The Department of Justice on Wednesday approved a $69 billion merger between prescription-drug behemoth CVS and insurance giant Aetna, with some strings attached.

The massive merger is just the latest grand-scale restructuring of the health care industry, which is under pressure to rein in unwieldy costs while facing competitive threats from tech giants, such as Amazon, joining the fray.

CVS, which racked up about $185 billion in revenue last year, runs the country’s largest retail-pharmacy chain and provides prescription plans to more than 94 million customers . By joining forces with Aetna—the nation’s third-largest health-insurance provider with over 22 million medical members , earning $60 billion in revenue in 2017—CVS will have a tight grasp on the market. The combined enterprise aims to be a first-line health care hub with clinics in its ubiquitous brick-and-mortar stores.

"CVS Health and Aetna have the opportunity to combine capabilities in technology, data, and analytics to develop new ways to engage patients in their total health and wellness,” CVS Health President and Chief Executive Officer Larry Merlo said in a statement. “Our focus will be at the local and community level, taking advantage of our thousands of locations and touchpoints throughout the country to intervene with consumers to help predict and prevent potential health problems before they occur.”

To have antitrust officials at the DOJ sign off on the merger, Aetna will sell off its Medicare Part D business to a subsidiary of WellCare Health Plans, Inc. The move appeases the DOJ’s concerns of anticompetitive effects given that CVS already has its own Medicare Part D prescription drug plans under the “SilverScript” brand.

Major changes

The Aetna-CVS mashup is just the latest tectonic shift in the health care industry. Last month, the DOJ gave the green light to a similarly colossal $67 billion merger between Cigna, another top health insurance company, and Express Scripts, the country’s largest pharmacy-benefit manager with more than 80 million members. Last year, UnitedHealth Group, yet another leading insurance provider, announced plans to buy a large physician group, DaVita’s primary and urgent care services, for $4.9 billion.

And just yesterday (October 10), CVS-rival Walgreens announced a partnership with diagnostic titan LabCorp. The pair plans to open in-pharmacy blood testing in at least 600 Walgreens stores across the country in the next four years. The move comes after Walgreens was burned by a similar deal with the disgraced and shuttered blood-testing startup Theranos. Walgreens settled a $140 million lawsuit with Theranos last year , reportedly for just $30 million. The new partnership, much like the CVS-Aetna deal, is designed to turn corner drug stores into one-stop health care centers.

“This reflects our commitment to transform our stores into neighborhood health destinations that provide a differentiated, consumer-focused experience, while providing access to a broad range of affordable health care services at a trusted and convenient setting,” executive vice chairman and CEO of Walgreens Boots Alliance Stefano Pessina said in a statement.

Consumer health advocates, meanwhile, are expressing alarm at the large mergers and deals.

“Despite the companies’ big promises that consumers will see greater savings thanks to new ‘efficiencies,’ history has taught us to remain skeptical,” George Slover, senior policy counsel for Consumers Union, said in a statement in the wake of the CVS-Aetna merger approval. “This type of consolidation in a market already dominated by a few powerful players presents the very real possibility of reduced competition that harms consumer choice and quality.”

Yet those big players in the health care industry may see themselves on the defense as big tech companies, including Amazon, encroach on their turf. Just in June, Amazon announced that it was buying an online pharmacy startup with proprietary software and licenses to work in all 50 states. The move shook retail pharmacies, causing stocks of Walgreens, CVS, and Rite Aid to collectively lose $12.8 million in the wake of the announcement.

And Amazon isn’t just going in on prescription drugs—it has partnered with Berkshire Hathaway and JPMorgan to form a venture that tackles healthcare access and costs for the trio’s employees. The endeavor, which is still in embryonic stages, will have public-health expert Dr. Atul Gawande as its CEO.