In the first half of 2023, CVS Health named a new leader for Aetna, and the payer acquired key contracts in North Carolina and New York City.
Parent company CVS Health also completed acquisitions of Oak Street Health and Signify Health, and it is entangled in a legal battle with Cigna over an executive hire.
Here are 10 key updates about Aetna and CVS Health from the past six months:
- The nation's retail pharmacy giants are playing an important role in Medicaid redeterminations through payer-agnostic outreach and education initiatives aimed at customers and employees in all 50 states. Aetna is leveraging its parent company's retail stores to let Medicaid members know they may need to renew their coverage, regardless of which managed care plan they are members of.
- A federal judge in St. Louis issued a preliminary injunction barring former Cigna executive Amy Bricker from working for CVS Health while a lawsuit over her noncompete clause moves forward. Ms. Bricker served as president of Cigna's pharmacy benefit manager, Express Scripts. She resigned Jan. 10 to become CVS' executive vice president and chief product officer-consumer. She was set to begin her new position Feb. 20, but Cigna sued to block her from taking the new job.
- A federal judge in North Carolina certified class action status June 5 in a lawsuit alleging Aetna and OptumHealth Care Solutions conspired to use "dummy code" to make administrative fees appear to be billable medical charges. The class action could cover more than 87,000 people enrolled in the plans.
- A group of retired New York City employees are suing Mayor Eric Adams and other city officials in an attempt to block the city's planned switch to an Aetna Medicare Advantage plan for the 250,000 retired city workers and dependents the city provides health coverage for. The contract, which has been in the works since 2021, has faced multiple challenges.
- Lawmakers are seeking more information about claims denials from the largest Medicare Advantage insurers, including CVS Health. In May, the Senate Permanent Subcommittee on Investigations sent letters to CVS Health, Humana and UnitedHealth Group seeking internal documents detailing how the companies decide to approve or deny claims, including how the payers use artificial intelligence in the process.
- Brian Kane will take over as president of Aetna on September 1, when current president Daniel Finke plans to step down for health reasons.
- CVS CEO Karen Lynch was paid $21.3 million in total compensation in 2022, according to regulatory filings. The company's CEO-to-median-employee pay ratio was 380-to-1 in 2022.
- CVS Health reported $4.2 billion in 2022 profit and said it will acquire primary care company Oak Street Health in an all-cash deal worth $10.6 billion.
- In January, CVS Health CEO Karen Lynch said the company was "disappointed" in its Medicare Advantage open enrollment numbers. The company is expecting Aetna's operating income to decrease by up to $1 billion in 2024 because the number of its Medicare Advantage members in four star plans has dropped significantly from 2022.
- North Carolina cited cost savings and more price transparency as reasons why it ended a 40-year relationship with Blue Cross Blue Shield and chose Aetna to administer employee health benefits. Starting in 2025, Aetna will take over a three-year, $17.5 billion contract for more than 740,000 North Carolina state employees, retirees and their dependents. Blue Cross NC is challenging the decision in court.