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    Pharmacy Is Dead

    The CVS/Aetna deal won’t kill traditional pharmacy—it just shows that it’s already dead.

    After months of speculation, CVS Health formally announced its decision to acquire Aetna on December 3. The deal will merge the largest pharmacy, the third largest PBM, and the third largest insurer. Perhaps most significantly, the deal represents a shift in pharmacy and in its value to health care.

    The deal is still subject to antitrust scrutiny, but many analysts believe the deal will go through without a hitch. The merger would fall under the category of a so-called vertical integration, which sees parts of the production path merge together. In this case, that would be insurance and drug benefits. Horizontal mergers—the joining of two competitors, like the failed Walgreens/Rite Aid merger earlier this year—have previously been more difficult to pass through antitrust regulations, since they more directly impact consumer choice.

    The Consumer

    Some argue, however, that the deal will limit consumer choice. David Balto, the former Policy Director at the FTC and current Director of the Coalition to Protect Patient Choice, told Drug Topics that this deal “raises serious concerns for employers and consumers.” He pointed to the recent AT&T/Time Warner merger—which has come under intense antitrust scrutiny—as evidence that vertical integrations are not always assured.

    Under this new deal, he said, CVS will be able to use its “gatekeeper position to prevent Aetna customers from using the pharmacy of their choice.” He added that the deal would give CVS more power to increase the price of drugs, and that the deal would be like “giving steroids to rebate schemes,” which he said are already problematic.

    Related article: CVS Limits Opioid Use

    B. Douglas Hoey, MBA, CEO of NCPA, said in a statement that the deal will not lead to reported cost savings. He pointed to UnitedHealth’s 2015 acquisition of Catamaran as an example, saying that since that merger drug prices continued to increase. He said that this deal deserves close scrutiny over “whether this acquisition will lead to higher drug prices and fewer quality and convenience options for consumers.”

    Hoey did concede that the deal could result in savings if CVS and Aetna contain the costs PBMs add to prescriptions.

    Up next: The Death of Traditional Pharmacy?

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    • UBM User
      This is more or less being referred to as merely one of the "steps" in the public execution of "traditional pharmacy." I disagree - on a couple points: 1. Pharmacy has been in a downward spiraling suicide situation for a couple of decades. During my 45½ years in the practice of Pharmacy, I spent the greatest percentage of it in hospitals. I spent a total of about 10 years in discount retail pharmacy over the years, most recently from 2003 - 2004 with CVS. Two tangential occurrences hit during these years and the years immediately bookending them: a. The introduction of Certified/Registered Pharmacy Technicians - we got by quite well before our techs needed certification or registration. By giving them a "license" on the wall and a "title," they took this to mean that they were on par with REGISTERED/LICENSED Pharmacists. Their "rise" is tied closely with the need to make a profit in the arena of hospital pharmacy, what with 3rd parties determining what pharmacists and pharmacies could charge to provide professional service. Make no mistake about it: techs are NOT professionals in the true sense of the word because they have no body of "higher learning" that is unique to what they do, when compared to pharmacists. Retail pharmacies saw them as cheap RPh replacements and pushed for State Legislatures to change Laws/Regulations to allow one RPh to supervise large numbers of techs, while pretending to be "professionally engaged in the practice." I was outnumbered by techs 3 or 4 to one, most days, in a busy store with a hostile pharmacy manager and an equally hostile district manager. The pharmacy manager, herself an RPh of course, let them run the store and when I tried to practice as professionally as possible, they thwarted me at every turn. I finally resigned when a hospital job became open. I go through this LONG explanation to enforce the idea that WE in PHARMACY have been ruining our once-great profession in an ever-accelerating spiral to the inevitable death that we're now announcing on the obituary pages. AND, b. The second tangential thing referred to a number of lines above: the Pharm D degree as being the ONLY degree in Pharmacy anymore. They call themselves "Doctor" and it's almost laughable. I'm one of those dinosaur BS Pharm graduates with ONLY 5 years of education in college. They have one more year, and from what I'd experienced going back about 15 years, when I worked in a big teaching hospital with Pharm Ds out the wazoo, they STILL didn't learn even HALF the actual knowledge required to be a PHARMACIST, and their chemistry knowledge was mediocre at best. Oh, they knew the normal lab values for everything measurable, and knew how to say cool things like "patient is on Vancomycin 15 migs per kig" and other really clinical things like that. They knew what differentiated every type of breast cancer from another kind, but didn't know both the generic and brand names of even the 50 most popular drugs in the hospital. This was before "Google," and they had little books in their pockets to look up such unimportant stuff...some even had PDAs. They looked down their noses at us old farts. Oh, but if you looked on their licenses hanging on the wall, they had the VERY SAME license that we BS folks had. That meant that they had NOTHING on us legally speaking. Many of my colleagues with "only BS degrees" ponied up 10-20K bucks to get "non-traditional Pharm Ds" and for all their trouble, they didn't get a penny more in salary, and the youngsters with the "real" PharmDs looked down their noses at THEM too! Summarizing: Certified/Registered Pharmacy Technicians and the advent of Pharm D-only degree programs started the ball rolling. Read on for my rant on this second item. 2. The second point...Pharmacists have allowed chains and insurance companies (and I would suspect PBMs also) to dictate how they were to practice pharmacy, even if it was because of de facto dictatorial edicts. It took LEGISLATION at the State level to FORCE chains to give RPhs a mandatory 30 min lunch break. This was usually not possible...on my 14 hr shifts I usually ate lunch on the way home, about 16 hours after leaving the house. Now THAT'S a healthy way to live. We had go get used to drive-thru windows, coupons that encouraged patients to transfer Rxs back and forth - you know, "transfer in an Rx and we'll give you a $10 coupon on your next purchase of dog food or beer" promotions. Then when Rx margins got so damned thin, we became "vaccine-givers" to make money for our bosses. What's next..."stop in today and we'll check you for rectal cancer while you wait." I'm just SICK of it. I actively told young pharmacists who'd hold still long enough to listen, to go back to school and get another degree - ANY kind of other degree and go into banking, insurance, real estate, dog-grooming...ANYTHING. I thank God that I got in and was able to work as an ACTUAL healthcare PROFESSIONAL for at least the first 2/3 of my many years in pharmacy. OH, and by the way, hospital pharmacy became nothing but getting used to new ways to make sterile products, requiring the wearing of bunny suits, masks, gloves, shoes, etc like we're transferring E bola virus specimens from one container to another, or juggling turbo-Plutonium. RIP Pharmacy.