Stacy Mitchell

CVS says it's going to break itself up. After more than a decade of calls to separate its retail pharmacies from its PBM/insurance business, that's big news. But here's the thing: CVS's breakup has two major loopholes. Both are designed to preserve its power. First, CVS Health would keep its specialty pharmacy business. These pharmacies dispense expensive, often complex medications. They account for 40+% of the pharmacy market by revenue. They're a major site of anticompetitive practices that squeeze independent pharmacies. Second, CVS says the ties between the two new companies will be "preserved in commercial agreements." In other words, separate ownership, but keep the arrangements that create conflicts of interest and enable anticompetitive practices. A real (government-led) breakup would sever those ties. CVS didn't arrive here all on its own. Tennessee and Arkansas passed laws forcing a breakup of vertically integrated pharmacy giants like CVS. CVS is fighting the laws in court. Senators Warren and Hawley have a federal bill. Antitrust scrutiny has grown, both at the state level and when @linamkhan ran the FTC. Trying to sidestep these efforts is one motivation here. But CVS also has business reasons to jettison its struggling retail stores. Amazon's growing pharmacy business is one. The perils of running an overbuilt retail chain when you haven't invested in workers is another. Anyone who's been inside a CVS lately knows these stores suck. For more than a decade, I've been working with independent pharmacies and my colleagues here at @ilsr to expose the anticompetitive structures and practices that have driven so many local pharmacies out of business, and calling for a breakup of CVS. But CVS shouldn't get to decide what counts as an effective breakup. Policymakers need to ensure that it actually dismantles its power.