The purpose of this study was to test the unexplored relationship between market orientation (MO), alliance orientation (AO), and business performance (PERF) in the medical/healthcare subsector of the Canadian biotechnology industry. The study surveyed Canadian biotechnology executives via mail and web-based questionnaires. It was found that the relationship between MO and PERF was positive and significant and the relationship between AO and PERF was positive and significant. It was also found that the relationship between MO and AO was positive and significant, supporting the existence of a mediation relationship. Specifically, MO’s influence on PERF was found to be fully mediated by AO. This suggests that Canadian medical/healthcare biotechnology companies that were highly market-oriented were also highly alliance-oriented, and highly alliance-oriented companies were top performing companies. This study outlines the apparent sequential relationship between market-oriented behavioural commitments, alliance-oriented activities, and business performance outcomes among Canadian biotechnology companies. Furthermore, it has business development and the commercialization process implications for biotechnology managers.