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AHF Says CVS-Aetna Merger is Bad for HIV Patients

Thursday Nov 29, 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 closed this week.

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 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."

Confidentiality
"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."

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