This week, the Justice Department blessed a $69 billion merger between pharmacy chain CVS and insurance giant Aetna. CVS also owns Caremark, one of the three largest pharmacy benefit managers (PBMs), which negotiate drug discounts on behalf of health plans. With another tie-up between a PBM and an insurance company—Express Scripts and Cigna—awaiting likely approval, this signals an almost formal merger between the PBM industry and the health-insurance industry.
When the CVS/Aetna merger was proposed, I wrote at the Prospect that this vertical combination would be incredibly dangerous. If CVS/Aetna knows the prescription drug usages, methods of delivery, and pricing data for all of its rivals, who all have patients who order prescriptions from CVS pharmacies, it can exploit that data advantage to skim off the top of every side of the pharmaceutical market.
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