- A group of anonymous HIV/AIDS patients filed a class-action lawsuit against CVS Health Corp. earlier this month alleging their CVS Caremark pharmacy benefit plans required them to fill their prescriptions at the pharmacy benefit manager's locations.
- The lawsuit comes as CVS attempts to merge with one of the biggest insurers in the country: Aetna Inc. Despite the U.S. Department of Justice asking for more information about the deal, CVS told investors in early February that it still expected the deal to close in the second half of this year.
- CVS told Axios on Wednesday that they have not yet received the complaint, which was filed Feb. 16, but said its " highest priority is assuring patient access to clinically appropriate drugs while managing overall health care costs for our clients. To that end, we offer our clients multiple clinical tools and pharmacy network options targeted at achieving both of these goals."
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 Group Inc. and Anthem Inc.
"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."