Mergers and acquisitions have been the lifeblood and also the fear of many industries. Sometimes these transactions work out, sometimes they have been catastrophic. That said, it is difficult to properly process the forthcoming merger of CVS Health, the pharmacy chain, with Aetna Insurance. What will it mean for us? Who Will be the ethical watchdog?
Approval – Who Will Be the Ethical Watchdog?
The merger between CVS Health and Aetna is troubling. On the surface, I agree with many experts that it could potentially cause patients to have less say over what they can pay for drugs, the types of drugs they might be able to access and even how they are treated.
Who can stand up to this alliance? In 2017, CVS Health had revenues of $185 billion. Data shows that more than 94 million customers passed through CVS doors. Aetna did about $60 billion in sales and they cover 22 million people. There are tens of thousands of physicians, clinics, and hospitals operating in their plans. You can see, I believe, where I am going with this.
In hearings, CVS Health and Aetna claim that the merger will be a plus for their customers. The CEO of CVS Health has said:
“(The approval) is an important step toward bringing together the strengths and capabilities of our two companies to improve the consumer health care experience.”
Those are nice words, a definite call to action but what happens to “control?” Will Aetna plan subscribers, and more importantly, their physicians have any say over their prescription drugs?
This consolidation between mega-pharmacies and insurance providers is not a first, but it is a trend. In September 2018 the Express Scripts organization was acquired by Cigna.
A quote attributed to the counsel for the Consumers Union, George Slover states:
“This type of consolidation in a market already dominated by a few, powerful players present the very real possibility of reduced competition that harms consumer choice and quality.”
Consumers Union is opposed to the CVS Health merger. They argue, as would I, that it will automatically force patients in need of medical treatment, for example, to seek urgent care at CVS Health clinics, and consumers outside of Aetna coverage could be forced to pay higher prices for prescription drugs than those covered by the plan.
The government, in approving the merger, has ordered that Aetna sell off some of its private plans. But is that enough?
Who cares for us?
It is hardly a secret that there are numerous, rather unethical deals between pharmacy managers and pharmaceutical companies. The trouble with the deals is that any savings (in terms of ‘illegal’ discounts) is not passed along to consumers.
The huge insurance provider-drugstore chain conglomerates that are being created are being done, we are told, to approve our healthcare experience, but is it?
What happens in the case of a patient who needs a special medication that neither the insurance company covers nor the drug chain carries? What happens when physicians, presumably looking out for the best welfare of their patients, have a course of treatment that both the insurance provider and the drug chain itself deems medically unnecessary.
What alternatives will the patient have to better maintain and improve their health? Though this will sound absurd, for now, what might happen at some time in the future when the insurance company and the drug chains acquire clinics or hospitals? It is somewhat frightening to think that decisions are based solely on price.
Somewhere in this discussion, I would submit that there must be an “ethical screen” or an “ethical board” of some type to ensure that patients are treated and not railroaded into healthcare decisions. Who will be the ethical watchdog?
While I am not suggesting we revert 100 years to the days of the single-family physician treating everything and then writing a prescription to the local, free-standing pharmacy, I am asking who really has the best interest of the patient at heart?
Who ensures the treatment is the best treatment and not the treatment the conglomerate dictates? In my view, there must be an advocate who can review reasonable options. Finally, what is to prevent the pharmaceutical companies, megaliths in and of themselves from cutting deals with the conglomerates? It is almost impossible for law enforcement to control unethical drug rep behaviors now, what occurs when the same behaviors occur at much higher levels, behind closed doors in board rooms?
Without ethics, I fear for the creation of these conglomerates.
