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Georgia Society of Clinical Oncology - GASCO

GASCO Helps Achieve Big Wins for Patients and the Cancer Care Community on CVS/ Aetna Merger in GA

GASCO, in partnership with MAG, The Ga Pharmacy Association and Georgia Watch worked with the GA Office of the Insurance Commissioner to secure what is described as "significant, one-of-a-kind concessions" from Aetna & CVS before the state signed off approval of their merger. In what can only be described as a major win for patients and community healthcare providers, Georgia’s conditions for approval were significant and noteworthy. We argued that without proper protections, a single company controlling health insurance, medication access (via the CVS Health PBM), and acting as a pharmacy could be hazardous to patients’ health by restricting their choice of healthcare providers and access to care.

So, at the urging of the four organizations, Georgia Insurance Commissioner Ralph Hudgens demanded those protections before approving the merger. Of note and, to date, unique to Georgia:

  • CVS/Aetna must invite non-CVS healthcare providers (pharmacies, physicians, clinics, etc.) to join its networks and must set the same criteria for all those providers.
  • CVS/Aetna must allow Georgia patients to use any healthcare provider - in or out of network - if that provider accepts the same conditions as those within the network.
  • CVS/Aetna cannot require patients to use CVS-owned pharmacies, period - not for regular prescriptions, refills, or specialty drugs. These concessions reduce the chance that a combined CVS/Aetna can limit patients' choice of healthcare providers.
  • CVS must disclose the amount of rebates it receives from drug makers and how much of those it passed on to insurers!

Please tell your colleagues that stories provided by GASCO members went a long way in honing a compelling message to the State and shows the continuing value of our organization. We must now work on making sure that the State Employee Health Plan and other self-insured programs hold Aetna/CVS to the same standards. We will continue this fight on PBM reform over the next year at the State and National Level. The Final order signed by the parties and the News release is attached.