Integrated CVS-Aetna: What’s at Stake

Will the health care marketplace function more efficiently with huge health insurers, pharmacy retailers and benefits managers working together in an integrated business model? We’ll soon find out.

For the second time in less than a month, the Department of Justice has approved a megamerger between leading players in the health insurance and pharmacy worlds. The DOJ said it will allow the $69 billion merger of CVS Health with Aetna once the insurer sells its Medicare Part D business, which raised concerns about the companies having too much market control. The move comes on the heels of the DOJ’s approval of the $52 billion Cigna-Express Scripts merger.

Even with the sale of its private Medicare plans, some believe that once Aetna joins forces with CVS Health, the combined entity still may have too much market power. CVS had about $185 billion in revenue last year and provided prescription plans to about 94 million customers, The New York Times reported. Aetna had about $60 billion in revenue last year, covering about 22 million people in its health plans. Then there is the unresolved question of how aggressive Aetna may be in incentivizing members to get their prescriptions and possibly retail care at CVS locations.

This latter possibility could affect health systems’ retail pharmacy strategies, notes Lindsay Conway, managing director of the Advisory Board’s Pharmacy Executive Forum. If Aetna succeeds in getting more patients to fill their prescriptions at CVS, Conway says, “the change will threaten not only health system-owned pharmacy revenues, but may also compromise health systems’ abilities to coordinate medication management.”

Supporters believe these megamergers will lead to sharp cost reductions and greater access for patients. Some consumer groups, state regulators and others argue that the deals will undermine competition by reducing patients’ choices and raise their out-of-pocket costs. In the meantime, activity continues to sizzle in this sector. This summer Amazon bought online pharmacy PillPack for $1 billion, a deal that is expected to shake up the drugstore industry due to Amazon’s long-proven distribution infrastructure and strong competitive edge in home delivery.