In March 2018, Cigna announced its intention to purchase Express Scripts for $67 billion and accelerate the shift to value-based care in the U.S. healthcare market. The company recognized that there had been significant changes to the health care market and delivery system that made the combination of a pharmacy provider and a company with an integrated medical offering and health services portfolio like Cigna's a perfect tie up. In short: the time was right for a new model of care that would focus on the whole person, accelerate personalized health care options, and improve patient outcomes and total health.

As any M&A practitioner knows, even the best combinations can face detractors. Despite the clear rationale for the deal, the management team was tasked with navigating a number of challenges, including uncertainty around the current administration's views on pharmacy benefit managers, general concern around corporate consolidation following news of CVS's proposed acquisition of Aetna, and Amazon's, Berkshire Hathaway's, and JPMorgan Chase's announced plans to form an independent health care organization for their employees in the United States. There was also seemingly unrelated, but noisy discussion of corporate tie-ups stemming from the Justice Department's decision to attempt to block AT&T's planned merger with Time Warner, creating further uncertainty among Cigna's stakeholders regarding antitrust enforcement. As a result, in the days following the announcement, shares of the Company declined. Despite these headwinds, the management teams remained confident that the core benefits of this combination – focusing care on the whole person, accelerating personalized health care options, and improved patient outcomes and total health – would ultimately be realized by all of Cigna's stakeholders.