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The health insurance deal went public Thursday morning. Photo: James Leynse / Corbis via Getty Images

Health insurer Cigna has agreed to buy pharmacy benefit giant Express Scripts for $52 billion in cash and stock. Including debt, the deal is valued at $67 billion. The Wall Street Journal first reported about the deal Wednesday night.

The big picture: The health care industry continues to consolidate at a breakneck pace. CVS Health and Aetna are attempting to combine in a similar tie-up of health insurance and pharmacy benefit management. Numerous hospital systems and other health care companies also are rushing to merge in what has become an all-out turf war.

Driving the news: Anthem split ways with Express Scripts after Anthem said Express Scripts pocketed "obscene" profits from their prescription drug contract.

  • Because Express Scripts lost a highly profitable drug plan client, which drove a lot of negativity on Wall Street, Express Scripts became a takeover target.
  • We previously reported that Cigna had a lot of cash to spend and made it clear it would be on the prowl for some kind of deal after its merger with Anthem flopped. But it appears Medicare rival Humana is not on the table for now.
  • Health insurers and pharmacy benefit managers have been aligning more, like CVS and Aetna, in an attempt to save costs on drugs.
  • Yes, but: What's old is new again.

Go deeper

Mike Allen, author of AM
34 mins ago - Politics & Policy

Manchin's next power play

Photo: "Axios on HBO"

Sen. Joe Manchin (D-W.Va.), America's ultimate swing voter, told me on "Axios on HBO" that he'll insist Republicans have more of a voice on President Biden's next big package than they did on the COVID stimulus.

The big picture: Manchin said he'll push for tax hikes to pay for Biden's upcoming infrastructure and climate proposal, and will use his Energy Committee chairmanship to force the GOP to confront climate reality.

Why picking a jury for the Derek Chauvin trial is so hard

Illustration: Eniola Odetunde/Axios

The tough task of selecting a jury for former MPD officer Derek Chauvin's trial for the killing of George Floyd is set to begin Monday.

The state of play: "This case may be the most highly publicized criminal trial in a long time. ... That means that it's harder to find people who really have an open mind," Richard Frase, University of Minnesota Law School professor of criminal law, told Axios.

Why it's so hard to sign up for vaccinations online

Illustration: Aïda Amer/Axios

The verdict from Americans trying to get the COVID vaccine is in: the sign-up websites are awful.

Why it matters: Appointment systems are a vital part of getting Americans vaccinated, but a series of missed opportunities, at every level, left local governments scrambling. And the frustrating, confusing process now carries the risk that some people will simply give up.