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Max Nisen

Congratulations, Cigna! Now Comes the Hard Part.

It just got the green light to pay up for a company in an industry whose business model has come under siege.

A megadeal, with health risks.

A megadeal, with health risks.

Photographer: Andrew Harrer/Bloomberg

Cigna Corp. has successfully dodged two giant obstacles in its attempt to purchase pharmacy-benefit manager Express Scripts Holding Co. First, it got past Carl Icahn, who tried to convince investors to vote no on the deal in August, only to drop the effort days later after giving it further thought. And on Monday afternoon, it won clearance from the Department of Justice to go ahead with the transaction. 

But the hardest part lies ahead. This is a period of massive uncertainty for the PBM business, and Cigna is paying $54 billion for the pleasure of having to navigate it.