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HIV Patients Claim In Court CVS Steered Beneficiaries To Its Pharmacies

By David Lim, HEALTHCARE DIVE

February 22, 2018

https://www.healthcaredive.com/news/hiv-patients-claim-in-court-cvs-ste…

Dive Brief:

Dive Insight:

One antitrust expert says the case has "a lot of legs" because of the unique role specialty pharmacies play in the delivery of healthcare for HIV beneficiaries, citing successful Consumer Watchdog lawsuits against UnitedHealth and Anthem. 

"There are claims that CVS is going to make all the time that the [Aetna] merger is good for the delivery of healthcare for consumers. But the reality is that when you look at CVS Caremark's past conduct in the market, they use their market power to deny consumers the access to their pharmacies of choice. Consumers get far worse healthcare," David Balto, former policy director of the Federal Trade Commission, told Healthcare Dive.

The class-action lawsuit raises questions about how CVS would act if the giant pharmacy chain successfully merges with Aetna.

The plaintiffs on the CVS drug plans allege that they were previously able to go to other specialty pharmacies to fill their HIV/AIDS medications. When CVS changed its pharmacy benefits, it required them to pick up drugs at a CVS store or have them mailed to their homes, leaving them high out-of-pocket costs if they go to their old specialty pharmacies, the lawsuit states. One plaintiff said that CVS did not give advanced written notice of the policy change. 

"Especially with this deal pending, if CVS has an ounce of common sense, they'll settle this case as quickly as possible," Balto said. "The last thing in the world that you want is a group of HIV beneficiaries objecting to the merger."

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