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CVS Bloom Corp. bought bloom insurer Aetna Inc. for about $70 billion. Cigna Corp. paid about $54 billion for pharmacy-benefits administrator Express Scripts Holding Co.

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These deals and others accept been able accumulation armament in the U.S. bloom industry, with aerial amount tags accompanied by investment-grade band issuances.

Now they alert a new question: Is banking accident additionally accepting concentrated?

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Maybe, according to a new agenda out from Fitch Ratings.

Just ten companies, including CVS CVS, 0.60%  and Cigna CI, 0.09% annual for 51% of the investment-grade bloom affliction bonds outstanding, according to the acclaim appraisement agency. Investment-grade refers to low to abstinent acclaim risk, and includes Fitch ratings amid “AAA” and “BBB.”

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“The angle for the area charcoal complete due to solid basal appeal advance for best types of healthcare articles and casework but bottomward appraisement clearing is occurring as the area is accumulation and companies are allotment ample cardinal acquisitions,” the Fitch address said.

Related: These 7 states are best at accident from ascent health-care costs

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To some extent, this is annihilation abnormally new, the address notes, calling the bloom affliction area “one of the better contributors to the access in absolute high-grade band arising over the accomplished decade.”

Lower accident bonds, in aggregate, accept about tripled back 2008, to absolute about $609 billion as of the end of September, per Fitch. Today, 30 bloom affliction companies are amenable for about 90% of industry investment-grade bonds outstanding, the address said.

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Notably, CVS issued $40 billion of chief apart bonds in abutment of its Aetna AET, -0.08% acquisition, and Cigna issued $20 billion in following of its Express Scripts ESRX, 0.63% deal, Fitch noted.

Read: Medical practices accept become a hot advance — are profits actuality put advanced of patients?

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Most of the sector’s outstanding bonds accept a blended appraisement of “BBB,” or 58%, Fitch said; beneath than 10% of those “BBB”-rated bonds are “BBB-”, which is the everyman of the investment-grade ratings, including Mylan NV MYL, -0.35% and Allergan PLC AGN, -1.92%

Credit ratings agencies may decline aggregation ratings afterwards ample acquisitions, depending on the company’s specific bearings and banking leverage.

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See: Added and added bloom affliction bills are over $1 million—and big-ticket drugs are arena a above role

One archetype of that is Teva Pharmaceutical Industries Ltd. TEVA, -0.61% which was downgraded two notches by Fitch from “BBB-” to “BB” because of debt from the company’s Actavis accretion and added operational stressors. “BB” is the additional accomplished speculative-grade, or “junk” rating, at Fitch.

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The Bloom Affliction Select Area SPDR XLV, 0.25%  was up 1% in Monday trade, and shares accept acquired 0.4% over the aftermost three months. The S&P 500 SPX, -0.66%  has alone 5.6% over the aftermost three months, while the Dow Jones Industrial Average DJIA, -0.99%   has beneath 3.2%.

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