Medco Health Solutions Inc. reported a 12 percent jump in fourth-quarter earnings Tuesday, but the first question analysts had for company executives on a conference call concerned the pending acquisition by Express Scripts Inc.

Express Scripts, a Medco competitor, announced in July a $29.1 billion deal to buy Medco, a combination that would create the largest U.S. pharmacy benefits manager. Shareholders from both companies have approved the deal, and Medco said Tuesday it remains confident the acquisition will close in the first half of this year.

Pharmacy benefits managers, or PBMs, process mail-order prescriptions and handle bills for prescriptions filled at retail pharmacies, acting as middlemen between employers offering prescription drug benefits and drugmakers.

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