THE GEORGIA SOCIETY of Clinical Oncology (GASCO), in partnership with the Medical Association of Georgia, the Georgia Pharmacy Association, and Georgia Watch, worked with the Georgia Office of the Insurance Commissioner to secure what is described as “significant, one-of-a-kind concessions” from Aetna and CVS before the state signed off approval of the merger.1
In a move that generated continued freedom of choice for patients and community health-care providers, Georgia’s conditions for approval were significant and noteworthy. The organizations argued that without proper protections, a single company controlling health insurance and prescription through a pharmacy benefit manager—and acting as a pharmacy—could endanger patients’ health by restricting their choice of health-care providers and access to care.
Protections for Patients and Providers
THUS, AT THE URGING of the four organizations, Georgia Insurance Commissioner Ralph Hudgens demanded those protections before approving the merger. Of note and, to date, Georgia specifically requested the following steps:
- CVS/Aetna must invite non-CVS health-care providers (pharmacists, physicians, clinicians, etc.) to join its networks as well as set the same criteria for those providers
- CVS/Aetna must allow patients in Georgia to use any health-care provider—in or out of network—if that provider accepts the same conditions as those within the network
- CVS/Aetna cannot require patients to use CVS-owned pharmacies, whether for regular prescriptions, refills, or specialty drugs. These concessions reduce the chance that a combined CVS/Aetna merger could limit patients’ choice of health-care providers
- CVS must disclose the amount of rebates it receives from drug makers and how much of it will be passed on to insurers. ■
REFERENCE
1. Georgia Watch: As CVS and Aetna prepare to merge, Georgia wins major concessions. November 27, 2018. Available at www.georgiawatch.org/as-cvs-and-aetna-prepare-to-merge-georgia-wins-major-concessions. Accessed January 3, 2019.
Ms. Adams is Specialist Policy Communications Coordinator, ASCO, Alexandria, Virginia.
