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CVS has been very much in the news, given its purchase of Aetna Health–pending Federal antitrust review–for $69 billion. The review will be done either by the Justice Department or the FTC, both of which have jurisdiction–the FTC being the more lenient according to Reuters (https://www.reuters.com/…/cvs-likely-wants-ftc-antitrust-re…), although either is likely to approve the merger as not harming consumers.

In a New York Times report (https://www.nytimes.com/…/…/04/health/cvs-aetna-merger.html…), CVS spokespeople were quoted saying that joining a large insurer with a large pharmacy “‘will create a world where patients will get the “human touch”…fewer people will fall through the cracks…and getting high-quality, low-cost medical care will be as close as your corner drugstore”

“Skeptics say,” the Times article continues, “CVS and Aetna entered into the deal not to benefit consumers but to strengthen their competitive positions…The two are already major healthcare players…Others pointed out that a major rival, UnitedHealth Group, already owned a large pharmacy benefit manager, OptumRx, yet drug prices have continued to rise, and consumers remain frustrated.”

Dan Primack, reporting in Axios December 3 (https://www.axios.com/4-big-questions-for-cvs-aetna-mega-me…), asked many of the same questions his colleague Bob Herman asked in October:
– “What relationship will exist between patients covered by Aetna insurance and CVS?” Will they be required to buy drugs at CVS and use the MinuteClinics?
– Will CVS report your other purchases to Aetna–the junk food, for example?
– How will other insurers respond to CVS? Will they favor other pharmacies?
– Will this trigger other similar mergers? Will this create mega-companies with fewer choices for patients?

What about northeast Indiana and Fort Wayne? CVS MinuteClinics have had a relationship with IU Health in the past. As reported by IU Health (http://iuhealth.org/…/cvs-caremark-minuteclinic-and-indian…/), “Under the agreement, IU Health physicians will serve as medical directors for 19 MinuteClinic locations, including 17 in the Indianapolis area, one in Bloomington and one in West Lafayette. Signage at participating MinuteClinic locations will inform patients that each site has a clinical affiliation with IU Health. In addition, MinuteClinic and IU Health will collaborate on patient education and disease management initiatives and will inform patients of the services each offer. IU Health will accept patients who need a level of care that is not provided at MinuteClinic.”

Why this is important:
– CVS lists 46 MinuteClinics in Indiana with 6 in the Fort Wayne area
– CVS has announced its intent to open hundreds more
– The presence of IU Health in northeast Indiana will make expansion of this joint venture relatively easy and should provide increased access to urgent care and routine primary care
CVS clinics have already entered the occupational health and medicine field with a partnership with Alere (EOHN) in screening tests for workers (seehttps://cvshealth.com/…/minuteclinic-announces-new-partners…)
– Ten-fold price differences between free-standing emergency departments (FSEDs) and urgent care facilities combined with MinuteClinic expansion guarantees copycat expansions and most likely more downward pressure on FSED profits