland's tax advantages remain compelling: 12.5% corporate rate (increasing to 15% for large multinationals under OECD global minimum), 6.25% Knowledge Development Box rate for Irish R&D-derived IP, and 30% R&D tax credit (effective 42.5% total deduction). The regulatory environment is strong, with HPRA maintaining excellent relationships with FDA and EMA.

Euronext Growth Dublin offers lighter SME requirements (€5 million minimum market cap, admission document instead of full prospectus) and crucially, a streamlined dual Dublin/London AIM listing process. Enterprise Ireland's IPOready program supports pre-IPO preparation, with the 2024-2025 cohort being ~80% tech/life sciences companies.

Bottom line: Ireland is optimal as corporate domicile and manufacturing hub, but Euronext Dublin is best used for secondary listing, debt instruments, or fund structures rather than primary biotech equity raising. The Jazz Pharmaceuticals model—Irish domicile, Nasdaq primary—represents the proven template.

Exchange Support Programs: What Actually Helps

Exchanges have developed programs specifically supporting biotech companies, though their impact varies significantly.

Programs Worth Engaging

Euronext IPOready: 1,000+ alumni, 33 successful listings raising €1.6 billion. Free pre-IPO training covering governance, investor relations, and capital markets mechanics. The November 2025 Scale-Up Track specifically targets high-growth private companies preparing for public markets.

SIX Stage Program: Mandated research coverage from Baader Helvea, UBS, and Zürcher Kantonalbank addresses the critical analyst coverage gap. Newron Pharmaceuticals credited Stage Program participation for "increased investor awareness and interest due to the additional analyst coverage."

Nasdaq First North Certified Adviser: Mandatory adviser requirement provides ongoing guidance throughout listing—similar to AIM's NOMAD system. Useful for earlier-stage companies navigating public market requirements.

Structural Limitations to Understand

AIM's NOMAD System: While valuable for governance, cannot address the fundamental lack of specialist biotech capital in UK markets. Company numbers at 20+ year lows reflect deeper structural challenges.

Deutsche Börse Scale: Research coverage mandate helps, but cannot overcome German investor wariness toward biotech risk. The success stories (BioNTech, CureVac) chose Nasdaq over Frankfurt.

The 2026 Outlook: When to Move

Consensus among ECM bankers, investors, and advisors points toward IPO market normalization in 2026. The current environment reflects accumulated headwinds: Fed rate uncertainty, FDA budget cuts (proposed 25% workforce reduction), and biotech-specific regulatory concerns.

Per ION Analytics: "At some point, likely in 2026, we are going to have a normal biotech IPO market"—defining normal as 30-40 IPOs annually, consistent with 2017-2019 averages. EY's analyst stated: "For the rest of 2025, you do not see that IPO window opening, it's going to stay shut. But 2026 is a different story."

Interest rates remain the dominant macro variable. The XBI biotech index is extremely sensitive to Fed policy—it fell nearly 5% on a single day when the Fed signaled fewer 2025 rate cuts. J.P. Morgan forecasts Fed Funds declining from 4.0% to 3.5% by end of 2026, which should support biotech valuations.

The backlog is substantial. Per KELES Managing Partner David Buller: "There's a huge backlog of IPO-ready biotechs or biotechs that are ready for the next funding round, whether it's VC or IPO." HSBC notes that mega-rounds (>$100 million) grew 70% to 106 in 2024, with over half including crossover investors—suggesting a strong IPO pipeline.

Alternative Pathways in Closed Windows

PIPEs: Dominated 2024 with $15.5 billion across 107 deals—often priced at premiums rather than traditional discounts. Follow-on markets remain robust at $26.7 billion raised in 2025.

M&A: Biotech M&A YTD 2025 deal value ($49 billion) already surpasses all of 2024 ($44 billion). Johnson & Johnson's $14.6 billion acquisition of Intra-Cellular Therapies (January 2025) exemplifies how acquirers are stepping in as IPO markets remain constrained.

Strategic Decision Framework: Where Should You List?

Phase 2/3 Companies Seeking $150-300 Million

Recommended: Nasdaq directly.

The US offers superior capital depth, specialist investor participation, and higher valuations despite elevated compliance costs. Target Q4 2025 windows or 2026 for optimal market conditions. The median substantial biotech IPO now exceeds $200 million—achievable only on US markets.

Earlier-Stage Companies (Phase 1, Preclinical)

Recommended: AIM, First North, or Euronext Growth as interim venues.

Build clinical track record, achieve milestones, then pursue Nasdaq dual-listing when data supports a larger raise. The "Euronext-first, Nasdaq-later" path has proven effective for argenx, Galapagos, and numerous other European biotechs. Costs run 2-5% of transaction versus 10-15% in the US.

European-Focused Commercial Plays

Recommended: Euronext Paris or SIX Swiss Exchange.

For companies with primarily European commercial focus and limited US ambitions, these markets offer appropriate capital access with lower regulatory burden. SIX's Stage Program provides valuable research coverage; Euronext's Tech Leaders segment offers visibility.

Companies with US Commercial Ambitions

Recommended: Nasdaq, regardless of domicile.

The "European discount" makes US listing nearly essential for companies pursuing FDA pathways and US commercialization. US analyst coverage and investor familiarity directly support commercial success. The Jazz Pharmaceuticals model (Irish domicile, Nasdaq primary) provides tax efficiency with capital access.

Israeli Biotechs

Recommended: Nasdaq primary, TASE secondary.

75% of Israeli biotech capital has been raised on Nasdaq. Pursue TASE dual-listing post-IPO for Israeli institutional access, bond market participation, and index inclusion. The streamlined dual-listing framework (no additional prospectus for $150M+ companies) makes this efficient.

CEE-Based Companies

Recommended: Warsaw Stock Exchange.

Warsaw provides the most developed CEE infrastructure—dedicated WIGmed index, proven IPO track record (Diagnostyka's $425 million raise), NewConnect growth pathway, and FTSE Russell developed market status. Avoid Prague, Budapest, and Athens for biotech IPOs.

Companies Seeking Corporate Domicile Advantages

Recommended: Irish domicile with Nasdaq primary listing.

Ireland offers the best tax structure (12.5%/15% rate, R&D credits, IP allowances) and regulatory environment. Combine with Nasdaq primary listing for capital access—the Jazz Pharmaceuticals model represents the proven template.

Summary: Listing Requirements Comparison

Comprehensive Market-by-Market Summary

The fundamental reality facing pre-IPO biotech executives is stark: no European exchange matches Nasdaq's biotech-specialized investor depth, analyst coverage, or valuation premiums. The strategic question is not whether to access US markets eventually, but when and how. For companies with clinical validation and global ambitions, direct Nasdaq listing offers the clearest path to transformative capital. For earlier-stage companies, European junior markets provide viable stepping stones—building track records and achieving milestones before graduating to US markets when data supports larger raises.

The "European discount" is real and persistent. Trade European simplicity for US scale based on your company's stage, capital needs, and commercial ambitions. The data increasingly supports US listing as the destination—with European markets serving as strategic waypoints in that journey.

Disclaimer: I am not a lawyer or financial adviser. This article does not constitute investment advice, legal advice, or financial advice of any kind. All information presented here is derived from publicly available sources including SEC filings, press releases, and industry reports. Details of specific transactions may have changed since publication. Readers should conduct their own due diligence and consult with qualified legal and financial professionals before making any investment or business decisions.