CIGNA/Express Scripts Combination Approved in Big Step Back to the Future 

The Department of Justice has approved the proposed combination of CIGNA/Express Scripts and is likely to approve the combination of Aetna/CVS subject to the divestiture of some Medicare PDP membership. In many ways, these combinations are going “back to the future” when pharmacy and medical were managed by one provider.

What does it mean?

How these combinations will play out is still developing, but the following points are true:

• No large standalone “carve-out” PBMs are left
• While CIGNA/ESI, Aetna/CVS and United/Optum are all vertically integrated, each will have its own “flavor” of integration
• Many Blues plans who use ESI or CVS as their pharmacy “back office” may re-think that strategy given their new carrier relationships
  

Additionally it may mean that “carving out” to a PBM becomes more difficult and/or less necessary. It may become more difficult if the carriers impose fees or restrictions for carving out. At the same time, the value for carving out may decrease. In the past, employers often carved out because the carve-out PBM had better pricing. These combinations may revise that dynamic.

More to come

We’ll provide updates in future blog posts. While these arrangements aim to manage members more holistically, some important employer issues like transparency, value based contracting and guaranteeing a total cost of care have not been discussed -- yet remain top of mind for many employers.

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