CVS-Aetna deal casts chilling shadow over pharmacy landscape

YARMOUTH, Maine - If a planned merger between CVS Health and Aetna goes through, community pharmacists say it could flatten the industry.

“It's going to have a terrible negative impact on privately-owned pharmacies,” said Steve Nelson, CEO and president of Okeechobee Discount Drugs in Okeechobee, Fla. “They've got a pharmacy benefit manager (CVS CareMark) and now an insurance company. They'll be in direct competition with physicians, they'll sell you policies, you'll see their clinicians—there's no freedom of choice left.”

CVS Health and Aetna on Dec. 3 announced that CVS Health would pay approximately $69 billion in cash and stock for Aetna's outstanding shares. The companies tout the deal as a way to increase access for consumers and create a more personalized healthcare experience.

CVS currently has more than 9,700 pharmacy locations and 1,100 MinuteClinic walk-in clinics.

“The bottom line is they are just monopolizing the whole industry and making it worse for everybody in the end,” said one pharmacist who didn't want to be quoted for fear of reprisal from the PBM. “In any other industry, they'd be up in arms.”

Community pharmacies already struggle under CVS's PBM and others. The three largest—CareMark, ExpressScripts and OptumRx—control nearly 80% of pharmacy benefits in the U.S., according to the National Association of Community Pharmacists.

“I got locked out two months ago from a PBM that told my clients they could no longer shop with me,” said Nelson. “I have lost 40% of my patients because I have been beaten up by the bigger stores that own PBMs.”

The deal, which still needs approval from federal regulators, comes in the wake of reports that Amazon has filed applications for pharmacy licenses in more than a dozen states.

“Health care is being commoditized,” said a pharmacy manager who didn't want to be quoted. “It's like we are just heading into price conscious-only shopping where we don't care about anything else. That's scary.”