The CVS-Aetna Merger: Now Comes The Fine Print for Consumers. Is It A Match?

Amid the hoopla echoed by CVS and Aetna over their proposed merger, cost savings for consumers are what the duo talks about very much. But some worry that other mergers didn’t work out that way, history has this nasty habit of repeating itself, and the greatest benefit may be to the corporation rather than the average buyer of drugs and other pharmaceutical products and wellness services.

The proposed $69 billion merger “set off a wave of speculation “and “few expect drug costs, which have been rising, to decline under this arrangement,” said The New York Times.

At the outset, what does CVS, the large pharmacy, gain from the merger with the giant insurer? With the deal, CVS “would gain instant access to Aetna’s 23.1 million medical members and 15.2 million PBM (pharmacy benefit manager) customers,” the Employee Benefit Advisor said.

It noted that CVS already has tied the knot in different ways with Aetna. “CVS inked a 12-year contract with Aetna in 2010 to service about 9.7 million of the insurer’s PBM  members,” the EBA said. If the deal is approved by regulators, “what can brokers, advisors and their employer customers expect to see happen with drug prices?” EBA asked.

Answering that question is, well, pretty uncertain.

The Employee Benefit Advisor said that one of the CVS divisions has improved “patient engagement and medication adherence” through “personalized medicine” that many in healthcare are aiming for – but the EBA notes “some brokers worry that a CVS-Aetna pairing could corner the market on certain high-cost drugs.”

IMG_1493One of the top voices of concern is National Community Pharmacists Association CEO B. Douglas Hoey, who said in a statement he fears the proposed merger would not only generate cost savings for the corporation, but “there may be detrimental effects on consumers and community pharmacy providers.” The National Community Pharmacists Association represents the interests of America’s community pharmacists, including the owners of more than 22,000 independent community pharmacies.

“For all of the talk about cost savings, prescription drug costs have clearly continued to rise despite previous vertical mergers like UnitedHealth’s 2015 acquisition of Catamaran,” a pharmacy benefits manager, he said. “Moreover, the anticipated efficiencies CVS and Aetna tout may benefit the merged company more than the consumer, who is likelier to be driven to use health care resources chosen by the health plan rather than those of his or her own choosing.”

As regulators evaluate the plans for the potential impacts, the companies’ “previous and current behavior” should be considered, Hoey said. He emphasized two points:

  • “In 2015, Aetna was assessed a $1 million civil monetary penalty by the Centers for Medicare & Medicaid Services for significant disruption to patients and community pharmacists that occurred as a result of the company’s inaccurate representation of ‘in-network’ pharmacies in some plans.”
  • “CVS/Caremark is already the pharmacy benefits manager for Aetna, and independent pharmacies have been foreclosed from Aetna’s Part D preferred networks for the last two years. Consolidation of the two companies will only strengthen their ability to steer patients to CVS/Aetna-owned retail or mail order pharmacies.”

“Consumers should have the freedom to choose the providers that produce the highest quality health outcomes and cost-effectiveness, rather than being coerced into using certain physicians or pharmacies,”  Hoey said. “In short, bigger is not always better. A close examination of whether this acquisition will lead to higher drug prices and fewer quality and convenience options for consumers is warranted.”  – Joe Cantlupe


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