California Insurance Commissioner Asks DOJ to Halt Aetna, CVS Merger

The California insurance commissioner, who has spoken out against other large healthcare mergers, this week asked the Department of Justice (DOJ) to block the $69 billion deal combining Aetna with CVS Health.

In his letter to Attorney General Jeff Sessions, Dave Jones cited several areas of concern and said the proposed deal is anticompetitive, and, if allowed to go through, would forever end the ability of pharmacy benefit managers (PBMs) to operate as single entities in the state.

CVS owns the PBM Caremark, and the merger will substantially enhance market concentration and power in the PBM space, as well as Medicare Part D markets, he said.

A merger of this size and type will likely lead to increased prices and decreased quality, he said, citing experts on health insurer and healthcare mergers.

In addition, a partial sale or other remedies traditionally used by the DOJ will not go far enough to protect the public or address the adverse consequences, such as charging excessive rates, or the “creation of barriers to block a potential market participant with the resources to enter into new markets,” he wrote.

The merger will eliminate Aetna as an important potential competition in the PBM market. In the present health insurance and healthcare markets, it is impossible to create from scratch a PBM competitor capable of being on the same level as Aetna, he wrote.

“If there are any other entities considering entry into the PBM market, they will now have to enter the market in conjunction with a health insurer,” Jones said.

Jones said that 2 years ago, he was in favor of blocking the Anthem and Cigna merger, which ultimately was not approved, as well as the Aetna and Humana merger. As insurance commissioner, he said he imposed “stringent requirements” on the combination of Centene and HealthNet.