Cigna Corp. agreed to buy Express Scripts Holding in an about $54 billion deal that builds on the rapid transformation of the health care business as companies and consumers chafe at rising costs.
Express Scripts is the largest remaining independent drug middleman. Its biggest competitors are the pharmacy-benefits management companies run by CVS Health and UnitedHealth Group.
The transaction is the latest in a series of moves by companies inside and outside the health sector to tame medical expenses. Many of the complaints about costs have focused on drugs, with criticism focused not just on pharmaceutical companies but also on the middlemen in the supply chain that oversee, distribute and dispense medications.
Pharmacy-benefits managers have come under particular pressure in recent weeks. President Donald Trump’s Council of Economic Advisers, in a report last month, criticized the companies’ market power and the opacity of their drug-price contracts.
And on Wednesday, Food and Drug Administration Commissioner Scott Gottlieb took aim at what he called drug plans’ “rigged payment scheme.”
Employers also are increasingly restless over their high health care bills. Amazon.com said earlier this year it would team with Berkshire Hathaway and JPMorgan Chase on a new venture aimed at lowering employee health costs. And large employers from Wal-Mart to Blackstone Group are experimenting with ways to reduce their outlays on employee health care.
“This transaction is yet another proof of ongoing vertical integration of health care providers and payers,” said Brian Tanquilut, an analyst with Jefferies Group.
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On a conference call, executives said that the deal provided a particular opportunity to help manage spending for costly medicines for cancer and other complex diseases. Management of the use of those drugs has often been split between insurers and PBMs, and the merger could make their use more efficient.