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The Justice Department’s approval of the $69 billion merger between CVS Health and Aetna on Wednesday caps a wave of consolidation among giant health care players that could leave American consumers with less control over their medical care and prescription drugs. The approval marks the close of an era, during which powerful pharmacy benefit managers brokered drug prices among pharmaceutical companies, insurers and employers. (Abelson, 10/10)

The Justice Department on Wednesday approved the deal on the condition that Aetna moves ahead with its plan to sell its Medicare Part D prescription drug plan business, resolving some anti-monopoly issues. (10/10)

"Today's settlement resolves competition concerns posed by this transaction and preserves competition in the sale of Medicare Part D prescription drug plans for individuals," Assistant Attorney General Makan Delrahim, who leads the Justice Department's antitrust division, said in the announcement. "The divestitures required here allow for the creation of an integrated pharmacy and health benefits company that has the potential to generate benefits by improving the quality and lowering the costs of the healthcare services that American consumers can obtain." (Livingston, 10/10)

CVS said that it already had gotten “many” of the state approvals it needs. “We are pleased to have reached an agreement with the Justice Department that maintains the strategic benefits and value creation potential of our combination with Aetna,” said CVS’s chief executive, Larry Merlo. “We are now working to complete the remaining state reviews.” Aetna rival Cigna Corp. has already gotten Justice Department antitrust clearance for its acquisition of Express Scripts Holding Co. , which also brings together a major health insurer with a pharmacy-benefit manager. (Wilde Mathews and Maidenberg, 10/10)

The tie-up will allow CVS — whose retail pharmacy business serves 5 million customers a day — to turn more of its brick-and-mortar locations into front-line clinics for basic medical services and patient monitoring. By deepening its knowledge of and relationships with patients, CVS has said the combination could help Americans stick with medication regimens and stay out of the hospital. (Fung, 10/10)

Aetna and CVS have argued that a merger would improve health-care outcomes and reduce costs immediately. They have plans to turn CVS’s 10,000 pharmacies and clinics into community-based sites of care with nurses and other health professionals available to give diagnoses or do lab work. The merger also means that there will no longer be any independent pharmacy benefit managers in the U.S. (Hellmann, 10/10) 

Consolidation has increased across health care among hospitals, drugmakers and insurers, though some previous deals were thwarted by antitrust issues. The Cigna and CVS deals came only after the Justice Department blocked Cigna and Aetna from merging with rival health insurers last year. Completion of the CVS-Aetna deal could put pressure on rivals to come up with their own deals. Walgreens Boots Alliance Inc. is the U.S.’s last remaining giant standalone pharmacy chain, and its deal-friendly CEO, Stefano Pessina, has spoken about bringing together pieces of the medical supply chain. Walgreens holds a 26 percent stake in drug distributor AmerisourceBergen Corp., which helps supply Walgreens stores, and last winter the companies held early discussions about about a merger, according to reports at the time. (McLaughlin and Langreth, 10/10)

The Department of Justice’s blessing for CVS Health’s takeover of Aetna will have ripple effects that go far beyond the candy racks at your local drugstore. ... Although CVS still needs some state approvals, the Department of Justice agreement was the big milestone — a key victory for chief executive Larry Merlo and his leadership team. (Chesto, 10/10)