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Analysis

AMA Asks DOJ to Block CVS-Aetna Deal

By Steven Porter  
   August 08, 2018

The association, with others, already found sympathetic ears on the state level. The same may not hold true for the federal government.

The American Medical Association added itself Wednesday to the list of those urging the U.S. Department of Justice to block CVS Health's proposed $69 billion acquisition of Aetna, arguing that the combination would harm consumers by inhibiting competition.

While vowing to keep conversing with AMA as the merger progresses, CVS said in a statement that it disagrees with the group's assessment.

"We believe that competition within each of the business segments in which we operate—pharmacy benefit management, pharmacies and insurers—is fierce and will remain so," a CVS spokesperson said. "And this combination does not further concentrate the health care sector; instead it reconfigures it to bring together disparate parts of the health care system that today lead to inefficient, ineffective and more costly care."

The AMA had already made its opposition to the deal public during a hearing in June held by California Insurance Commissioner Dave Jones, who sent a letter of his own this month formally asking the DOJ to block the proposed acquisition on antitrust grounds.

The push for regulators to intervene in the CVS-Aetna deal comes as opponents of a similar acquisition plan involving Cigna and Express Scripts faces market-based criticisms from one influential shareholder.

But the complaints about CVS-Aetna may not be finding sympathetic ears in the Trump administration. Citing two unnamed sources, Bloomberg's David McLaughlin and Robert Langreth reported Tuesday that the DOJ's antitrust division hasn't seen any vertical-competition concerns in the proposed merger.

Analysts have long cited the deal's verticality as an asset that makes the deal more viable than horizontal mergers shot down in the past. Even so, Jones has successfully opposed major healthcare mergers in the past, so his criticism should not be given short shrift.

A spokesperson for the DOJ declined HealthLeaders' request for comment.

AMA President Barbara L McAneny, MD, said in a statement that the CVS-Aetna acquisition "is popularly described as a vertical merger" involving companies that operate in different markets.

"But in fact, CVS and Aetna do operate as rivals in some of the same markets, raising substantial concerns that are specific to horizontal mergers," McAneny said. "A merger of these two rivals would risk a substantial reduction of competition in the stand-alone Medicare Part D prescription drug plan market and the pharmacy benefit management (PBM) services market."

The association forwarded 29 pages of analysis to federal regulators, arguing that the merger would result in higher premiums by increasing concentration in most Medicare Part D regional markets. The AMA argued, further, that CVS-Aetna's vertical ramifications would violate federal law by increasing barriers to market entry in already-concentrated markets.

Editor's note: This story has been updated to note that a DOJ spokesperson declined to answer questions.

AMA Letter to DOJ Regarding CVS Aetna Merger by HLMedit on Scribd

Steven Porter is editor at HealthLeaders.


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