Express Scripts was the last large independent pharmacy benefits manager, or PBM, in the US. A PBM acts as a middleman in negotiations between drugmakers and the payers (i.e. employers, insurers, and government), which buy medicines in the US. With its $67 billion takeover of Express Scripts, health insurer Cigna is sending a signal that it will have to get bigger to deal with the most pressing malady of US healthcare: soaring costs. By buying Express Scripts, Cigna hopes to gain more scale so it can drive a harder bargain when buying drugs and services, not just from pharmaceutical companies, but also the doctors and hospitals that provide patient care.
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