Cigna Corp. CI -0.03% and Express Scripts ESRX 0.13% Holding Co. shareholders overwhelmingly supported Cigna’s $54 billion purchase of the pharmacy-benefit manager, a deal that activist investor Carl Icahn initially sought to block.
The deal received the backing of about 90% of Cigna shareholders, the health insurer said Friday, citing a preliminary vote tally. Of the Express Scripts ESRX 0.13% shareholders who voted Friday, 99% approved the deal.
Shares in Cigna and Express Scripts rose 0.1% and 0.6%, respectively, in Friday morning trading.
The Wall Street Journal previously reported Aug. 1 that Mr. Icahn had a stake in Cigna and planned to oppose the deal because of concerns that companies like Express Scripts that act as middlemen could see their revenue sources change under policy proposals expected from the Trump administration to lower drug prices.
The billionaire publicly opposed the deal about a week later and urged fellow shareholders to vote against it. But he dropped his plans to solicit votes against the deal less than a week later after two major proxy-advisory firms recommended shareholders support the deal.
He faced an uphill battle from the onset, in part because he waited until weeks before the vote to come forward, and a significant amount of Cigna shareholders also held stakes in Express Scripts, so had an interest in seeing the deal pass. Prominent hedge fund Glenview Capital Management LLC also came out in support of the deal.
Cigna and Express Scripts say their merger, announced in March, will expand their health-care offerings and help them control costs. The deal comes amid a furious round of consolidation as health-care companies seek to position themselves to provide more cost-effective care and fend off heightened competition from Amazon.com Inc. and others.
Cigna expects the transaction to close by the end of 2018.
—Cara Lombardo contributed to this article.
Corrections & Amplifications
About 99% of Express Scripts shareholders voting Friday backed Cigna’s $54 billion purchase of the pharmacy-benefit manager, based on a preliminary count. An earlier version of this article incorrectly said 78% of shareholders backed the transaction. (Aug. 24)
Write to Kimberly Chin at kimberly.chin@wsj.com