Cigna in March 2018 announced it will acquire pharmacy benefit manager Express Scripts in a $67 billion cash and stock deal.  According to Cigna CEO David Cordani, the merger “will drive health care costs down while improving the quality of care.” The proposed merger would allow Cigna to lower its costs by in-sourcing pharmacy benefit management (PBM) services, and to absorb Express Scripts’ profits. How can Cigna lower its