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CVS Is Said to Agree to Buy Aetna

nytimes.com

131–140 of 155 posts

Re: CVS Is Said to Agree to Buy Aetna

#131

Earlier quoted context omitted.

> Yes. If consumers and/or pharmacies in the US could easily and reliably source cheaper brand-name drugs from international markets where price ceilings are in effect, it would ruin many drug companies, especially smaller ones. Those price ceilings only exist because of the artificial trade barrier between the US and those other countries. Without that trade barrier, pharmaceutical companies would charge roughly equ…

The companies would be fine, but it would probably severely limit the availability of life-saving drugs in poorer countries. One can argue that on the whole, that's a worse outcome.

That cannot be the reasoning behind imposing import restrictions. And even then I find the economic reasoning fault.

> That it was the spirit of monopoly which originally both invented and propagated this doctrine cannot be doubted; and they who first taught it were by no means such fools as they who believed it. In every country it always is and must be the interest of the great body of the people to buy whatever they want of those who sell it cheapest. The proposition is so very manifest that it seems ridiculous to take any pains to prove it; nor could it ever have been called in question had not the interested sophistry of merchants and manufacturers confounded the common sense of mankind.

Re: CVS Is Said to Agree to Buy Aetna

#132

Um wtf. This is akin to comcast buying NBC. This is not good.

Can you identify any tangible negative effects on consumers which arose due to the purchase of NBC by Comcast?

No. But the potential is there. They were better off separate as they operated as different entities but together their incentives are overlapped and the potential to exert undue power over the market is that much easier. Separate Comcast and NBC had no incentive to go into any exclusive agreements. Disney buying Marvel is a similar case. They are pulling content licensed for viewing on Netflix into their own service. Not illegal but not a win for consumers in an already crowded steaming market. And unfair to Netflix in that sense.

Re: CVS Is Said to Agree to Buy Aetna

#133
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 This is timely now that it's possible that the individual mandate will be repealed.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…

>The risk is that poor people get basic care while rich people get full care, widening health disparities.

In my experience, that's already the situation. Actually, reality is worse. The rich (meaning, upper middle class and not sick) get full care and even excessive care, while the poor get basic or no care, often emergency only.

If you go to a hospital for an emergency procedure, the level of care and follow up care depends on your insurance. When the hospital thinks they probably won't be paid for services they choose to not offer them. So, the poor get basic care... while rich people get full care.

Re: CVS Is Said to Agree to Buy Aetna

#134

Earlier quoted context omitted.

>Amazon is going to buy drugs in major bulk (Walmart, or Mail-order-pharmacy style) All pharmacies, electronic and brick-and-mortar, go through one of 3 wholesalers: Cardinal, AmerisourceBergen, or Mckesson. It's, "which retailer can drive distribution?"

Speaking from the US, it's too bad that pharmacists are so disempowered here. I was just in France, and my friend came down with an eye infection. He went to a pharmacist, who just gave him antibiotics and told him to come back in three days if it didn't go away. We both agreed it would never have been so easy in the states.

While I agree that kind of ease of access to an Rx that would have otherwise required a doctor’s office visit sounds great, antibiotics is probably a bad example. Over-prescription of antibiotics is a known problem. Was your friend seen by a PA or nurse or something? Maybe that model makes sense but I hesitate to give pharmacists the added power of diagnosis.

Re: CVS Is Said to Agree to Buy Aetna

#135

Earlier quoted context omitted.

> 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.

The Minute Clinics are staffed by nurse practitioners and physician assistants https://www.cvs.com/minuteclinic/why-choose-us/our-practitio... To expand their services to all of their stores, they'd be looking at hiring 5 or 10 percent of the NPs and PAs in the country.

Or...the publically signaled demand for those relatively high paying jobs would encourage more people to seek training for those opportunities.

Re: CVS Is Said to Agree to Buy Aetna

#136
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…

>Amazon is going to buy drugs in major bulk (Walmart, or Mail-order-pharmacy style) All pharmacies, electronic and brick-and-mortar, go through one of 3 wholesalers: Cardinal, AmerisourceBergen, or Mckesson. It's, "which retailer can drive distribution?"

If Amazon enters the pharmacy business is there any reason they couldn't bypass the wholesalers and buy directly from pharmaceutical companies?

Re: CVS Is Said to Agree to Buy Aetna

#137
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…

>The risk is that poor people get basic care while rich people get full care, widening health disparities. In my experience, that's already the situation. Actually, reality is worse. The rich (meaning, upper middle class and not sick) get full care and even excessive care, while the poor get basic or no care, often emergency only. If you go to a hospital for an emergency procedure, the level of care and follow up car…

This may have been true pre-ACA, but it isn't the reality now.

It's now a system where wealthy, government employees, and the poor (i.e. subsidized) have access to full care, and most of the middle class just goes without.

In the past 5 years, I've gone from a decent $20 copay to a employer-sponsored high deductible to currently a fully out of pocket deductible of $2k before insurance pays a cent.

I've begun rationing my prescriptions and simply skip the doctor unless it's a true life-or-death situation.

The deductible for co-workers with a kid or two is something like $5k. That's on top of probably $10k in premiums a year.

Re: CVS Is Said to Agree to Buy Aetna

#138
They should break up the big insurance companies and not consolidate each point of sale area for more profit.

Ex: A knee brace went over the $500 requirement to have a prior approval before issuance. No one knew this at the time so the doctor gave a cost price of $100 for the brace to avoid phone calls, letters, and time.

Can we please eliminate medical bills if not sent to the patient within 90 days? 2-5 years late is just pathetic.

Re: CVS Is Said to Agree to Buy Aetna

#140
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.

No, it isn't. I worked for CVS for about 8 years, though not as a pharmacist. Some of this information could be Indiana-specific, however:

A brick and mortar pharmacy must have a pharmacist on-site to dispense drugs. Not only are they supposed to do a final check on prescriptions filled, but they must be available for patient question and sometimes medicine requires advice from a pharmacist before it can be dispensed. In addition, there are some stricter laws for certain controlled medications and these checks must be done by a pharmacist. If the pharmacist gets sick or in a car accident on the way to work, the pharmacy can't legally open (they can section the pharmacy off with its own locks to keep the convenience store open).

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