Amazon’s roughly $1 billion acquisition of online pharmacy PillPack marks the retail giant’s latest effort to push into the crowded healthcare space and follows its alliance with JPMorgan Chase and Berkshire Hathaway to lower the cost of covering employees.

Amazon’s might sent investors in competing companies running for the hills, with shares of Rite Aid, Walgreens Boots Alliance and CVS Health hard hit. Consolidation is a game plan for some, with Cigna in March saying it would buy Express Scripts for $52 billion and Rite Aid and Albertsons working on a deal.

Amazon was reportedly on the brink of deciding late last year whether to sell drugs online. In April, it shelved a plan to sell drugs to hospitals through its Amazon Business marketplace. Now, it’s going all in.

For good reason: The U.S. healthcare industry is a convoluted mess. According to a recent study by the Commonwealth Fund, the U.S. healthcare system is the worst among high-income nations, despite costing the most. The U.S. Centers for Medicare and Medicaid Services estimates U.S. health spending came to nearly $3.5 trillion last year.

Amazon’s intent for entering into the venture with JPMorgan and Berkshire was to squeeze waste out of the cost of care by dispensing with profit-sucking middlemen like pharmacies.

PillPack delivers medications in pre-sorted dose packaging, coordinates refills and renewals and ensures shipments are delivered on time. The service is currently available in every U.S. state, except Hawaii. The deal will let Amazon ship prescriptions overnight in a direct threat to the $400 billion U.S. pharmacy industry.

The purchase echoes Amazon’s buying a 40 percent stake in Drugstore.com in 1999. This time, Amazon CEO Jeff Bezos is betting on a better outcome, as Drugstore.com shares tanked during the dot-com bust and the was eventually shut down in 2016 after being purchased by Walgreens.