Following in the footsteps of other insurance giants, Cigna announced on Thursday plans to acquire Express Scripts, the largest pharmacy benefit manager in the U.S., for $52 billion.

The deal, which is expected to close at the end of December, is still awaiting regulatory approval as well as approval from both companies’ shareholders.

CVS Health, the largest pharmacy health care provider in the country, acquired Aetna in December 2017 for $69 billion. UnitedHealth owns OptumRx and Anthem announced plans in October 2017 to partner with CVS Health to start its own pharmacy business.

David A. Balto, an antitrust lawyer who worked at the Federal Trade Commission and the Justice Department, told the New York Times that federal and state officials may be reluctant to approve the Cigna-Express Scripts deal because that would leave no large independent pharmacy manager for smaller insurers.

Former Attorney General of Louisiana Charles C. Foti Jr., Esq. and the law firm of Kahn Swick & Foti LLC, have announced they are investigating the deal because shareholders of Express will receive only $48.75 in cash and 0.2434 shares of the combined company's stock for each share of Express that they own. The law firm is seeking to determine whether this consideration and the process that led to it are adequate, or whether the consideration undervalues the company.

A little over a year ago, a federal judge denied Anthem’s proposed $52 billion merger with Cigna. In January 2017, the federal court also blocked a $37 billion-merger between Aetna and Humana.

“Employers are growing increasingly frustrated with the cost of prescription drugs and a lack of transparency into the economics of how this works,” Jim Winkler, senior vice president for health at benefits manager and broker Aon, part of Aon Plc, told Reuters.

Cigna and Express Scripts claim that the acquisition will lower costs for corporate clients since it will foster more coordination between medical care and pharmacy benefits. It will also provide consumers with greater choice because the companies will work together to create an expanded portfolio of health services.

The transaction is valued at $67 billion — Cigna will owe Express Scripts $15 billion in debt. If the deal closes, Cigna shareholders will own approximately 64 percent of the combined company and Express Scripts shareholders will own approximately 36 percent.

The combined company will have Cigna branding, and its headquarters will be in Bloomfield, Connecticut, which is Cigna’s current headquarters. Thirteen directors will be added to the combined company’s board, including four independent members of the Express Scripts board.

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