Nothing would be different, and LP would have given away the store
The $250M cash would mean that instead of being 1.5+ B shares (counting all shares owed), there would be about 120M as they would not have needed to dilute. Try doing the market cap math.
And also cash to run the Direct trials.
Oh, and maybe it does not take MRK years after a trial is over to file for approval because they have people who actually do this stuff.