Georgia claims major concessions ahead of CVS/Aetna merger

by NCPA | Nov 27, 2018

Three cheers for the Georgia Pharmacy Association and its partners for winning substantive pharmacy concessions as a result of their opposition to the CVS/Aetna merger in that state. They lobbied the state insurance commissioner to protect patients from restrictions on access to care that would result from the merger. In response, the insurance commissioner demanded several patient and pharmacy protections before approving the merger – which CVS agreed to – including:

  • CVS/Aetna must invite non-CVS health care providers (pharmacies, physicians, clinics, etc.) to join its networks, and must set the same criteria for all those providers.

  • CVS/Aetna must allow Georgia patients to use any health care provider – in or out of network – if that provider accepts the same conditions as those within the network.

  • CVS/Aetna cannot require patients to use CVS-owned pharmacies, period – not for regular prescriptions, refills, or specialty drugs. These concessions reduce the chance that a combined CVS/Aetna can limit patients' choice of health care providers. (As a pharmacy benefits manager, CVS Health already requires patients on some plans to get their specialty medications from CVS pharmacies. This practice will no longer be allowed in Georgia.)

  • CVS/Aetna must disclose the amount of rebates it receives from drug makers and how much of those it passed on to insurers.

(Bear in mind: These concessions apply in Georgia only.)

In New York, thanks to the efforts of the Pharmacists Society of the State of New York, regulators set conditions on the merger, including enhanced consumer and health insurance rate protections, privacy controls, cybersecurity compliance, and a $40 million commitment to support health insurance education, enrollment, and other consumer health protections. Of particular interest to community pharmacy: Regulators required that participating provider networks for insured products will maintain access to non-chain New York pharmacies for three years.

In California, regulators approved the merger only if CVS and Aetna agreed to keep premium increases "to a minimum."

Take it from these states – you can fight back. Victories in Georgia and New York, in particular, set a precedent for other states proposing similar reforms via legislation. CVS can no longer say they've never agreed to such concessions.