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CVS Is Said to Agree to Buy Aetna

nytimes.com

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Re: CVS Is Said to Agree to Buy Aetna

#101

Post by just1nn »

briandear wrote: post #65
dd36 wrote: post #64

Earlier quoted context omitted.

Don’t the walking dead already pick up prescriptions there? I share your concern. Maybe they could service people out of Tesla Semis in the parking lot? Only half joking.

Why do we still have to pick prescriptions up? We have pizza delivery — why not for medicines? Order your drugs with an app and it shows up at your door.

Prescriptions have been available with delivery or mail order service for at least the last ten years. I have worked for at least two private pharmacies (in different states) who offered delivery service, and several of my classmates went to work for the mail-order fill companies as the "stare and compare" pharmacist checker.

Re: CVS Is Said to Agree to Buy Aetna

#102

Post by ikeboy »

>Both CVS and Aetna played down the prospects of regulators moving to block their deal. The breakup fee for the transaction is not especially large, reflecting that belief.

What's the causality here? Why does a lower chance of being blocked imply a lower fee if blocked?

Re: CVS Is Said to Agree to Buy Aetna

#103

Post by just1nn »

jrnichols wrote: post #76
allenz wrote: post #67

I see this as a move towards providing cheap basic medical care. This is timely now that it's possible that the individual mandate will be repealed. Millions of uninsured people could be treated for rashes or flus by nurses at CVS cheaper and faster than at doctor's offices. More competition in healthcare could be a good thing--many say it's bloated and overpriced. The risk is that poor people get basic care while ri…

> treated for rashes or flus by nurses I sometimes think that's one of the things that's kept health care so expensive. Nursing salaries aren't cheap. A lot of the home health and basic clinic stuff could be handled by an LPN/LVN or even a Paramedic in many cases. Not everything needs an RN. There are plenty of available telemedicine options to put a provider in touch with a higher level of care if necessary.

"Professional Extenders" are everywhere, and it hasn't caused anything to become cheaper. If you show up at an urgent care, just expect that you will be treated by a LPN and a PA or a NP. A Family Practice physician's salary is about comparable to a Sr. Engineer at many tech companies (~160k), and they can have significant malpractice insurance overhead and insane hours. A PA or NP still makes 6 figures, so the "savings" just aren't there.

If you've ever had to attend something like Physical Therapy, you'll see the actual PT (a MS/Doctorate level professional aka DPT) about twice. Once for an eval, and once for a discharge. An "aide" will guide you through all the other exercises, and they make very significantly less than a PT.

The savings are mysteriously gone, even adding lower-salaried professional extenders.

Re: CVS Is Said to Agree to Buy Aetna

#104

Post by just1nn »

mrfusion wrote: post #95
rdl wrote: post #2

If this turns every CVS into a uniform, inexpensive office/urgent care/etc., particularly with telemedicine, I'll be happy -- the "minute clinic" stuff already provides cheaper and more convenient access to care, but CVS+Aetna+some kind of EHR could do something amazing.

Is there a good way to do telemedicine now? I can’t get over the awkward factor but if it saves money.

I have used amwell with great success, recently. I have no affiliation with them, and I am paying them for their services, but my experience was top notch, and I have a PCP through them. I have yet to get my insurance to process automatically, but I just paid with their FSA VISA card and I'm doing an offline bill to submit. Many states REQUIRE covering telemedicine, even for Medicare/Medicaid in some cases.

Re: CVS Is Said to Agree to Buy Aetna

#105

Post by erebus_rex »

ikeboy wrote: post #102

>Both CVS and Aetna played down the prospects of regulators moving to block their deal. The breakup fee for the transaction is not especially large, reflecting that belief. What's the causality here? Why does a lower chance of being blocked imply a lower fee if blocked?

Takeovers cost time and money to execute (lawyers, consultants, bank fees) beyond just the purchases price. If the deal does not go through it is a loss for the acquirer, hence breakup fees. If the chance of takeover failure is low the acquirer will be willing to accept a smaller insurance.

Re: CVS Is Said to Agree to Buy Aetna

#106

Post by wfo »

cdolan wrote: post #18
LeoJiWoo wrote: post #10

Well I hope this a good thing, and won't lead to price gouging. The trend of corporate consolidation is concerning, we need more monopoly busting, and anti-trust investigations.

I agree the trend is concerning, but what data are you basing the “need” for monopoly busting and anti trust investigations off of??

Antitrust activities while still provided for in US law have essentially stopped in the modern era, leading to massive concentration of power and economic disasters associated with monopoly and consolidation (e.g. financial crisis). So a general call to bring that job of the federal government back is certainly a welcome one.

Re: CVS Is Said to Agree to Buy Aetna

#107

Post by jdmichal »

just1nn wrote: post #97
allenz wrote: post #89

Earlier quoted context omitted.

I agree that CVS wants to stave off Amazon and mail order pharmacies. But a buyout is an expensive way to secure a fraction of the market. Buying Aetna makes it easier to expand the new Minute Clinic business model. CVS no longer has to worry about getting paid less than a hospital for treating a cough or fever. Aetna could even charge zero copay for nurse visits. It's more competition in the "basic healthcare" space…

The "Caremark/CVS" insurance that I have for prescriptions allows me to go to Target/CVS for covered medications, but I also have the option to mail-order (from them, of course). I also have Aetna Health Insurance just by chance (we have a choice of 3 companies @work). Amazon is going to buy drugs in major bulk (Walmart, or Mail-order-pharmacy style), and likely will charge low "dispensing fees" (because robots will…

Is it even legal to dispense drugs without a pharmacist? The same way that a nurse practitioner is only legally permitted to do so much before a doctor is required.

Re: CVS Is Said to Agree to Buy Aetna

#108

Post by Spooky23 »

allenz wrote: post #67

I see this as a move towards providing cheap basic medical care. This is timely now that it's possible that the individual mandate will be repealed. Millions of uninsured people could be treated for rashes or flus by nurses at CVS cheaper and faster than at doctor's offices. More competition in healthcare could be a good thing--many say it's bloated and overpriced. The risk is that poor people get basic care while ri…

Sounds more like building a moat by aligning formularies with insurance requirements.

Re: CVS Is Said to Agree to Buy Aetna

#109

Post by Spooky23 »

jdmichal wrote: post #107
just1nn wrote: post #97

Earlier quoted context omitted.

The "Caremark/CVS" insurance that I have for prescriptions allows me to go to Target/CVS for covered medications, but I also have the option to mail-order (from them, of course). I also have Aetna Health Insurance just by chance (we have a choice of 3 companies @work). Amazon is going to buy drugs in major bulk (Walmart, or Mail-order-pharmacy style), and likely will charge low "dispensing fees" (because robots will…

Is it even legal to dispense drugs without a pharmacist? The same way that a nurse practitioner is only legally permitted to do so much before a doctor is required.

The pharmacist “supervises” te process. Mail order has been doing this for 20 years. There used to two big ones... Caremark and Express Scripts. Now CVS, the Comcast of drugs, swallowed both up.

Hospitals do this too. In some cases 2-3 pharmacists can cover 10-12 hospitals for off shift dispensing needs.

With the black horse cavalry running the country, we’re going to see lots of M&A activity like this.

Re: CVS Is Said to Agree to Buy Aetna

#110

Post by alphabettsy »

Spooky23 wrote: post #109
jdmichal wrote: post #107

Earlier quoted context omitted.

Is it even legal to dispense drugs without a pharmacist? The same way that a nurse practitioner is only legally permitted to do so much before a doctor is required.

The pharmacist “supervises” te process. Mail order has been doing this for 20 years. There used to two big ones... Caremark and Express Scripts. Now CVS, the Comcast of drugs, swallowed both up. Hospitals do this too. In some cases 2-3 pharmacists can cover 10-12 hospitals for off shift dispensing needs. With the black horse cavalry running the country, we’re going to see lots of M&A activity like this.

Pharmacists must directly supervise dispensing. Many hospitals use a central-fill pharmacy where the prescriptions are filled for many hospitals.

The problem with these mergers is they allow health plans that further disadvantage other pharmacies or providers. Once those other options are eliminated we’ll see prices rise. Do people actually want the Home Depot’s of healthcare rather than the equivalent of the local hardware store? We’ll see I guess.

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