Cigna is buying massive pharma middleman Express Scripts for $67 billion in a move that changes the industry as we know it

• Cigna is acquiring Express Scripts, the largest standalone pharmacy benefits manager, in a $67 billion deal that includes $15 billion of debt.
• Express Scripts is one of the three massive pharmacy benefit managers that help negotiate lower prices for prescription drugs. The other two are OptumRx and CVS Caremark.
• The acquisition, which also brings a pharmacy benefits under the same roof as a health insurer, comes at a time when the entire healthcare business is being redrawn by takeovers .
  

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Cigna is buying Express Scripts in a $67 billion deal.

The health insurer is acquiring the pharmacy benefit manager in a deal that assumes $15 billion of Express Scripts' debt, and consists of $48.75 in cash and 0.2434 shares in the combined company. Without the debt, the deal totals about $54 billion.

Express Scripts is one of the three massive PBMs that help negotiate lower prices for prescription drugs in the form of rebates on behalf of health plans. It was the only major PBM to stand on its own and its stock has been weathering news that Amazon is interested in getting into healthcare.

The move brings medical benefits and prescription benefits under one roof at a time when prescription costs for new medications are getting to be as high as some medical procedures.

"Adding our company's leadership in pharmacy and medical benefit management, technology-powered clinical solutions, and specialized patient care model to Cigna's track record of delivering value through innovation, we are positioned to transform healthcare," Express Scripts CEO Tim Wentworth said in a news release Thursday.

What this means for healthcare

The boundaries of the healthcare business are changing. Instead of growing by acquiring other companies in the same business, companies have started to move into new lines of business, with no two combinations looking exactly the same.

It's part of a push by healthcare companies to do two things: cut costs, and gain more control over the patients in need of their services. It's coming at the same time large tech companies are eyeing ways to disrupt the healthcare industry as it faces entirely new medications that challenge the existing way we pay for treatments.

Should the deal go through, Cigna wouldn't be alone in controlling both the insurer and PBM part of paying for prescriptions. UnitedHealthcare , for example, owns the PBM OptumRx, while Anthem , which owns a variety of Blue Cross Blue Shield health insurance firms, will be launching its own PBM called IngenioRx, and with the CVS Health - Aetna deal, CVS Caremark and Aetna would be under the same roof as well.

With the acquisition, Cigna could have more oversight into who's paying for prescriptions.