On January 5 of last year, we published an article about the proposed merger between CVS Health and Aetna. One year later, the acquisition of Aetna by CVS has been finalized and the two companies are now one.
Clearly, this deal was different than the big Aetna/Humana and Anthem/Cigna mergers that ended up falling through a couple years ago. In both of those proposed deals, two insurance giants would have joined forces, which is part of the reason the Department of Justice intervened. Federal officials were worried about reducing competition and limiting consumer choice.
In the CVS acquisition of Aetna, though, the nation’s largest retail pharmacy chain is expanding into the insurance industry, promising that the synergies created by the two companies joining forces will be transformative. In a press release about the acquisition, CVS Health President and Chief Executive Officer Larry J. Merlo says that the “combined capabilities” of the two organizations will allow them to “transform the consumer health experience and build healthier communities through a new innovative health care model that is local, easier to use, less expensive and puts consumers at the center of their care.”
According to the press release, the total value of the transaction is $78 billion, even more than we reported in our previous article. In order to get DOJ approval of the deal, Aetna agreed to divest its stand-alone Medicare Part D prescription drug plans, which have about 2.2 million members. Wellcare Health Plans will be taking over the Part D business.
While CVS Health and Aetna have the “lofty aspiration of transforming healthcare delivery for the better” and fixing “some of healthcare's most persistent problems,” an article in Modern Healthcare says that “the jury is still out on whether they'll accomplish that or leave employers and patients on the hook for higher healthcare costs.” It is true that we’re still early in the process and only time will tell if the new company can really make a difference, but it is interesting to look at the potential benefits of the two companies joining forces.
For instance, part of the vision is that “CVS walk-in clinics would become community healthcare hubs where pharmacists would manage patients' care and counsel them between primary-care visits.” At a time when many people do not have a primary care physician and those that do often have long wait times to see their doctor, this idea could be a game changer.
Another thing to keep an eye on, as reported in a recent article in Fortune, is the “new option to pass on 100% of drug rebates to its health plan sponsors (i.e., companies or organizations that sponsor health benefits for their employees and members).” CVS’ Caremark arm is one of the three largest pharmacy benefit managers (PBMs) in the nation, and the new “Guaranteed Net Cost” pricing option could help address some of the issues in the current model, including a lack of price transparency. It is worth pointing out that Optum, another one of the big three PBMs in the U.S., is owned by UnitedHealthcare. Increasingly, insurance companies are not just insurance companies, but rather companies that are involved in multiple areas of the healthcare system.
As for how this deal will ultimately impact your group and individual clients, it really is too early to say. Still, this is likely a sign of things to come in the industry, so we’ll keep an eye on it for you and let you know when there’s more news to share.