Key Points:
• Cash and stock is commonly used in combination in megamergers to
—Appeal to a wider array of target shareholders,
—Provide cash to allow target shareholders to pay tax liabilities, and
—Finance a portion of the purchase price with a noncash form of payment
• Fixed exchange ratios often are used to allow the buyer to better determine potential dilution to current
shareholders from issuing new shares
• Deal structures can be used to preserve valuable intangible property such as brand names, tradenames,
franchises, contracts, etc.
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With US healthcare spending at 18% of gross domestic product in 2018, healthcare delivery companies are
struggling to lower costs. An aging population, expensive new drugs and costly technologies, and an inefficient
delivery system combine to stoke the upward spiral in healthcare costs. Pharmacy chains struggled to compete in the
e-commerce space, where they are being undercut on price by online drug sellers. To make matters worse,
Amazon.com, already offering over-the-counter drugs, showed interest in selling prescription medications. Seeing
the threat, large healthcare providers pondered their response to the changing competitive landscape.
CVS has more than 9,800 retail locations and more than 1,100 walk-in clinics across the US. The firm is also a
leading pharmacy benefits manager with more than 94 million plan members, serves more than one million patients
annually through its senior pharmacy care business, and is a leading standalone Medicare Part D prescription drug
plan. As one of the leading diversified healthcare benefits firms, Aetna served 37.9 million people as of the end of
2017. Aetna offers a broad array of health insurance products, Medicaid healthcare management services, Medicare
Advantage and Medicare supplement plans, and workers compensation administrative services.
Characterized as a community based open healthcare model, CVS and Aetna see their combination as a means
of using CVS’ retail stores to slow escalating healthcare costs. The hope is to attract more people to walk-in clinics,
keeping them out of more expensive emergency rooms. The combined firms expect to improve the quality of care
To transfer ownership, CVS created a wholly owned subsidiary, Merger Sub, which will be merged with
Aetna at closing, with Aetna surviving. Known as a reverse triangular merger, this structure generally eliminates the
need for parent firm shareholder approval of the merger, as the parent is the sole shareholder in the Merger Sub.
Because of potential for significant current shareholder dilution, CVS did seek shareholder approval to issue 280
million new shares which it overwhelmingly received at a special shareholders’ meeting on March 13, 2018. Since
Aetna survives the merger, it retains any franchise, lease, or other valuable contract rights that otherwise may have