CVS Health’s bid to buy insurance giant Aetna for $69 billion likely won’t improve the high prescription drug costs facing employers and workers, say healthcare experts familiar with the pharmacy benefit management industry.
The deal is more likely “an information move,” says Brian Tolbert, benefits practice leader for Bernard Health in Nashville, Tenn., who is concerned it would give Aetna an unprecedented view into the prescription histories of CVS customers.
“It will allow them to … skim the cream and go after a healthy membership,” he says, adding that the temptation to market directly to healthy customers would be irresistible.
Additionally, Linda Cahn, founder of Pharmacy Benefit Consultants in Morristown, N.J., feels the proposed merger will do little to address the skyrocketing price of prescription medications. She takes issue with CVS Caremark, the company’s PBM arm, which, like other PBMs, provides little transparency in what it pays for drugs or how it handles rebates from manufacturers, the consultant says.
CVS Health did not respond to a request for comment by publication time. Cahn says she spent many years litigating with PBMs and the companies zealously guarded their purchase arrangements with drug manufacturers.
In fact, benefits consultant Patricia Sorowich, president of PBIRx in Milford, Conn., predicts the proposed deal could raise drug prices. “If you’re an Aetna member, you can expect they’ll push you to CVS and you’ll pay more money for prescriptions.” She also predicts employers may face higher premiums for that reason.
A long road ahead
Tolbert believes the deal will have a hard time passing the anti-trust gatekeepers at the Department of Justice. He expects other insurance carriers and PBMs will start screaming soon in Washington to nix the proposed deal.
Jim Winkler, global chief of innovation for Aon, agrees the deal has a long road ahead with regulators, but doesn’t see all downside. “This is two organizations that are at different points in the value chain,” he says. As well, “they’re talking about running Aetna as an independent entity.”
Winkler points out that United Healthcare owns the PBM Optum and no major problems have arisen. But, the proposed deal brings together a far larger PBM and health insurer than have married in the past.
CVS says the combined company would provide greater integration of care, “empowering consumers and health professionals to make more informed decisions.” Executives pointed to the advantages of connecting Aetna’s network of providers with CVS Health’s 9,700 pharmacies and 1,100 MinuteClinics.
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