CVS-Aetna Merger Settlement Will Harm Patients, Physicians Warns DOJ and Court


U.S. District Judge Richard J. Leon asked CVS and Aetna to keep operations distinct, while he reviewed public comments on the settlement.

Comments submitted by the Association of American Physicians and Surgeons (AAPS) in a Dec 5 letter to Peter Mucchetti, Chief, Healthcare and Consumer Products Section, Antitrust Division, Department of Justice, warned that the proposed settlement “will result in less competition, fewer options, harm to patients’ pocketbooks, and ultimately their health.” AAPS president Marilyn Singleton, M.D., J.D., cautioned that “the settlement does not address harm to patients resulting from vertical consolidation that will occur between a merger of an insurer, pharmacy benefits manager, and providers of medical care and prescriptions.”

Dr. Singleton also writes: “CVS is in the position to steer patients covered by Aetna to receive their care from CVS-run clinics, instead of from their own trusted physician. Moreover, the patients in the name of convenience or coerced by a limited network would get their prescriptions from CVS.”

CVS-run pharmacy benefit plans are already on the forefront of limiting patient choice of pharmacy. According to, the CVS Health’s Maintenance Choice program is the most prominent limited network model for commercial plan sponsors. Under the program, a beneficiary can obtain maintenance medications from either a CVS retail pharmacy or a CVS Caremark mail pharmacy.

“Given the track record of CVS in limiting patient choice, it is inconceivable that it will not use the merger with Aetna to move more patients into CVS restricted pharmacy networks,” Dr. Singleton continued.

“And CVS makes the most of its captive consumers by charging the highest prices for drugs. Earlier this year, Consumer Reports compared the prices of five standard prescriptions and found they cost a combined $66 at an online pharmacy, $105 at Costco, while the bill at CVS was $900. Meanwhile at an independent physician’s office in a state allowing in-office dispensing, a patient can bypass the middlemen and get the same drugs for a total of $29.”

AAPS concludes that “a merger should not proceed while there is an ongoing federal whistleblower case, Behnke vs. CVS Caremark, alleging CVS violated federal laws while under contract with Aetna to administer Part D plans. Aetna recently suspended the whistleblower who brought these claims against CVS to light—claims that include a complex scheme for rigging payments to pharmacies in an anti-competitive manner. A merger prior to the resolution of these allegations could improperly allow CVS to influence Aetna’s cooperation with this investigation.”

AAPS earlier wrote the DOJ in September 2018 expressing additional concerns prior to the settlement announcement.

The Association of American Physicians and Surgeons (AAPS) is a national organization representing physicians in all specialties, founded in 1943. Its motto is “omnia pro aegroto,” or “all for the patient.”