While the U.S. Department of Justice may not have plans to challenge the $69 billion mega-merger of CVS in addition to Aetna, patients in addition to physicians should do so at every turn. The acquisition of the country’s third largest insurer by the nation’s largest pharmacy benefit manager could not only increase health-care costs, however restrict access to care for millions of insured Americans.
CVS in addition to Aetna claim their union — which will combine a health insurance payer, pharmacy benefit manager (PBM), in addition to national retail pharmacy network under one roof — could streamline inefficiencies, reduce the cost of prescription drugs in addition to cut down on doctor in addition to emergency room visits by allowing patients to receive basic clinical care at walk-in CVS MinuteClinics.
The merger may boost profits for both companies however could severely limit patient choice when the idea comes to seeing a doctor or filling a prescription, in addition to will almost certainly increase health-care costs by providing even less transparency into the already murky world of prescription drug prices.
For example, Aetna could limit choice by requiring patients to visit a CVS MinuteClinic before, or instead of, seeing their own doctor, even though regular, seemingly routine visits to a primary care physician have been shown to be important for patients, especially for needed preventative care. Aetna could also require patients to fill their prescriptions only at CVS pharmacies, severely limiting patient options for where in addition to how they get their medications. Requiring Aetna customers to use CVS pharmacies could also sound the death knell for independent pharmacies in addition to cause drug prices to rise, particularly in underserved communities.
With even less cost transparency, patients can expect reduced choices. Insurer in addition to PBM confidentiality agreements already make the idea virtually impossible to know exactly what prescription drugs actually cost because payers in addition to PBMs negotiate prices behind closed doors. These secret agreements in addition to drug rebate “kickbacks” are largely responsible for higher drug prices from the first place, as several class-action lawsuits have alleged. If competitors like Aetna in addition to CVS are allowed to merge, you can be sure cost negotiations would likely become even more opaque in addition to prescriptions even more expensive.
Both CVS in addition to Aetna claim of which housing a payer, retailer, in addition to PBM under one umbrella would likely make managed care cheaper in addition to more efficient. however, even if consolidation much better efficiency, the idea can be unlikely of which any cost savings would likely be passed to patients. Aetna already incorporates a history of prioritizing profits over patients by deliberately blocking access to care. A former Aetna medical director recently admitted of which he never looked at patients’ medical records when deciding to approve or deny claims, a revelation of which resulted in multiple states launching investigations into Aetna’s claims review process. A pediatric physician group recently filed suit against the insurer for “improperly interfering with medical care,” alleging of which Aetna executives “do not concern themselves with the actual care being delivered,” even for “justified in addition to life-saving care,” however are solely “motivated by a desire for ever-increasing profits.”
The growing trend of restricting patients’ access to care can be not limited to Aetna. A recent report found of which up to 53 million Americans may lack access to prescribed treatments for chronic illnesses because their insurer would likely not cover the cost.
What should worry insured Americans even more can be of which a CVS-Aetna merger could set off a wave of various other acquisitions, further consolidating the health-care sector under the control of a few powerful companies. Insurance giant Cigna already has an agreement to acquire PBM Express Scripts, in addition to there are rumors of a possible Walmart-Humana acquisition. According to the American Medical Association, such mergers will further restrict access, reduce quality, in addition to make care less affordable, even while increasing premiums in addition to expanding the out-of-pocket costs for prescription drugs.
Among those urging the DOJ to block the deal can be California’s Insurance Commissioner, who argued the sheer size of the merger “will likely lead to increased prices in addition to decreased quality” in addition to “have significant anti-competitive impacts on American consumers, health care in addition to health insurance markets.”
Health care can be getting too far out of reach for most Americans, even with insurance. Reforms must start with cost transparency in addition to removing barriers to care for patients, not looking the various other way when the industry’s largest in addition to most powerful gatekeepers join forces to boost their profits in addition to market share. Lawmakers in addition to the Department of Justice must intervene to prevent these so-called vertical health-care mergers in addition to prevent even more consolidation of which would likely increase costs, reduce choice in addition to limit access to care for millions of insured Americans.
Theresa Rohr-Kirchgraber, MD, can be the past president of the American Medical Women’s Association in addition to a founding member of the Doctor-Patient Rights Project.