CVS Health and Aetna $69 Billion Merger Is Approved With Conditions

CVS Health, the giant drugstore and pharmacy manager, will acquire one of the country’s biggest insurers, another sign of industry consolidation.

Comments: 132

  1. Do I understand correctly that CVS charges for meds, to be paid by Aetna? Sounds like self-dealing to me. How are refusals to pay out resolved, if at all? What am I missing?

  2. you're going to be missing your health care. I dont want to get my healthcare from the local drug store! I'm already having major problems with Aetna refusing to pay for services my doctor deems necessary.

  3. @Irwin Moss, LA

    It's certainly complicated - however, we've had this before (albeit on a smaller scale). Years ago many of the HMOs had in-house PBMs (pharmacy benefit managers) so the HMOs were buying and dispensing drugs to their members (or at least trying to do so). While the name on the door is CVS - and one can assume that any AET customer will have to get their prescriptions filled at a CVS - the health plan will still be driving the approval/denial process.

  4. "What am I missing?"

    The lobbyist bribes. Don't worry, few of us get those either.

  5. And this is EXACTLY why we will never see universal healthcare in the US.

    With this much money to be made and so many millionaires in congress, there is zero motivation to help the average citizen get healthcare that is affordable.


  6. We should be very careful. The last time monopolies became ubiquitous in the US it didn't work out so well.

  7. This is the first step toward the vertical integration of the health care system into what could be called "Super HMOs." Your will have several entities, each one with an insurer, a drug distributor, hospitals, and a doctor network. And, of course, each one will make sure that its own components are favored (i.e., reduced or no out-of-plan benefits).

    However, if we get to the point where all health care is provided by a handful of entities, we are very close, probably one election away, from having a true national health care system, either with single payer as in Canada or with our version of the British National Health Service. However, the transition will probably involve mega-billion payouts to the health care entities, so that they will not lose out!

  8. @John Graubard - Not that I'm against the conversion, but "fairness" dictates that the shareholders being bought-out not lose the value of their investments. It would be just like an average middle-class home owner needing to be paid fair market value for their home if it was going to be torn down to put in a highway.

    The REAL problem is, the "fair market value" of their shares needs to be established at a point prior to speculation having set in. AND, the market needs to be warned that's going to be the case and that any speculators will end up losing any speculative inflation of the stock price -- thus "don't speculate".

  9. @John Graubard You can get all the health care you want and more at the COMPANY STORE. /s

    Any issues with prescriptions, billing, care, and service - I'm so very sorry we only care about revenue and profits.

    No oversight, no recourse, no choice - pass, except there will be no other choice than to die early.

  10. What was overlooked in the article is these insurers are evolving, step by step, toward the Kaiser model. One key difference that remains is the Kaiser model was built up with preventative medicine and doctors at the center, while the insurers are evolving while being Wall Street centric.

    The insurers will, presumably, EVENTUALLY stumble their way into being preventative medicine centric since that is where the real cost reductions are to be found. What will still remain is health care consumers having to pay, through their premiums if nothing else, for Wall Street's single driving force of maximizing stockholder return -- not maximizing healthcare outcomes.

    The distinction can be seen by realizing what is in the best interest of a for-profit pharmaceutical company: Creating a drug that AIDS (or chose an ailment) patients have to buy for the rest their lives, or creating a drug that cures patients of AIDS.

    A drug which must be taken for the rest of the patient's life is the "subscription revenue model" which is the darling of nearly every business that can manage to figure out how to implement it. It's what's behind Amazon wanting people to sign up for Prime. It's what's behind streaming services trying to replace buy-once DVDs and Blurays.

  11. Probably great news for CEOs and stockholders but I'll bet that many of us struggling to pay for insulins under the various Medicare D plans still won't be able to afford them. But I'm happy that the CEOs will be getting richer.

  12. This is so big.
    I am not sure that the Federal government has the means - and right now it has no will - to police an entity this big, which is also operating according to multiple state rules.

    Those who fear "government" control of a single payer system should take note; we are moving towards a PRIVATE version of single payer- not quite single, but with a very limited group of insurers with massive power to set prices and control the drug availability-- who are dedicated to profits.

  13. I’ve never been able to afford healthcare and reading this article has me frightened.

    Currently, without health insurance, I am prescribed generic Xanax and it costs me only $14 for 120 pills. That is incredibly cheap. Too cheap. But I need to get a cavity done? Easy $350. And I have 4 of them.

    I’m afraid this type of merge will lead to people seeking drugs over actual self care. The latter is much more expensive.

  14. Why do I feel like healthcare will soon be like cable, with a handful of providers, most markets with only one or 2 companies, and some service better than others, billing monopolies, and on and on and on?

  15. @Currents Except you can tell the cable monopoly to stuff it and not die.

  16. Corporate Single Payer healthcare.

    The radical, Randian, Robber Baron dream of Republicans materializes.

    Greed Over People

    November 6 2018

  17. @Socrates I think I missed the sarcasm up front... Single Payer/Medicare For All is what we DO want! Yup? I do! We all should.

  18. Mergers are often great for big companies, but not so great for consumers. As a CVS Medicare Part D customer, I am already leery of next year, let alone beyond.

  19. Medicare D has to sold or risk the ire of seniors and AARP and impact the budget projections. Mess with everyone else.

  20. @Carry On


  21. Question will CVS look at the purchases customers make with those tracking discount cards as a part of an algorithm to determine premiums?

    If so, better leave the chips and candy alone. Stick with the salt free almonds when you need a snack.

  22. This is the equivalent of what has happened when it comes to cable t.v. in many communities: almost no choices. I would not use a CVS store for any sort of medical testing. The stores I've been in are not clean enough, don't insure patient privacy, and are not where I want to go for brief medical care. The GOP and Trump can praise these developments all they want but what we're seeing here is the privatization of medical care at the expense of those who do not have health insurance or the right kind of health insurance.

    CVS charges quite a bit more for prescription medications than some other places. Their pharmacies are not always well stocked or well staffed. If you want privacy to discuss a problem there is none.

    If our politicians had our best interests in mind health care in America would not be a for profit industry. It would not be a wealth care industry. It would work for patients and see to it that patients get the services and care they need. This merger is one more example of how to exploit American patients for profit rather than improving the system.

  23. Sure, this will "help tighten cost controls" order to produce more profits for Aetna and CVS. It won't save money for the rest of us, and is likely to restrict our options for care.

    Cost control in a healthcare system that is based on private insurance will always be about profits. Cost control in a single-payer/Medicare-For-All type of system (which, remember, is what every industrialized nation *except* the U.S. already has) helps to ensure that better care reaches more people.

    Maybe one day America will figure out that our outlier status as the only advanced nation without national health care is the reason we have skyrocketing costs, a sicker population than the rest of the modern world, and millions of people who can't get the care they need.

  24. I hope this doesn't adversely affect my health insurance that my wife has for us through Aetna. I would have had to file for bankruptcy in 2018 without it.

  25. @VJR Don't know what state you're in, but generally, medical debt is NOT protected by bankruptcy.

  26. My husband has a plan in Ohio called Aetna Better Health. It is a combination of Medicare and Medicaid. The plan only covers generic drugs. We really hate the thought of CVS taking over Aetna (we don't like going into CVS now). No matter what those promoting the CVS take-over are saying it's going to be profits versus helping people get decent medical care.

  27. Name one country with democracy that allows Pharmaceuticals to be promoted & advertised to their society? Name 1 democracy country that has gone bankrupt because of universal healthcare? Name one socialized country that has converted to America's capitalistic demand that employers provide Healthcare? This was a post World War II endeavor that is now outdated and is the big cause lack of equal pay for USA workers compared to other nations and our manufacturing competitors! merger like this only profits the pockets of the corporation not any of 93% working class Americans. even the employees of CVS Pharmacy get below minimum wage in USA states!

  28. @muse
    Those same countries that actually protect their citizens also don't let them become homeless or go bankrupt because of illness.
    A friend who immigrated from the Netherlands was appalled that those are some of the draconian consequences of healthcare in the United States.

  29. New Zealand also allows pharmaceutical recruiting directly to patients.

  30. @muse- we aren't a democracy. We're a capitalist republic with elements of democratic practices thrown in. The American sheep have gone along with this willingly.

  31. Open enrollment has arrived and I am left to navigate the least manipulative option or most beneficial—both are of course, illusions. As a current United Healthcare customer, they also require using CVS for prescriptions. In the end, for those of us fortunate enough to have any coverage with employment, we are left to feel that we should be thanking the carrier and employer...

  32. “The combination of CVS and Aetna creates an enormous market force that we haven’t seen before,” said George Slover, senior policy counsel for Consumers Union, an advocacy group.

    Actually, we have seen such market forces before.....all over the world; it's called government regulation of healthcare so citizens don't get ripped off by corporations.

    Here are four places where that 'enormous market force' has existed successfully for a long the form of good government regulation of healthcare at a fraction of the for-profit medical extortion prices in the United States of Greed Over People:

    National Health Service in England

    National Health Insurance in Taiwan

    National Health Insurance in South Korea

    Medicare (For All) in Australia

    The United States is an unregulated for-profit disgrace.

    Vote for change on November 6 2018

  33. @Socrates This country already has a model for low-cost government provided health care. It's the VA hospital system.

  34. @Hen3ry

    In fact, wealthy people travel to other countries that have universal health care in order to get their surgeries and medical care. They know that America has among the worst medical care / health outcomes in the world.

  35. I am a big proponent of universal health care but I wish people would stop idealizing the British National Health Service. It’s lovely that care is free at the point of access, even for the poorest among us. Prescriptions are free for the elderly or needy and around $11 each for everyone else. What’s less lovely is waiting three weeks to be seen by a GP, and many months for a specialist. “Elective” surgeries such as a knee replacement or cataract surgery often have wait times of up to a year, even if the patient can’t walk or see. Mental health treatment is even worse. There is a dire shortage of nurses and no money to upgrade or buy equipment. People who can afford it have private insurance. Many NHS doctors moonlight in the private sector so you see the same doctor but without the wait. I’m actually a proponent of universal health care but the NHS is not a model for how to do it well.

  36. Great. My blue cross blue shield Medicare advantage plan is moving to Aetna in January. I was already concerned about the move before this. Things only get worse never better.

  37. @Shellbrav

    Political parties have priorities and elections do have consequences...

  38. Americans with Chronic Pain are already suffering from regulations that preclude too many from receiving the only treatment that gives them quality of life: opioids.
    This has been done in the name of public safety, however the CDC admittedly used faulty data which blamed patients and the doctors who were trying to stop the pain.
    Now, the government is more than willing to hand medical decisions about who can get what medication to insurance companies instead of doctors. Insurance companies operate based on bottom lines, not quality of care or the Hippocratic Oath.
    Elected officials are betraying the human beings they are supposed to represent; instead they pander to faceless corporations that don't have the capacity of suffering that their constituents do.
    It is time for the American People to demand that their healthcare be put back into the hands of their physicians.

  39. The ninety nine percent losses again. There is no such thing as market driven healthcare unless you own stocks in pharmaceuticals or medical devices or market health insurance industry. Time to socialize health care.

  40. The United States has the highest cost for healthcare with the worst outcome in the world.
    Perinatal mortality, low life expectancy,opioid crisis, cost of prescription drugs , deaths by firearms etc. are depicting a country with serious widespread national problems.
    Universal healthcare like our Canadian neighbors and most European countries could be a good starting point to bring America to level of countries who really care about their citizens.
    Isn’t it time to make America great again ???

  41. Anyone who believes that maximizing shareholder returns and maximizing positive healthcare outcomes are in sync has swallowed the koolaid. Every day we watch giant corporations and the wealthy win while ordinary citizens pay the price. But , hey, aren't we making America great again??? Oh, and enjoy the latest hurricaine caused by global warming....which doesn't exist....

  42. The real question is...will this merger be beneficial to most Americans. I seriously doubt it will.

  43. One of the sleaziest companies out there. Don't you remember the days of walking into your neighborhood pharmacy, getting good local service and getting your prescription filled in minutes? Places like CVS killed that. Between sweetheart deals with insurance companies and drug companies, they made the playing field unfair. Such as forcing customers to go mail order or automatically refilling prescriptions patients didn't ask for. Add this to a growing list of insane mergers that only help the top of the pyramid at both companies and harm every single other person involved. Now you walk into CVS, not a single employee can help with anything (and its usually literally 1 employee for 15 people waiting in line). Another business Corporate America has ruined.

  44. I walked into a cvs to buy pretzels. Took me 15 minutes to find them. Snack foods were scattered around in seemingly random areas. No one to ask. Only one person behind a cash register. A black holehole of chaos. The vibe and experience was so depressing I would never go back to a cvs again. And that was just pretzels, forget something as precious as healthcare.

  45. I would never shop at CVS or have scrip filled there. Stores are dirty, understocked, understaffed. They couldn't fill a scrip for 4 valium for a dental visit when I walked in. Would have to come back the next day! If that's any indication of the overall concern of the company for their customers, I would be apprehensive.

  46. Just what we don't need; a mega healthcare conglomerate controlling access to affordable healthcare.

  47. Aetna's reputation as an insurer is the worst of the worst. They are expensive and do not like to cover items like new drugs or new hospital procedures. Employers like Aetna because it is the low cost insurance for employers to provide for their employees. Not good news.

  48. Mega-corporations go totally contrary to capitalist competition. These hoper-large companies shrink power of options by consumers, lead to higher prices, and, most of all, fuel leftist movements against capitalism. We will see more Venezuelas in the world, thanks to this twisted form of capitalism!

  49. Yet another corporate mega merger. Only this one affects lives in the name of major profitability. Lord help us...

  50. Anyone else amused by the CVS Health general counsel name being "Moriarty"? What say you to this, Mr. Holmes?

  51. CVS Pharmacy literally attempted to pay me to use they're Pharmacy! 10 years ago in Los Angeles California, I would be what some call a subscription Pharmacy user by needing my insulin prescriptions refilled every month. I got a $25 gift card 4 moving my Rx to CVS. The first refill could not be done because they did not have the two common types of insulin I take. In insulin pen forms.

    The pharmacist is a very sweet woman and she apologized and said to come back in 3 days and she gave me another $25 gift card. The second month of refills the same thing happened! This time she gave me a $50 gift card simply because I made an uproar about how my life depends on having simply because I made an uproar about how my life depends on having insulin refilled promptly especially when it's automated to refill the same prescription month after month. And again my life depends on it.

    Yes I went for a fourth time but changed location of the CVS Pharmacy. I got my insulin at the new location but I was prescribed penicillin antibiotic by a substitute Dr. I was unaware that this strain of antibiotic for a urinary tract infection had penicillin in it. All over my medical file says I am allergic to PCN! It was called into the pharmacy at CVS, all over my pharm account says I'm allergic to PCN!No one caught it.

    nearly died, went to 5 different attorneys but you cannot sue doctor or Pharmacy only medical devices... Stay away from CVS!

  52. Yeah, this works just great for Aetna long as they change pharmacies. But for a surprising number of us, our pharmacist gives more dependable drug advice than our physicians. We don't want to change pharmacists.

    One example is in finding out the adverse effects of medications. When I got foot cramps and then muscle cramps and then torn tendons, etc., it was my pharmacist who told me that this could be from the statin drug I'd just been put on. The pharmacist had seen other people who, like me, permanently lost the ability to walk after taking a statin.

    It's cost me about $150 so far to stick with this pharmacist, but that's because I didn't fully catch onto the scam soon enough. The main prescriptions I'm now on cost the same at CVS and competitors like Walgreen's, but the little medications have co-pays that are over ten times greater.

    To keep my outstanding pharmacist, I have to pay more. Or I can make two trips to the pharmacy and gritting my teeth put money into the CVS/Aetna machine.

    This is wrong. The pharmacists know it's wrong and say so right out.

    If we're going to have one entity running the show, let it be the government. Corporations are run for stockholder profit, and we wind up with the least efficient, most costly healthcare system in the world. Yuck!

  53. Im so sick and tired of our government not standing up for our citizens in this country. They dictate what we can or can not have, while they choose what they want at the expense of our tax dollars. They dont pay so they dont care...and we wonder why they keep raising taxes. This needs to stop now, only our votes at the polls could possibly end this onesided farce!

  54. More corporate socialism. Waiting for the other shoe to drop: the evisceration of Medicare...

  55. The Trump version of the Affordable Care Act? This is what he boasted about when campaigning, that he alone will make our premiums more affordable for all Americans? Do the people of the US not see what this administration is aiming for? The goal is not for us. We are nothing in its eyes. It is all about profit, profit, and more profit for the already disgracefully wealthy.

    I am an RN, and this behavior is an outrage. Do not believe for one moment the spin that is inevitable. Our health care is going down the tubes. And this is not about Obama who actually tried to help us. Trump owns it now. So all you folks in the South and Heartland, who continue to vote for this fraud and his Congressional clowns, think about your kids or aging loved ones before you cast your ballots.

  56. They should just abolish healthcare completely.
    Survival of the fittest baby!

  57. No megacorporation merges with another for philanthropic reasons. Do they really think customers are so stupid that we will believe they want to save us money? Every company exists for one reason: to make a profit. The purpose of this and every other huge merger is to decrease competition and raise prices.

  58. If you massive drug megacorps can't handle a little "competition" in the "market", then perhaps you should step aside and let a well-funded, competent government do your job with SPMFA.

    You pay the taxes you owe our country to make it well-funded, and we cast the votes we owe our country to make it competent.


  59. Good, keep merging until there is one left and then we can take over it and have single payer healthcare finally.

  60. Make it easier for corporations in effect to practice medicine without a license, for their own profit. Isn't this illegal? Shouldn't laws and licensure be enforced? Oh, only AGAINST doctors! Will no one prosecute the already ubiquitous degrading and killing of Americans through life-and-death medical decisions made by insurance companies and pricing by big pharma, over the objections of medically-trained, do-no-harm, actually-licensed but now endlessly-overruled doctors?

  61. Are we winning yet?

  62. Do I have to get my drugs at CVS or can I use my local Mom & Pop pharmacy?

  63. if u r with aetna you must go to cvs. exceptions are if there are doctor's orders, prescriptions, that CVS does not carry. Such as the day after pill and some opioids. and you would have to fill out paperwork and send to your insurance to get the exception approved. Otherwise you have to pay out-of-pocket competitor pharmacies.

    I am under military health insurance call Tricare. I go to a mom-and-pop pharmacy and they delivered to my home at no extra cost! They call and check up on me for my monthly insulin pens! They alerted me that there was a competitor newer insulin that my own endrocrinologist did not alert me to! I had so many problems with CVS Pharmacy over the years. I am so glad I go to this local mom-and-pop in Los Angeles.

  64. @NYC Dweller @NYC Dweller You don't *have* to go to CVS, but you will certainly pay a premium to shop local.

  65. Welcome to the Corporate State, brought on by Citizens United. The last one was Italy under Mussolini. Does anyone remember what happened to it?

  66. More corporate fascism running amok.
    Mega mergers MUST be stopped somehow.
    This is not the direction our nation should be going in, but it is.
    We will soon only have one 'choice' of everything. A neo-Capitalisitc twist on the old USSR.

  67. It is insane that this was approved. Americans don't realize it, but they are living in "Soviet America," except it's extreme capitalism instead of extreme socialism.

    Why do Americans put up with this nonsense? Have you not traveled to Europe or Japan and witnessed how much better regular people live there?

  68. @James yes I have been to Europe and what struck me back in the 80s was how much happier they were than us even then. I've been to Canada and Canadians are happier. Only in America are we expected to become impoverished in order to receive needed medical care, get a decent education, or to live in decent housing. And only in America is the social safety net non-existent for average citizens but set up to cater to those who don't need it at all: the richest corporations and the uber rich.

  69. “too big to fail”

  70. I think we all just saw our drug prices go from merely outrageous to truly astronomical. One more huge reason for the Dems to headline healthcare.

  71. They don't want healthcare to be nationalized but they'll approve a merger that will have devastating effects on Americans. So crazy.

  72. Now is the time for folks to become even more serious about health issues like poor food choices, lack of physical exercise, lack of sleep and a plethora of lifestyle choices that increase healthcare costs.

    As a general rule I am more libertarian, less government in my thinking and a believe more local co-op medical coverage choices need to become the norm. Where the more you strive to be healthy the lower your costs.

    Rather than mega outfits like Aetna, Blue Cross whose CEO's make millions of dollars in pay. Like $8 MILLION a year. Obscene!

  73. @Beth Grant DeRoos

    There is only so much that lifestyle can do to reduce the need for medical care. In fact, overall, very little beyond the obvious obesity related ones.

    My genes, food choices, and exercise give me a blood lipid panel to die for - pun intended - at age 72. Off of the charts excellent. But nothing in my control would have stopped the need for cataract surgeries five years ago or a knee replacement this year.

  74. For-profit healthcare is a disaster for patients. Lousy care, high prices and now monopolistic providers that don't say "take it or leave it" but "your money or your life".

  75. I agree. What’s worse is that instead of costs simply increasing, methods of treatment for various conditions are being scaled down without much downward adjustment of costs. The quality and quantity of standard care is being lowered to match what insurance companies are willing to pay. The focus isn’t on the best level of care possible, the focus is on what’s minimally sufficient for the largest/average population with that condition. If you fall through the cracks because of some differences, you’re in trouble, because you’re likely being “treated” by a doctor who spends just a few moments on your care, before passing you off to a “team” of less qualified and less trained “providers” who aren’t trained to think analytically like doctors(scientists) are.

    You can’t sit back and hope to be well cared for. You need to ask questions about your care and either be your own advocate, have family members advocate for you, hire a professional to advocate for you, or get a facility’s Patient Advocate involved.

  76. Interesting that the two industry executives in the photo don't look very healthy. The blind leading the blind ...

    It is my understanding that CVS stopped selling alcohol some years ago. Now that it is owned by an insurance company, I would not be surprised to see further changes. It might stop selling alcohol, for instance, or sugary snacks, or soda ....

    That might be the only good thing to come out of this merger. I guess only time will tell.

  77. another reason NOT to shop at cvs, where they undercount prescribed pills but charge for the amount on the doctor's scrip.

  78. @linh Or give me the completely wrong prescription, as has happened at our local CVS drugstore. Right name, right Medicare policy. Wrong pills.

  79. Got a letter from Aetna two weeks ago advising that (of course) I can continue to get my prescriptions filled wherever I like, but that if I switch them to CVS or Aetna's own mail-order service (presumably fulfilled by CVS), I'll get 90-day refills at rock-bottom prices... so far, that's sounding like a good deal. What I'm not looking forward to is being told I can't see a doctor if a "minute doc" is available at the pharmacy, or that my blood work can't be done at a lab if a CVS phlebotomist is cheaper....

  80. Does this and the like make it easier to transition to single payer healthcare insurance or start to make it impossible?

  81. @HANK Excellent question. I'm wondering the same thing because once the companies dig in it may almost impossible to dislodge them.

  82. Oh, goody. Higher prices for premiums and for medications and more denials. Surely, you don't think it's going to be better for the insured, do you?

  83. Definitely time to modify ERISA, the law limiting legal liabilities for employee funded health insurance. The vertical integration in the industry which will extend to hospital systems is dangerous. Aetna will require (through cost incentives) insured to use CVS. as UHC pushes their insured to use mail order. MY pharmacist is important to my health. They know me and my history for over a decade. I shouldn’t be forced financially to change. We need new legislation. The worst economic performance indicator is health costs driven by insurers.

  84. I live in Palo Alto, where you’d expect higher level of customer service. Our local Walgreens consistently makes mistakes. We finally switched to CVS. Guess what? They make them too. I’m guessing that there are increasing numbers of Rx being filled every day and dirth of competent pharmacists and “technicians.” No sugar, no flour, no processed foods, daily exercise can help.

  85. One of the recent articles on the FIRE people was about a pharmacist who said it was a very stressful job. He said people yelled at him regularly about their prescriptions ... that they had to go get them renewed at their doctors, the prices were higher, the drug no longer covered in their plan. Many of these people are sick and in pain too.

  86. corporate commune


    corporations so large and all-encompassing of salaries and benefits that governments enable or expect them to take care of every otherwise public benefit and function

  87. We have Aetna PPO plans and if they remain as is, then we are ok with this merger.CVS is our only drug store hereabouts, so no problem there either...

  88. Name one...Repeat...ONE merger in the age of mega-greed that has brought prices down!

  89. “More access “ or “ better coordinated “ are fluffy terms. Show me the strategy backed up with numbers showing benefits to all parties. Oh yes, and don’t forget to include the consumer as one of the parties.

  90. Hey come on --- for just 200 billion more they could've merged with the America's, old people's homes, funeral homes and cremation sites.

    What a terrific money maker. Drugs, insurance, that's Heritage Institute thinking.

    Any thoughts on eating the deceased?

  91. Will CVS offer by pass surgery @ their drive through windows?

  92. My employer's 2019 benefits election window opens soon. I'm dropping Aetna. I don't trust CVS, and I wouldn't put it past them to make massive changes to Aetna's provider network. Specifically, designating my current providers "out-of-network", especially competing pharmacies. Our local CVS charges 40% to 60% more than independent and supermarket pharmacies in the area.

  93. This sure raises the spectre of a monopoly in the making. Massive distribution combined with massive content. Impossible barriers to entry/expansion for new and small competitors within the market. The scale alone should be very concerning.

    On the other hand, scale could conceivably be a benefit, if Aetna and CVS can find a way to do well by doing good. This is an opportunity for both players to make resounding profit while expanding access at lower costs, though that thinking would certainly be seen as anathema within the general corporate quest for rapacious profits.

    We don't begrudge either a fair profit, but not at the expense of higher costs, more restricted access and, ultimately, an unhealthier nation.

  94. I can already imagine what cutbacks my Aetna policy is going to suffer. I know I'm going to need certain procedures in the near future and I shudder to think what the MBA's at CVS have in mind for me.

  95. Used CVS for years with insurance. Lost job, questioned what my prescriptions would be. They tripled and quadrupled. Called Walgreens. The pharmacist quoted prices I didn’t believe. And if I joined drug plan with them at$20. for the year they would be even less. After years with CVS they couldn’t even be bothered to help me. For over 20 years I have been lucky enough to do business with them. And after helping me with my moms prescriptions and being familiar with me they offered me my flu shot for free. I still use them. CVS is crazy expensive now, just wait till this arrangement goes through.

  96. @Elly CVS used to be a good, local New England company. They have gotten too big and too powerful. Once a huge retail outfit forces competitors out of the market, that is the cue for prices to rise and service to erode. This is why CVS and other mega chains that used to be a value for the consumer are no setting prices higher.

  97. Yes Joe, I lived in RI most my life and when you have BCBS and it’s paid for you don’t think about it much. Couldn’t get over how friendly and so helpful Walgreens was. Even down here until I got coverage again they are always personable.

  98. I already go to a CVS pharmacy that is out of network for my Rx insurance for almost 20 years ,I pay a few more bucks for my wife's Parkinson's medicine by staying with CVS over another nearby pharmacy that takes my Rx insurance .the reason the people at CVS know me and my wife and will give me a few pills that are important for my wife's movement issues if her prescription runs out ,the other pharmacy across the street have their pharmacists behind glass who often change from one store to the next and could care less if I we go there or not.
    This of course may change and CVS may give bigger discounts to Aetna customers then those of United health Care Insurance.

  99. They give her unprescribed pills?

  100. CVS- the mega corporation that steals billions from Medicare and taxpayers each year by their automatic refill system.
    Billions are wasted on refilling millions of prescriptions no longer active - seniors end up taking the wrong medications and have a stockpile of discontinued medications in their home.
    Sadly, multiple senators, congressman, Attorney Generals have been informed of this costly scam, and none have investigated or acted.

  101. @Anne automatic refill system helps the elderly by making sure they don't miss needed medication. Problem is that many elderly DO NOT remember to take it or just think they van stop whenever they feel like it against their doctor's orders. I know. My 85 year old mother is like that and I am constantly supervising her.

  102. What effect will these mergers have if we finally get Universal Healthcare? With companies becoming too big to fail I see trouble ahead.

  103. Sheer insanity. We should be breaking up a lot of corporations, not allowing them to get bigger. We will pay a terrible price for not enforcing our anti-trust laws.

  104. “You’re going to have to go where your payer tells you to go” says Mr. Hill.

    For any of us that has insurance, there’s only been one place to go for years. (Year’s!)

    Before that, some of us only had the option of mail order and they didn’t manage to send the medicines out on time so for anyone requiring meds without interruption- whoops - forced to buy locally without reimbursement.

    You know where you get to go next? Bankruptcy court.

    So yeah, one place now, with cranky, rude obnoxious pharmacists and techs who don’t know/don’t care (but the store still wants you to fill out the survey!) and the annoying texts at all hours or...they drop the ball or scream over the phone when you need something out of state.

    So now, there’ll be no other option. What could possibly go wrong.

    And yet knowing people who have NO health insurance, I know I’m still very lucky. Try explaining this to friends in countries that have “normal” healthcare.

    I won’t even go into how I just self diagnosed ankylosing spondylitis- after an internist showed me my bloodwork and told me it didn’t mean anything even though I described the symptoms, had been in for imaging..,

    Yes. What could possibly go wrong.

  105. "It granted conditional approval to the CVS-Aetna deal as long as Aetna sold off its private Medicare drug plans." What is a "private" Medicare drug plan? One bought by an individual on the open market and/or one provided as part of an employer contract?

    This scares me. I am a retiree whose former employer offers its retirees a negotiated contract for an Aetna Medicare Advantage Plan and CVS is the PBM. This is the only option for retirees. Wonder what happens now - as open season is about to start.

    God I hate this business. It just shouldn't be so threatening and complicated.

  106. How long before the US with the corporate megadollars conspire to overthrow other countries' health care systems? The greedy plutocrats in Europe may see the logic of it yet.

  107. There are definitely things I don't care for in the CVS pharmacy model - most notably that services are siloed. The people at the register can ring you up - but they can't tell you why a prescription costs more or less than it should or why something isn't covered....or covered yet. I've also experienced shortages for a number of medicines because CVS ordered "too many" -- and get varied answers as to why a scrip can't be filled.

    Ultimately, I don't like getting my healthcare in a place that is carpeted.

  108. Is “consolidation” just a kind way of saying “monopoly”?

  109. @Mark Cutler
    Well, maybe the threat of Amazon will keep their service from going completely off the deep end.

  110. as with all corporate mergers someone has to foot the cost of the merger. Those who have health plans and those who shop at CVS phamacies will bear the brunt of the cost. We are slowly going back to the Pre- Sherman Antitrust Act days of the late 1800's. Laissez- faire rules. Just as the right wing corporate crazies want. Thanks Trump and Repubs of Congress you're getting what you've wanted for decades at the cost of the average working and poor American. Ugggh!!!!

  111. This administration has no sense of the danger of too much consolidation in any industry. If this purchase goes forward, the new health care giant will certainly throw its clout against the idea of single payer, which is our last best hope. In the meantime, consumers will pay for corporate over-reach.

  112. @Joe
    This administration is sadly no different in that regard from the corporate democrats who were in charge of the last administration.

    The biggest issue with these mergers is that any semblance of privacy is essentially being eliminated every time there is another consolidation in health care. The degree to which your health history can now be accessed by an ever larger number of people is so astronomical as to not be believable. Sorry, but give me paper records and independent pharmacies any day.

  113. CVS is strongly situated, with its network of retail pharmacy locations that already serve customers in neighborhoods, with trusted pharmacists at hand. I'm surprised it takes so long for insurers to come to appreciate that value, and the built-in trusts with end-customers.

    What is not so clear, of course, is how the locked-in relationship stifles competition, thereby reducing consumer choice and very likely driving up prices. It would not be too farfetched to worry about reduced level of customer services due to lack of competition.

    State and federal regulators should demand and put in place more safeguards to ensure some levels of competitions. Healthcare is far too important to allow monopolies to fester.

  114. Thank goodness I have Kaiser Permanente, even if it does feel like factory medicine.

  115. Can someone ask the second amigo, Lieberman, if it was worth it?

    He blocked universal healthcare because he was worried about losing jobs in his state, CT.

    Was it worth it? So many Americans suffering because of a senator’s self-interest?

    Just like Lindsay Graham is fine with tariffs as long as his state’s corporate employers are protected.

    It was a nice myth: The three amigos. Principled. Above it all...

  116. My "smaller government" that stays out of way of business doesn't seem all that small and seems very much in the way. Wait until you see the size of your government and how much they have influenced the economic landscape if our Dealer-in-Chief wins in 2020.

  117. I guess that now we'll be calling Big Pharma "Super-sized Pharma". I can't even imagine the kazillions that these vultures will reap off the average American with bottom-pit insurance!

  118. So this is where corporate tax reductions were spent? Acquiring companies. I am sure that will result in additional jobs -- not.

  119. I find it appalling how CVS has been taking advantage of the new opioid laws and twisting them to endure they get to collect more copays. Established chronic pain patients are allowed to have their entire 30 day supply of narcotic medications filled all at once each month, per the new regulations. My best friend has been on Tylenol 3 for several years for a chronic back issue that will eventually lead to surgery, and CVS had been making her go every 7 days to fill a portion of her monthly Rx with a $7 copay each time, then inexplicably the 4th time it was $15. Fortunately for her, CVS dropped her insurance plan and she started going to Rite Aid. The first time she brought her monthly Rx in last week she was shocked, they filled the entire 150 count bottle all at once, for 12 CENTS...yes, her copay was 12 CENTS! The 7 day rule only applys to newly discharged hospital patients with newly diagnosed chronic pain, patients with established chronic pain are allowed to have their entire Rx filled once per month. CVS is just out to collect a weekly copay, there are plenty of patients out there who are being taken advantage of and just don't realize it, and can't afford to be paying 4x or more what they used to for the same drug they've been on for years.

  120. Just great. It wasn't enough that CVS created Caremark to become a prescription plan provider for insurance companies with CVS as the sole distributor to control what prescriptions patients are allowed. Now CVS is going to control an insurance company. It's only a matter of time before they buy a hospital chain or a doctors network. They'll control every aspect of healthcare, from diagnosis to determining patients' treatments and which medications are covered, with CVS's finances being the determining factor for healthcare decisions...and all the government lobbying power that comes with it.

  121. Yes, of course we will lose control of health care under these mammoth and, under this administration, most certainly increasingly under-regulated entities. Deregulation of air carriers led to their colluding and dictating costs to consumers. Why should this be any different except for the fact that we can elect not to fly? We cannot escape the need for health care.

  122. So the company that struggles just to issue ordinary scripts is now going to run somebody's health insurance too.

    Sounds like a prescription for disaster.

    Maybe they should tap somebody from Wells Fargo or Volkswagen. You know, somebody who knows how to "cut corners" and "get the job done" regardless of ethics and the law.

  123. Costco, please don't leave the pharmacy business. I don't want my only viable choices to be Aetna, United Healthcare, and Cigna.

  124. Doesn't the supposed free market state that monopolies are anti-competitive? crony capitalism rules; real democracy a mirage. Goodbye America.

  125. The "Free Market" is a lie. Unbridled, unregulated capitalism leads to monopoly and rigged markets. Only the destruction of the private health insurance industry and the imposition of Medicare for All will remove the immoral status quo that profits off of disease.

  126. Reading this article on my table. There is an ad for Aetna medicare prescription plans along the top of the page (which I already have). If I read the article correctly, Aetna will have to sell off their (private) medicare plans. Is anyone beside me confused about what this means for us?

  127. @TomW

    They'll just move the membership to some other existing MAPD plan. Cigna, will all depend on where you are located. If you want to end run them - you can look at other plans for 2019 year....that way you won't be stuck with whatever they pick.

  128. I have to wonder how many congressman own stock in these companies?

  129. Get in line behind the lady at the pharmacy counter buying toilet paper, pop, and assorted junk for the privilege of getting your strep throat treated.

  130. @Pondweed
    To be fair, you go to the Pharmacy, not to the general cashier.

    Even tho' I have CVS coverage, I have used a competitor ( which was paid. via CVS SIlver Scripts) for standard vaccinations - flu, and shingles. It has never involved much waiting, and the pharmacists are excellent at covering questions, and a private room is provided. It required less time than arranging a visit at my doctors office -- which had the downside of having a lot of sick people in the waiting room.

  131. "The companies involved say that they will be better able to coordinate care for consumers as the mergers help tighten cost controls."

    Yeah, right. There are some things that should not be at the mercy of unbridled capitalism. Healthcare for one.

    Vote. Vote. Vote

  132. One of my biggest worries about our corporate drug jugglers is that the meds are being manufactured in China (!). Also, counterfeit drug manufacturing ending up in our supply.
    This has already happened in big pharmacies, including CVS.
    Not discussed much or at all. We should be making our own drugs here, for recalls, inventory/quality control and other purposes. China. Yeah, I really trust them to make my scripts.
    This could be potentially really bad someday.