Express Scripts Holding Co. agreed to pay $3.6 billion to acquire closely held EviCore Healthcare, a company that preapproves scans and other costly medical tests for health plans.

The deal comes as Express Scripts, a pharmacy benefit manager (PBM), is facing challenges on a number of fronts, including the possible loss of its largest customer, health-insurance giant Anthem Inc., and the potential entry of Amazon.com Inc. into the business of managing prescription-drug benefits.

Shares of Express Scripts, which have shed more than 15% of their value so far this year, fell 2.1% to $57.97 at 11:37 a.m. in New York.

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