Underscoring the transformation in health care, the CVS (CVS) pharmacy giant’s deal to buy Aetna, one of the nation’s largest health insurers, has the potential for lowering costs, but also further concentrating key services among a very few large companies.

The $69 billion merger, which must still be approved by shareholders and regulators, would combine the vast network of 9,700 CVS pharmacies, 1,100 walk-in clinics, and its Caremark pharmacy benefit management business with Aetna’s expansive employer and government health plans. The insurer covers more than 22 million Americans.

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