Chester County Medicine Winter 2019 - 13

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How would an Aetna-CVS merger increase costs? Both CVS
and Aetna have been forthright in stating that their intended
purpose is to expand on CVS Minute Clinics as their model for
improving access to care. The 22 million Aetna enrollees could be
financially led to use these clinics for their primary care needs.
This approach is penny-wise and pound foolish. This new
captive audience will likely be required to use CVS pharmacies for
their prescription and non-prescription needs, giving one of the
biggest retailers in the country significant pricing power. Patients
will lose the ability to shop around for a lower price.
In addition to more pricing power, Minute Clinics, staffed by
mid-level professionals, not doctors, tend to over-prescribe and
over-refer to specialists, driving up system costs. According to a
Centers for Disease Control study released this year, nearly half of
people who visit walk-in clinics with cold or flu symptoms walk
out with an antibiotic, despite clear guidelines that antibiotics are
useless for treating such viruses.
Minute Clinics are cheaper for a reason, namely they eschew
committed doctors for roving health professionals. They disrupt
the doctor-patient relationship that has long been proven to
improve health outcomes, especially in cases of chronic illness
which account for 86 percent of health-care costs in the U.S. A
meta-analysis published this year in BMJ found a marked link
between continuity of care and lower death rates. The trust, caring
competence associated with this relationship leads to better health
outcomes.
One other merger consequence patients would likely face is
fewer prescription drug options. That's because CVS, through
its Caremark subsidiary, is a pharmacy benefit manager, which
control the formulary of prescription drugs while receiving
legalized kickbacks from drug manufacturers. Its leverage over
manufacturers and drug choices will increase significantly with its
massive new insurance customer base. As a result, CVS Caremark
will be incentivized to provide those drugs that make a profit for
its insured patients. Previously, Caremark had to respond (at least
partially) to the market demands of the third party health insurers
it was serving.
The corporate conflict of interests and increased control
generated among pharmacy, insurer, benefit manager and,
pharmaceutical manufacturers will leave patients with a bigger bill
and erosion of trust in care.
What's a primary care alternative that overcomes these conflicts
of interest and maintains trust? There's a growing competing
health-care model known as Direct Primary Care, which allows
patients to see their personal doctor and have all their primary
needs covered without insurance for a fixed monthly rate of around

$100, providing rapid access, while receiving prescriptions at
cheaper, wholesale prices. Paired with an inexpensive catastrophic
insurance plan, this is a better health-care model to lower costs and
improve patient outcomes.
In contrast, the CVS-Aetna merger would consolidate
the insurance, pharmacy benefit manager, pharmacy, Minute
Clinic brick and mortar CVS stores, threatening to destroy an
already eroding primary care system and fraying doctor-patient
relationships.
At the moment, Judge Leon is the only one standing in the way
of this future that threatens the public interest. But if the public can
be educated on the merger consequences while he does, there's still
time to block it.
Dr. Ken Fisher is a nephrologist and author of
"Understanding Healthcare: A Historical Perspective."
He is an advisory board member of Practicing Physicians
of America. Dr. Marion Mass is a pediatrician. She is the
co-founder and vice president of Practicing Physicians of
America. The views expressed by contributors are their
own and not the medical society's.

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WINTER 2019 | CHESTER COUNT Y Medicine 13
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Chester County Medicine Winter 2019

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