MM Curator summary
Analysts speculate that the move is simply CVS excluding a top competitor.
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The removal of one pharmacy chain from the network has not created or contributed to network access issues, Aetna says.
As of December 1, Aetna dropped CVS competitor Walgreens from its Illinois Medicaid plan.
Aetna’s decision to exclude the Walgreens chain from its Aetna Better Health of Illinois pharmacy network affects about 400,000 residents in the state, according to the Chicago Tribune. Many in this population are poor, unemployed and disproportionately suffering from COVID-19.
Nearly 2,000 pharmacies participate in Aetna’s Better Health of Illinois network, Aetna Medicaid said by statement, including other national pharmacy chains such as Walmart, regional chains such as Osco and many independent pharmacies.
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In Chicago, there are 271 in-network pharmacies with an average distance to these locations of half a mile, Aetna said.
“The removal of one pharmacy chain from the network earlier this month has not created or contributed to network access issues, and we meet or exceed all of the state’s access requirements for managed care organizations,” Aetna said. “In fact, the Illinois Department of Healthcare and Family Services has reviewed our updated network and determined it promotes equity.”
Aetna said it has worked with its pharmacy partners to offer and expand coverage of 90-day prescriptions through mail order, offer free delivery to members across the state and empower pharmacists to allow early medication refills where situationally appropriate.
WHY THIS MATTERS
In November 2018, the $69 billion merger for CVS Health to acquire Aetna closed.
Aetna has given no reason for its decision to exclude Walgreens, leaving critics to fill in the blank that eliminating a large competitor from its network would be the motivating factor.
In 2019, CVS Health topped a Becker’s Hospital Review list of the nation’s largest pharmacies, which were ranked by total prescription revenue. CVS was followed by Walgreens, Cigna\Express Scripts, UnitedHealth Group’s OptumRx and Walmart.
THE LARGER TREND
In 2018, the Tribune reported that pharmacy access was a growing concern in Chicago. Some public health experts said that more than a dozen low-income neighborhoods, mostly on the South and West sides of Chicago, were becoming pharmacy deserts.
Providers have increasingly been addressing the social determinants of health for patients as it has become clear that SDOH issues such as food and housing insecurity, transportation and isolation have as much influence on health as clinical concerns.
RWJBarnabas Health recently launched a social determinants of health program called Health Beyond the Hospital in collaboration with NowPow and ConsejoSano, in order to refer and connect patients to community-based services.