CVS Health → Aetna
CVS Health's $69bn takeover of Aetna, agreed in December 2017, put a drugstore chain, the Caremark benefit manager and a national health insurer into one company — a bet on vertical integration that a federal judge was still examining nine months after the deal had closed.
About $77bn including debt, combining a pharmacy chain and benefit manager with a health insurer.
- Value
- $69B
- Announced
- December 2017
- Completed
- November 2018
- Sector
- Healthcare
- Deal type
- acquisition
- Acquirer
- CVS Health (United States)
- Target
- Aetna (United States)
Why it mattered
Aetna, with 22 million medical members, had just lost its own attempt at scale: in January 2017 a federal judge blocked its merger with Humana because it would leave older people with fewer Medicare options. CVS owned CVS Pharmacy and CVS Caremark, which manages prescriptions for more than 75 million plan members. The logic was to combine an insurer's members and claims with CVS's local stores, turning them into places that offered medical services as well as medicines.
The terms, announced on 3 December 2017, were $145 in cash and 0.8378 CVS shares for each Aetna share — about $207 a share, or $69bn, and $77bn including Aetna's debt — leaving Aetna's shareholders with about 22% of the group. Three banks committed $49bn of financing, and CVS promised $750m of near-term synergies.
The Justice Department cleared the deal on 10 October 2018 on condition that Aetna sell its individual Medicare Part D prescription drug plans to WellCare, and CVS completed the purchase on 28 November 2018, when the price was worth $212 a share, about $70bn. Judge Richard Leon, reviewing the settlement under the Tunney Act, insisted on hearing the deal's critics; in the meantime CVS agreed to let Aetna make its own pricing and personnel decisions. He approved it on 4 September 2019, while criticising the practice of closing deals before that review ends.
What it left behind
Karen Lynch, who had run Aetna after the deal, was named chief executive of CVS in November 2020, and the company pushed further into care delivery, agreeing to buy Signify Health for about $8bn in 2022 and Oak Street Health at an enterprise value of about $10.6bn in 2023. The insurer then became the problem. In 2024 medical costs ran above forecasts, CVS took about $1.1bn of premium deficiency reserves, mainly for its Medicare and individual exchange business, and on 17 October 2024 Lynch was replaced by David Joyner. In May 2025 CVS said Aetna would leave the Affordable Care Act exchanges in 2026; Aetna remains a CVS subsidiary as of September 2026. Vertical integration stacks the risks of each business rather than averaging them: pharmacy and benefit-management earnings could not shield the group when the insurer's medical costs outran its forecasts.