Largest nonprofit provider of care and treatment to people with HIV/AIDS in the world is “profoundly troubled” by merger of CVS and Aetna because of its potential harmful impact on vulnerable HIV patients. Merger combines an insurer (Aetna), pharmacy benefits manager (CVS Caremark), and providers (CVS pharmacies) into a conglomerate that threatens to reduce patient choice and eliminate competition.
WASHINGTON (November 27, 2018) AIDS Healthcare Foundation (AHF) today went on record once again in its strong criticism of the merger of CVS Health and Aetna, a deal that is expected to close tomorrow, Wednesday, November 28th (CVS-Aetna Merger Expected to Go Forward This Week After Securing Final Approval from New York Regulators,’ Kaiser Health News 11/27/18).
At a hearing held by New York regulators on the CVS-Aetna merger earlier this year, AHF expressed its objection to the merger — outlining five (5) specific areas of concern. AHF also sent a letter expressing its opposition to the merger to the New Jersey Department of Banking and Insurance’s Office of Solvency Regulation. AHF’s five areas of concern include:
- ‘Minute Clinics’ Short-Shrift Care for Patients
Minute clinics within CVS pharmacies replace fundamental elements of the patient-physician relationship – essential for good HIV care — with cookie cutter treatment administered by non-physicians. AHF fears, “another level of compulsion when the insurer has the potential (and bottom line-driven motivation) to coerce a patient to visit a minute clinic (instead of a patient’s personal physician) owned by the company that owns the insurer.”
- Mail Order Coercion and Customer Foreclosure
“…when the business that controls the insurer and the pharmacy also controls the PBM (pharmacy benefits manager), there is an increasing risk that mail-order delivery becomes obligatory, even for those for whom pharmacist interaction is necessary, and that competing pharmacies will be driven out of networks, to the harm of members with special needs and chronic conditions.”
- Oppressive Pharmacy Reimbursement
A combined CVS/Aetna “will be able to use its increased leverage to take anticompetitive measures such as driving down reimbursement rates and dispensing fees to uncompetitive levels.” This is already happening. For example, “the Arkansas Attorney General is currently investigating a scheme in which CVS Caremark is alleged to be providing unprofitable reimbursement arrangements to independent pharmacies, rendering pharmacies unable to remain in operation, and then offering to buy out these pharmacies for pennies on the dollar.”
- Anticompetitive Effects in Health Insurance Markets
AHF is also concerned about CVS’s aggressive tactics in narrowing its networks to exclude small and specialty pharmacies. The merger exacerbates this concern. Moreover, “CVS as a PBM would have the power and financial incentive to offer Aetna larger drug rebates or other significant discounts. This would allow CVS/Aetna to lure policyholders away from those insurers to Aetna.”
“CVS Health is currently being sued for revealing the HIV-status of up to 6,000 Ohioans through a mailing about prescriptions to their homes. This follows a 2017 breach by Aetna that revealed the HIV status of patients across several states, . . .” AHF is concerned that these episodes reflect an overall insensitivity to the special needs of people with HIV and the stigma they still face today.
“Shareholders may win, but patients and customers—and we as a society—will ultimately lose with consolidation running rampant in the healthcare industry today, as epitomized by this CVS-Aetna merger—a merger which we strenuously oppose,” said Michael Weinstein, President of AIDS Healthcare Foundation. “Conglomerations like the new CVS-Aetna entity raise many red flags, which state and federal regulators sadly glossed over in granting approval.”
“Allowing one company to control both ends of the service spectrum for a person with HIV interferes with patients’ control over their treatment, eliminates choice by reducing competition, and will likely increase prices,” said Donna Tempesta, CPA, Vice President – Northern Region and Finance for AIDS Healthcare Foundation. “For these reasons, AHF has significant concerns about the merger.”
About AIDS Healthcare Foundation
AIDS Healthcare Foundation (AHF), the largest global AIDS organization, currently provides medical care and/or services to more than 1,000,000 individuals in 42 countries worldwide in the US, Africa, Latin America/Caribbean, the Asia/Pacific Region and Eastern Europe. To learn more about AHF, please visit our website: www.aidshealth.org, find us on Facebook: www.facebook.com/aidshealth and follow us on Twitter: @aidshealthcare.