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Fortune: The Justice Department Approved the CVS-Aetna Merger, But It’s Still Not a Done Deal. Here’s Why

Bloomberg News, October 19

New York state officials are considering blocking parts of the $68 billion mergerof drugstore store chain CVS Health Corp. and Aetna Inc., jeopardizing billions of dollars in insurance premiums for Aetna.

CVS (CVS, +0.38%) and Aetna won approval from the U.S. Justice Department on Oct. 10, contingent on Aetna (AET, +0.00%) divesting its Medicare Part D business, which covers prescription drugs for seniors. But the deal still needs to pass through state regulatory bodies.

At a public hearing in Manhattan on Thursday, Maria Vullo, superintendent of the state Department of Financial Services, said her agency might block CVS’s merger with Aetna’s New York unit. She called U.S. approval of the overall deal “myopic” and repeatedly asked CVS and Aetna representatives for written evidence that they would deliver on promises to lower prices.

Several groups, including the Pharmacists Society of the State of New York and the Medical Society of the State of New York, urged the state to block the deal. They said the merger would limit competition and drive up the cost of prescription drugs. Assemblyman Richard Gottfried, chairman of the Health Committee, said the deal introduces “dangerous trends” in consumer access.

Elizabeth Ferguson, deputy general counsel for CVS, said there wasn’t a plan to lower prices.

CVS and Aetna announced the deal in December 2017 but continue to face regulatory hurdles. Connecticut approved the deal Oct. 17, and the New York will reach a decision after Oct. 25.

Shares of CVS and Aetna were little changed in New York Thursday.

City and State: Making New York City a Primary Care Town

By Annie McDonough, October 2

A primary care physician is your go-to clinician, the doctor you’ve developed a years-long relationship with, who knows your history, treats your family, and who, ideally, makes you feel safe and comfortable. But according to some experts, New York is some ways away from being able to call itself a “primary care town.”

At City & State’s Health & Wellness Summit today, a panel of policymakers and community health providers discussed the challenges facing New York’s primary care system, and some of the efforts being made to restore the primacy of primary care.

“Being a primary care town is where we really enable primary care to do everything it’s capable of doing,” said Theodore Long, vice president for ambulatory care at New York City Health + Hospitals. “Is that our current state in New York State and New York City? I think we have a little ways to go to get there.”

Between 2012 and 2016, visits to primary care doctors in the U.S. declined 18 percent, according to a 2016 study by the Health Care Cost Institute, while visits to specialists increased. Primary care provides benefits that visits to specialists and emergency care can’t, including long-term disease prevention.

“If you cut a person up into his various diseases and send him off to the specialists, you’re really not able to see the whole picture,” Louise Cohen, CEO of the nonprofit Primary Care Development Corp., said during the panel discussion

Some argue that the rise of urgent care and “minute clinics” set up by retailers like CVS and Walmart also pose a threat to primary care. Assemblyman and Health Committee Chairman Richard Gottfried argued that eventually, people will stop going to primary care providers for annual check-ups when they can address all of their health needs at drop-in clinics, and advocated for restrictions on these clinics.

“I think the horse is too far out of the barn to outlaw them, but I think we need to at least limit them to truly episodic, drop-in care, or else I think health care, in a very short period of time, is going to look very different in a way that we’re not going to like,” said Gottfried, a Democrat.

State Sen. Kemp Hannon disagreed, saying that if these clinics had adversely affected primary care providers, those primary care providers would have complained about it.

“No one has said these urgent care centers are cutting in on their primary care practices,” said Hannon, the Republican chairman of the Senate Health Committee.

Another impediment to primary care visits is the fact that the system has not always appreciated the social determinants of health in minority and underserved communities. These social determinants include conditions like access to safe housing, quality education, affordable day care. Health care that doesn’t address these factors can result in a lack of patient trust in doctors.

“If we’re going to improve the health of those individuals in the long term, it’s a failing approach if we don’t recognize how important it is to invest in what we now call the social determinants of health, or the context in which people live that actually creates health,” said Sonia Angell, deputy commissioner of prevention and primary care at the New York City Department of Health.

Gottfried pointed to the state Department of Health’s Doctors Across New York program, which provides loan relief for doctors working in underserved communities. “People relate better to a provider who they sense shares their background,” he said.

The high cost of medical school can also deter doctors from entering a primary care practice, as student debt can be more quickly repaid when doctors choose more lucrative specialties. This summer, New York University announced a new policy of free tuition for medical students – a move some hope will encourage graduates to pursue practices like primary care that are not as lucrative, but sorely in need of physicians. Whether or not it will work is yet to be seen.

“It’s measurable,” Cohen said. “Today, according to the report that I have, NYU graduates 36 percent of its residents go into primary care. Let’s see if that goes up. That’d be great.”

Assembly Health Committee Update, 1/21/16

Assembly Health Committee Update

The Assembly Committee on Health favorably reported 22 bills at its first meeting of the 2016 session on January 21.

The Committee reported the bill to establish safe staffing requirements in hospitals and nursing homes (A8580, Gunther). The evidence is clear that having enough nurses on staff has a direct impact on the quality of patient care. Research published by the American Medical Association estimates five additional deaths per 1,000 patients in hospitals with an 8-to-1 patient-to-nurse ratio compared to those with just a 4-to-1 ratio. More nurses per patient means fewer deaths and improves patient outcomes. It is well documented that hospitals with better staff ratios have lower rates of problems such as pneu­monia, shock, and cardiac arrest.

The ratios in the bill are based on academic and evidence-based studies. The Health Department could also set more demanding and specific ratios. California was the first state to mandate nurse staffing ratios and it has seen significant improvements in outcomes for both patients and staff.

For more information on a particular bill, please contact the sponsor listed after the description. For the text of a bill, supporting memorandum, and information on its status, go to:

Genetic Disease Screening and Counseling – Authorizes grants for familial dysautonomia, Canavan’s and Tay-Sachs disease screening and counseling. (A126, Dinowitz)

Adult Home Residents Right to Sue – Lets adult home residents go to court for a court-appointed receiver to operate the adult home when the operator has endangered the health, safety, or welfare of the residents. (A154A, Weinstein) 

Law 360: New York Legislation And Regulation To Watch In 2016

By Pete Brush, 12/24/15

Law360, New York (December 24, 2015, 8:38 PM ET) — Empire State attorneys will be watching to see whether state lawmakers take the future of the daily fantasy sports wagering industry out of the courts by affirmatively legalizing it. Convictions of top elected officials, meanwhile, will increase pressure to step up the oversight of Albany, where a potentially nasty fight over billions in infrastructure dollars also looms.

In New York City real estate attorneys are monitoring an effort to redo zoning laws so that plans to raise dizzying Midtown high-rises don’t end up blotting out the sun over Central Park.

Here are eight legislative and regulatory issues that lawyers expect to come to the fore across New York state in 2016:

May Health Committee Update

Assembly Health Committee Update:
Protecting Nursing Home Residents From Abuse of Psychotropic Drugs

The Assembly Committee on Health favorably reported 39 bills at its meetings in May.  The Committee advanced legislation strengthening the “prescriber prevails” rule in Medicaid Managed Care; authorizing community paramedicine; and protecting nursing home residents from overuse of psychotropic drugs.

New York law gives patients in nursing homes the right to be fully informed of their proposed treatment, including the right to refuse treatment and be free from chemical restraint unless consistent with certain requirements.  However, psychotropic drugs are being used not just to treat illness but as a form of behavioral control.  The Assembly Health Committee held a hearing in February in which patients’ families, advocates, and adult care experts testified to the frequency of overuse.  A.7351 (Gottfried) requires that before psychotropic drugs are ordered in a nursing home or adult care facility, the patient or their surrogate must be informed of the potential benefits and side effects; dosage and duration of the prescription; reasonable alternatives (such as therapeutic activities); and their right to refuse consent.  The bill also requires written consent by the patient or surrogate.

For more information on a particular bill, please contact the sponsor listed after the description.  For the text of a bill, supporting memorandum, and information on its status, go to: .

Tuesday, May 5

Early Intervention Covered Lives Assessment – Provides funding for Early Intervention services through the “covered lives assessment” paid by health insurance companies.  (A273, Paulin)

Credentialing for Group Practices – Requires insurers to expedite review of applications of health care professionals who are joining a group practice and grant provisional credentials to these professionals (A501, Cusick)

Healthy Teens Act – Establishes a Department of Health grant program for providers of age-appropriate sex education.  (A1616, Gottfried)

City & State: Big Box Healthcare

By Ashley Hupfl, City & State, January 19

One of the next big things in medical care is offering healthcare services inside retail stores such as CVS, Price Chopper and Walmart, which recently opened primary care clinics in stores in Georgia, South Carolina and Texas.

But if Assembly Health Committee Chair Richard Gottfried has his way, New York will preemptively ban or at least regulate such primary care services offered by major retails chains.

“We are seeing more and more so-called ‘retail clinics’ opening in chain pharmacies, even in supermarket chains,” Gottfried told City & State in December. “The issue of commercialized delivery of outpatient care needs to be confronted. Whether it’s urgent care clinics or retail clinics in pharmacies or supermarkets, there’s a real need to protect consumers and protect the ability of ordinary primary practices to stay afloat.”