CVS Merger With Aetna: Health Care Cure Or Curse?


Published:

The announcement that CVS plans to acquire Aetna for US$69 billion raises hope and concerns.

The transaction would create a new health care giant. Aetna is the third-largest health insurer in the United States, insuring about 46.7 million people.

CVS operates 9,700 pharmacies and 1,000 MinuteClinics. A decade ago, it also purchased Caremark and now operates CVS/Caremark, a pharmacy benefits manager, a type of business that administers drug benefit programs for health plans. CVS/Caremark is one of the three largest pharmacy benefits managers in the United States. Along with ExpressScripts and OptummRXTogether, these three control at least 80 percent of the market.

Should American consumers be happy or concerned about the proposed merger? As a professor of health law and bioethics, I see compelling arguments on both sides.

Good For Consumers, Or For The Companies?

CVS and Aetna assert they are motivated by a desire to improve services for consumers and that the merger will lower health care costs and improve outcomes.

Many industry experts have postulated, however, that financial gain is at the heart of the deal.

CVS has suffered declining profits as consumers turn to online suppliers for drugs. Reports that Amazon is considering entry into the pharmacy business raise the specter of increasingly fierce competition.

The merger would provide CVS with guaranteed business from Aetna patients and allow Aetna to expand into new health care territory.

The Heart Of The Deal

The merger would eliminate the need for a pharmacy benefits manager because CVS would be part of Aetna.

Pharmacy benefits managers, which sprang up in the early 2000s in response to rising costs of care, administer drug benefit programs for health plans. Most large employers contract with pharmacy benefits managers that are different from their health insurers.

Nevertheless, a consolidation along the lines of a CVS/Caremark and Aetna merger would not be unprecedented. The nation’s largest health insurance company, United Healthcare, operates its own pharmacy benefits manager, OptumRx.

Pharmacy benefits managers process and pay prescription drug claims, negotiate with manufacturers for lower drug prices, and can employ other cost-saving mechanisms. They thus act as intermediaries between the insurer and pharmacies.

They also make a lot of money. They have been controversial in recent years for how they do so, allegedly keeping a keener focus on profits than on patients.

The merger has not been finalized and requires approval from government regulators, which isn’t always easy to get. In 2016 the U.S. Department of Justice sued to block two health insurer mergers: one between Aetna and Humana and a second between Anthem and Cigna. The government objected on antitrust grounds, arguing that the mergers would unduly restrict competition. Both efforts were abandoned.

CVS and Aetna argue that their proposed merger is different. It is a vertical rather than a horizontal merger, which means that it would combine companies providing different services for patients (insurance and filling prescriptions) rather than two companies doing the same thing.

However, the Trump administration is currently opposing another vertical merger, that between AT&T and Time Warner. It is unclear whether the administration will likewise oppose the CVS/Aetna merger.

Benefits Of A Merger

There is some evidence that a merger could help consumers.

A merger could result in more negotiating power. Combining the power of a leading pharmacy and a top insurer may allow CVS/Aetna to negotiate more effectively for price discounts from drug and device manufacturers.

It also could cut out the middleman. PBMs themselves have been blamed for raising health care costs. They often do not pass on negotiated drug discounts to consumers, but rather keep the money themselves. In addition, many believe they “make money through opaque rebates that are tied to drug prices (so their profits rise as those prices do).” With the merger, CVS/Aetna would not need CVS/Caremark to function as an intermediary. Eliminating a profit-seeking middleman from the picture could lower consumer prices.

The merger could provide easy access to health care for minor injuries and illnesses. CVS said it plans to expand its MinuteClinics, walk-in clinics that provide treatment by nurse practitioners for minor conditions. Also, CVS said it would offer more services, such as lab work, nutritional advice, vision and hearing care, and more. Thus, CVS promises that its clinics will become “health hubs.”

Many patients could turn to these clinics instead of seeking more expensive care from physicians or emergency rooms. Furthermore, health hubs could provide “one-stop shopping” convenience for some patients. This could be particularly beneficial to elderly individuals or those with disabilities.

Another benefit could be improved and expanded data analytics, which could result in better care. Combining information from patients’ health insurers with that of their pharmacies, including nonprescription health purchases, may promote better care. CVS pharmacists and health hub providers would be able to monitor and counsel patients regarding chronic disease management, pain management, prenatal care and other matters. Such attention could reduce the risk of complications and hospitalizations and thus also decrease expenditures.

Increase Of Other Risks?

Skeptics argue that the CVS/Aetna merger is unlikely to yield cost savings and improved outcomes. They note that mergers in the health care sector generally lead to higher, not lower, prices and worry about other adverse consequences.

If the market shrinks to fewer pharmacy benefits managers because of consolidation, costs may actually increase. The remaining pharmacy benefits managers may have little incentive to compete with each other by demanding discounts from drug companies. As noted above, they may actually profit from higher pharmaceutical prices and thus welcome increases.

After the merger, Aetna may require those it insures to use only CVS pharmacies. In addition, it may require individuals to turn to CVS MinuteClinics for certain complaints even if patients prefer to visit their own doctors. Such restrictions would mean less choice for consumers, and many may find them to be very distressing.

The merger could also decrease competition and bar other companies from entering the pharmacy market. For example, Aetna may refuse to cover prescription drugs that are not purchased from CVS. In that case, Amazon may find it extremely difficult if not impossible to break into the industry. Less competition, in turn, often means higher prices for consumers.

It is difficult to predict the precise consequences of a CVS/Aetna merger. One way or another, however, its impact will likely be significant.

This article was republished from The Conversation.

See also:
Gov. Charlie Baker Signs Law Guaranteeing Birth Control Without Copays In Massachusetts
An Easier Way To Get To Universal Health Care

Edit Module
Edit ModuleShow Tags
Edit Module Edit ModuleShow Tags

Daily Astrology

September 24, 2018

Full Moon madness is going strong. Not long after midnight the Moon goes void of course in Pisces, staying in the disengaged state until her evening arrival in Aries. As a result of the hyped up lunar energy, moods may fluctuate wildly…
Edit ModuleShow Tags

Alternative Health Directory

Browse all listings »

Edit ModuleShow Tags
Edit ModuleShow Tags

Calendar

September 2018

September 23 - 25 A discipline called "Qigongology" has emerged as a result of the experimental data from modern medicine and clinical research combined into a 20 year study and...

Cost: Please see our website

Where:
Eastover Estate & Eco Village
430 East St.
Lenox, MA  01240
View map »


Telephone: 866-264-5139
Contact Name: Yingxing Wang
Website »

More information

Start date: September 23, 2018  Take your knowledge to the next level and become a holistic professional facilitating treatments with clients and/or teaching. Eight month program assists...

Cost: $1199 (Early Bird $1099)

Where:
Women of Wisdom
118 Washington Street
North Easton, MA  02356
View map »


Sponsor: Women of Wisdom
Telephone: 508-230-3680
Contact Name: Women of Wisdom
Website »

More information

Hosted by members of the Reflexology Association of NH and Renu Spa Complimentary mini reflexology sessions in honor of world reflexology week. Holistic Wellness practitioners, vendors, and...

Cost: Free

Where:
Renu Body Spa and Salon
583 Daniel Webster Highway
Merrimack, NH  03054
View map »


Sponsor: Reflexology Association of NH
Telephone: 603-234-5769
Contact Name: Andrea Montgomery

More information

Dates: September 23, October 20, November 17, December 8; 10am - 5pm Instructor: Linda Patterson, Clinical Herbalist & Aromatherapist Learn how essential oils work to heal the body, mind...

Cost: $500 plus $50 materials

Where:
12 Pelham Terrace
Arlington, MA  02476
View map »


Website »

More information

This transformational workshop for singles and couples will equip you with the awareness, tools and skills to create the connection and intimacy you desire. Register here: https://bit.ly/2MocBcv...

Cost: $147 per person

Where:
Watertown Center for Healing Arts
22 Mount Auburn Street
Watertown, MA  02472
View map »


Sponsor: Watertown Center for Healing Arts
Telephone: 508-340-0781
Contact Name: Brynn Bishop
Website »

More information

If you seek peace and happiness outside of yourself, this is a call to return home. What you think, you become, and what you seek is already within. This is a unique blend of practices for mind,...

Cost: $22 per class

Where:
Sohum Yoga and Meditation Studio
30 Lyman Street, Suite 108B
Westborough, MA  01581
View map »


Sponsor: SOHUM
Telephone: 508-329-3338
Contact Name: Ritu Kapur
Website »

More information

Show More...
Show Less...

Break emotional patterns that keep you stuck in the pain of addictive habits. Heal mental trauma through physical practices involving movement, breath, and meditation.

Where:
Yoga at the Ashram
368 Village Street
Millis, MA  02054
View map »


Sponsor: Yoga At The Ashram
Telephone: (508) 376-4525
Website »

More information

Show More...
Show Less...

What better way to end a busy day than with a little bliss. We'll support your body right where it is today and help you to open your spine to find more movement and flexibility. Begin and end...

Cost: $18

Where:
Body Love Wellness Center
484 Bedford St
East Bridgewater, MA  02333
View map »


Sponsor: Bliss Through Yoga
Telephone: 508-331-3564
Contact Name: Janice
Website »

More information

Show More...
Show Less...

Have you heard of natural birth control and wondered how that can be possible? Or are you trying to or planning to conceive? This session is for you! We’ll talk about the benefits of charting...

Cost: Free

Where:
The Democracy Center
45 Mt. Auburn St
Cambridge, MA  02138
View map »


Telephone: 617-899-7624
Contact Name: Anna Churchill

More information

Enjoy The Experience Of Being Fully Human And Transcendental With Enlightenment Transmission An Enlightenment Transmission happens when there is a connection between a person’s inner Self...

Cost: Free

Where:
Quaker Meeting House
1837 Forest Avenue
Portland, ME  04103
View map »


Sponsor: Enlightenment Transmission Foundation
Contact Name: Board of Directors
Website »

More information

With Jonathan Glass, Ayurvedic practitioner Presenting a 28-day program designed to initiate and maximize detoxification and nourishment of your body, mind and soul, inspiring results that can...

Where:
Zoom online class
Once you register, you will receive a link to the location of the Zoom class.
, MA
View map »


Website »

More information

With Carrie Rowan Wednesday evenings at 7pm, a 4-week introductory class that teaches quick energy medicine tools, mini meditations to help moms/dads and caregivers reduce stress and stay calm...

Where:
Fitzgerald Institute
Northboro, MA


Telephone: (508) 273-2610
Website »

More information

Show More...
Show Less...

Singer/songwriter Linda Marks releases her new album “Moments” at Club Passim in Harvard Square at 8 pm. Joining her will be her seven piece band. Rick Drost opens. Tickets:...

Where:
Club Passim
Harvard Square
Cambridge, MA
View map »


Website »

More information

September 27 - 30 Led by Chuck Raffoni ( E-RYT200) this sure to be unforgettable weekend is designed to allow you to experience Vermont in the beautiful transition from summer to fall. You...

Cost: $650

Where:
Good Commons
Plymouth, VT


Sponsor: Relax and Recharge with Chuck
Telephone: 978-807-3131
Contact Name: Chuck Raffoni
Website »

More information

“Reality itself is always already the case.” In every time and place, human beings have sought to grasp the ultimate mysteries of life and death. From time to time, great...

Where:
West Newton Cinema
1296 Washington Street
West Newton, MA
View map »


Telephone: (508) 650-0136
Website »

More information

The H.E.A.R.T. Program® (Health Empowerment and Real Transformation) is an innovative holistic curriculum addressing the current health crisis and epidemics of obesity, heart disease, and...

Cost: Free

Where:
Wilbraham Senior Center
45 Post Office Park, #4502
Wilbraham, MA  01095
View map »


Sponsor: Harmony Way
Telephone: 413-636-2475
Contact Name: Michelle Caron
Website »

More information

Grades 3-5 Instructor: Peyton Pugmire Spend September at Sorcery School! Students will be “sorted” into houses of their own design, create personalized wands, pen and cast rhyming...

Cost: $145

Where:
Creative Spirit
80 Washington Street
Marblehead, MA  01945
View map »


Sponsor: Creative Spirit
Telephone: 781-797-0389
Website »

More information

Daily practice for peace, healing, Christ mindedness, meditation, awakening.

Where:
Milton, MA


Telephone: 617-696-5685
Website »

More information

Show More...
Show Less...

September 28 - 30 Sheng Zhen Gong is not just a qigong practice, it is timeless wisdom that guides us to the way (dao) of life – a path to feeling liberated. It is the sacred truth of...

Cost: Please see our website

Where:
Eastover Estate & Eco Village
430 East St.
Lenox, MA  01240
View map »


Telephone: 866-264-5139
Contact Name: Yingxing Wang
Website »

More information

Special Offer - take both Simply Healing classes and save $25. Please click here to register. Many of us have some knowledge of attachments, thought forms and extraterrestrial influences....

Cost: $125

Where:
Circles of Wisdom
386 Merrimack Street
Suite 1-A
Methuen, MA  01844
View map »


Sponsor: Circles of Wisdom
Telephone: 978-474-8010
Contact Name: Cathy Kneeland
Website »

More information

Fundraiser for the Framingham Public Library Share in this extraordinary evening of spirit communication. Join Diane as she bridges the gap and connects to spirit delivering messages from...

Cost: $25 per person

Where:
Framingham Public Library
49 Lexington Street
Framingham, MA  01702
View map »


Sponsor: Friends Framingham Library
Telephone: 508-875-1918
Contact Name: Marsha Farmelant
Website »

More information

September 28, 12pm-7pm and September 29, 10am-6pm Experience therapeutic mini foot, hand or ear reflexology treatment. Your donations will benefit cancer patients associated with Lucy’s...

Where:
Heart and Soul Holistic Healing Center
North Easton, MA

More information

Bee Kind Music Class with Carrie Rowan inspires a love to music in little ones. 10am on Fridays for 8 weeks at Playtown Express in Southboro. To register call (508) 480-0022 or...

Where:
Playtown Express
150 Cordaville Road
Southboro, MA
View map »


Telephone: 508-273-2610
Website »

More information

Show More...
Show Less...

Blue Skye Wellness Presents: Essential Oils and Aromatherapy Full Day Workshop Learn how to effectively use essential oils Practice safe use guidelines Discern how to choose which oils...

Cost: $120

Where:
Lenox Community Center
65 walker Street
PO Box 98
Lenox, MA  01240
View map »


Sponsor: Blue Skye Wellness, LLC
Telephone: 413-242-4069
Contact Name: Kay Judge
Website »

More information

With Ross J. Miller, psychic healer, medium, regression therapist In this unique, experiential workshop you’ll learn how to identify your guardian angels and spirit guides by name and...

Where:
Newton, MA


Sponsor: Ross J. Miller
Telephone: (617) 527-3583
Website »

More information

Prequisite – Simply Healing Part 1 Special offer - Take two classes and save $25 - see info in link. This class continues the knowledge gained in Simply Healing - Level 1 as we...

Cost: $175

Where:
Circles of Wisdom
386 Merrimack Street
Suite 1-A
Methuen, MA  01844
View map »


Sponsor: Circles of Wisdom
Telephone: 978-474-8010
Contact Name: Cathy Kneeland
Website »

More information

With Katie Malloy Ramaci  Expand your connection to the angels by learning IET levels 2 and 3 certification. Truly move forward on your path. Learn Soulstar activation and release...

Cost: $1099 (Early Bird $999)

Where:
Women of Wisdom
118 Washington Street
North Easton, MA  02356
View map »


Sponsor: Women of Wisdom
Telephone: 508-230-3680
Contact Name: Women of Wisdom
Website »

More information

September 29 - October 5 7 individual days of immersion in the wisdom, healing and bliss on the life-changing Enlightenment Transmission Intensive in beautiful MidCoast, Maine, USA. In theory...

Cost: Sliding Scale $125-95/day

Where:
Damariscotta, ME


Contact Name: Board of Directors
Website »

More information

Learn basics of Tachyon and quantum physics. Sample the Tachyon healing and meditation chamber. Raffle and door prize.

Cost: $25 at the door or $20 pre-register

Where:
The Sanctuary for Celestial Empowerment
10 Grassmere Avenue
Suite #300
West Hartford, CT
View map »


Telephone: 860-586-8700
Contact Name: Celeste E Mattingly, LCSW
Website »

More information

There are few instruments like the Gong that can heal us through its purification properties of sound vibrations. In this energy field, the beginnings of removing all blocks can occur allowing you...

Cost: $35 early bird till Sept 25 ($40 after)

Where:
Sohum Yoga and Meditation Studio
30 Lyman Street, Suite 108B
Westborough, MA  01581
View map »


Sponsor: Sohum Yoga and Meditation Studio
Telephone: 508-329-3338
Contact Name: Ritu Kapur
Website »

More information

September 28, 12pm-7pm and September 29, 10am-6pm Experience therapeutic mini foot, hand or ear reflexology treatment. Your donations will benefit cancer patients associated with Lucy’s...

Where:
Heart and Soul Holistic Healing Center
North Easton, MA

More information

September 29 - 30 We all want to feel joy, happiness, contentment — and with the tools you get at this workshop — you can. Access and sustain a higher level of consciousness.

Where:
Boston, MA


Website »

More information

Show More...
Show Less...
Edit ModuleShow Tags
Edit Module Edit ModuleShow Tags