Payer Roundup—DOJ expected to approve CVS-Aetna; Confusion over UnitedHealth's exchange entry

U.S. Justice Department
DOJ officials are reportedly not planning to block the CVS-Aetna merger. (Coolcaesar/Wikimedia)

DOJ reportedly set to approve CVS-Aetna 

Justice Department officials are expected to approve the $69 billion merger between CVS and Aetna, according to Bloomberg, which cites a report from Reorg Research.  

The trade publication said Department of Justice staff are expected to recommend the merger's approval to senior staff, who will have final say at the end of the month. 

The report comes less than a month after the American Medical Association urged regulators to block the deal, arguing it would hurt patients by reducing competition. 

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An Aetna spokesperson declined to comment to FierceHealthcare. (Bloomberg

Confusion over UnitedHealth's entry into Massachusetts exchange 

There appears to be some confusion over whether UnitedHealth will sell ACA plans on the Massachusetts exchange. 

Massachusetts Health Connector, which approves insurance plans for the state, tweeted on Thursday that UnitedHealth would be returning to the exchange in 2019. According to the agency, UnitedHealth was the lone new carrier to the exchange for 2019 thanks to a state law that requires insurers that pass 5,000 covered lives on the merged market to participate in the exchange. 

 

But a UnitedHealth spokesperson told FierceHealthcare, "we believe it’s a mistake and are looking into it," adding "not sure it's going to happen."  

A Massachusetts Health Connector spokesperson said the insurer submitted plans for a "seal of approval" by the state. Although the board voted to add the insurer on Thursday, final approval is scheduled for September.

Colorado exchange improperly transferred $2M in grants 

Connect for Health Colorado, the state's ACA exchange, did not always comply with federal requirements overseeing grant awards, leading to $2 million in improperly transferred funds, according to the Office of Inspector General.  

An additional $3.2 million in grants may not have been allowable "due to a lack of certifications that the new charges were correct." The OIG recommended that Colorado refund the improper payments and work with CMS to refund the grants in question.  

Connect for Health Colorado didn't agree with the OIG's report, indicating it could provide evidence the payments were allowable. (Report