Cigna-Express Scripts clears final regulatory hurdle.

The lines are now blurring between pharmacy benefit managers, which used to operate independently, and insurers. Now, many payers have gobbled up PBMs.

The union highlights the growing trend of healthcare companies vertically integrating to combat headwinds including softening patient admissions and ever-rising healthcare costs.

By combining both the medical and pharmaceutical benefit under one umbrella, analysts say companies can potentially achieve greater costs savings than may have been possible with separate entities.

Analysts have said that by vertically integrating, PBMs and payers will have a better shot at reining in the rising costs of specialty drugs.

But some have said the deal was a way to stave off a threat poised by Amazon as it delves deeper into the healthcare space.

The Express Scripts acquisition came on the heels of its rival, CVS, making a bid for Aetna.

CVS and Aetna are still waiting for final approval for their marriage agreement from a federal judge who has proved to be an unexpected barrier to the deal’s closing.

While Cigna and Express Scripts escaped intervention from the DOJ, CVS and Aetna agreed to sell off Aetna’s Medicare Part D business in order for the deal to clear DOJ scrutiny.

D.C. District Court Judge Richard Leon raised concerns about the potential anticompetitive effects of the deal since the settlement only addresses “one-tenth of one percent” of the almost $70 billion deal. The deal needs Leon’s approval, which is usually a formality, experts have said.

In court on Tuesday, Leon suggested a monitor be appointed to ensure the two entities remain separate until the deal is finalized.