The United States is the world’s most expensive healthcare system, and insurers are contending with rising drug costs, changes to the Affordable Care Act and possible competition from companies like Amazon.com Inc (AMZN.O), Berkshire Hathaway Inc (BRKa.N) and JPMorgan Chase & Co (JPM.N). The deal follows the proposed $69-billion tie-up between insurer Aetna Inc (AET.N) and one of Express Scripts’ biggest rivals, CVS Health Corp (CVS.N), announced in December. Express Scripts shares were up 11.5 percent at $81.99 on Thursday morning, but they were trading more than 10 percent below the current value of the bid, suggesting that some investors believe there could be difficulties closing the deal.
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