Anthem Inc. is nearing a deal to buy Cigna Corp. for more than $48 billion in a transaction that, alongside another recent proposed tie-up of rivals, would reduce the number of companies atop the U.S. health-insurance industry to three from five.

Anthem is expected to pay about $187 a share for Cigna, according to people familiar with the matter. A deal between the two companies could be announced as soon as Thursday afternoon, one of them said. The combination still hasn't been signed and the timing could slip and terms could change.

An Anthem-Cigna tie-up would continue a rapid-fire attempted reconfiguration of the top echelon of the managed-care industry, which provides a vital service to vast swaths of the American population. The biggest players are seeking cost efficiency and scale as the health-care landscape changes dramatically as a result of the Affordable Care Act and other factors.

The deal would follow by about three weeks an agreement by Aetna Inc. to buy Humana Inc. for $34 billion. In a sign of the takeover frenzy among the companies, Cigna had also been vying for Humana, but failed to arrange the cash-heavy offer that Humana had requested, according to people familiar with the matter. The only company among the five major health insurers that is sitting out this merger wave, at least so far, is UnitedHealth Group Inc., the largest by revenue.

There is no guarantee regulators would bless either union, and indeed legal experts have said they would likely take a close look at both.

An agreement between Anthem and Cigna would cap off a monthslong and sometimes contentious mating dance between the companies, with Anthem at one point going public with its offer.

The two health insurers began holding talks about a combination last summer, but they broke down over issues including who would run a combined company. A particular point of contention has been the role Cigna Chief Executive David Cordani would play in a new company, and whether and when he would run it. In June, Cigna rejected a $47.5 billion offer from Anthem, calling it "inadequate and not in the best interests of Cigna's shareholders."

Write to Dana Mattioli at dana.mattioli@wsj.com and Liz Hoffman at liz.hoffman@wsj.com

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