Cigna to buy Express Scripts

Cigna agreed to buy Express Scripts Holding Co. 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.

The price includes $48.75 in cash and 0.2434 shares of stock of the combined company per Express Scripts share, the companies said in a statement Thursday.

The terms represent a roughly 31 percent premium to Express Scripts’ closing price on Wednesday, according to the statement. Cigna will assume approximately $15 billion in Express Scripts debt, which the companies said will put the total value of the deal at $69.6 billion.

Express Scripts is the largest remaining independent drug middleman. Its biggest competitors are the pharmacy-benefits management companies run by CVS Health Corp. 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 dis- pense 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.”