The dominant player behind the Trade-Related Intellectual Property (TRIPs) agreement, as regards patents, was a handful of American pharmaceutical transnational corporations ('big pharma'). Given that TRIPs was exceptionally controversial, how was US big pharma uniquely enabled to command the entire trade diplomatic machinery of the US and, through that, enact global law in its favour? This paper explores one crucial factor in the enacting of TRIPs, namely the prior pursuit of domestic US patent reform, from which a highly integrated and powerful single-issue political coalition between US big pharma, the new biotechnology sector and academic life science departments was formed. This created the political context in the US in which patent issues, particularly those affecting the pharmaceuticals industry, came to be considered matters of state. But explaining both the success of this patent coalition and the subsequent success of the US-led international demands for TRIPs in turn demands appeal to analysis of the structure of the global economy and its transformation to one of neoliberal financialisation, from a watershed of 1980. The paper explores how the critical histories of each of the three sectors of the patent coalition are illuminated by analysis in the context of this structural change and the underlying connections between apparently disparate issues it reveals.