Welcome back to the Deep Dive. Today we are unpacking
a company that you probably see maybe every week,
but its real size, its true complexity is so
much bigger than what you see on the store shelves.
Oh, much bigger. We're diving deep into CVS Health.
And it's important to just, you know, set the
stage right away. This is not just a retail chain
we're talking about. We're looking at the second
largest health care company in the world. Second
largest. Who's number one? United Health Group.
But CVS is right there behind them. That scale
is just, it's hard to wrap your head around.
I mean, we're looking at the 2024 financials
and the revenue was, what, U .S. $372 .8 billion?
Billion, with a B. And they have something like
300 ,000 employees. It's a true behemoth. Right.
And the sources you've provided, they give us
this complete picture from their history of just
aggressive acquisitions to this incredibly complex
web of subsidiaries. And crucially. decades of
some very serious legal and ethical problems
that just seem to follow a company that gets
this powerful. So our mission today is really
to get past that image of consumer value stores.
That's actually what CVS stood for back in 1963.
I have no idea. Yeah. And we need to understand
how they built this. This vertically integrated
giant, how they got control of prescription management
with Caremark, insurance with Aetna, and then
the retail clinics with MediClinic. And there's
a real tension there, isn't there? This massive
scale on one hand, but it brings this massive
scrutiny on the other. It always does. OK, so
let's break this down. We're going to trace the
path from one single store in Massachusetts to
this global powerhouse. We'll look at the pillars
of their current structure and we'll definitely
spend a lot of time on the controversies, especially.
the opioid crisis and, you know, the issues with
prescription costs. For you, the goal is to see
how this company isn't just selling you shampoo.
They are actively, really actively shaping the
entire American health care system. So the origin
story is it's deceptively simple. It starts in
1963, Lowell, Massachusetts. It was founded by
two brothers, Stanley and Sidney Goldstein, and
their partner, Ralph Hoagland. And it was just
a store selling health and beauty products. No
pharmacy. No pharmacy at the beginning. That
was the key. The name, Consumer Value Stores,
was literal. It was all about low prices on everyday
items. So when did the pharmacy piece come in?
Because that seems like the entire identity of
the company now. It took four years, 1967. That's
when they opened their first stores with actual
pharmacy departments, one in Warwick, one in
Cumberland, Rhode Island. And that was the pivot.
That was the game changer. That was the strategic
shift. It established this dual identity that
they still have today. Yeah. A retail store,
but one that's anchored by this essential health
care service. And then the other defining piece
of their DNA showed up just two years later.
Aggressive expansion. Fueled by corporate change.
Exactly. In 1969, they were sold to the Melville
Corporation, which is this huge retail conglomerate.
And that wasn't just a sale. It was like getting
a massive injection of cash. It's what let them
go from being a regional player to a national
one. And that's when the acquisition sprint really
kicks off. For what, the next three decades?
Pretty much. By 1970, they already had 100 stores
just in the Northeast. But they knew that wasn't
enough. They needed to go national. Right. And
you can see their strategy on the map. It's so
methodical. In 1972, they buy 84 Clinton drug
and discount stores. And that was their first
big leap, right, into the Midwest. That was it.
Centered in Indiana. They learned very early
on that it's just faster to buy your way into
a market than to build from scratch. Okay, so
they keep filling in the map. Let's jump ahead.
1990. 1990, they buy 500 people's drugstores.
500? And this one was vital. It gave them a huge
presence in the Mid -Atlantic. We're talking
D .C., Pennsylvania, Maryland, Virginia. It wasn't
random growth. They were targeting these critical
population centers. And then in the late 90s,
the scale just gets, I mean, it gets kind of
overwhelming. Well, that's when they were spun
off from Melville. 1996, they start trading on
the New York Stock Exchange as their own company.
And they immediately go on a shopping spree.
A huge one. In 1997, they acquire over 2 ,500
Revco drugstores. Let's just pause on that. 2
,500 stores. In one transaction. Yes. It cemented
their footprint across the Midwest, the Southeast,
and the East. Overnight, they went from being
a major player to an undisputed national contender.
It happened in a single quarter. And they kept
being precise, like when they wanted to get into
Michigan. They just bought their way in. 207
Arbor drugstores in 1998. It was like they were
playing a game of Risk. just strategically taking
over territories. But at the same time, while
they're doing all this brick and mortar consolidation,
they're also looking at the Internet. Yeah, which
is something a lot of people forget. They were
a pioneer in online pharmacy. With Soma .com.
Right. In 1999, CVS buys Soma .com, which was
the first online pharmacy in the country. They
quickly rebranded to CVS .com. And suddenly,
they're the first company that's truly integrated.
Both physical and digital. Exactly. They saw
where things were going. And they wanted to control
that channel right away. And that desire to control
the channel, and more importantly, the customer
data, that leads directly to the extra care card.
Launched in 2001. And to the average person,
it just looks like a discount card. Yeah, you
scan it, you get a coupon. But for CVS, it was
this unbelievably powerful data collection engine.
The success was just, it was staggering. 30 million
people signed up in the first year. 30 million?
In a year. And it eventually grew to over 70
million cardholders. At the time, it was the
largest retail loyalty program in the country.
And it gave CVS this incredible ability to track
everything. Not just what shampoo you bought,
but when you refilled your prescriptions, what
over -the -counter meds you bought with it. It
created this incredibly detailed profile on tens
of millions of Americans. Which laid the groundwork
for a lot of what was to come. A lot of what
was to come. Both good and, as we'll see, pretty
controversial. The buying didn't stop, of course.
They bought Statlander Pharmacy in 2000 for their
specialty division. And then a huge one in 2004,
1 ,268 Eckerd drugstores. That one pushed them
into Texas and Florida, right? Yeah. Yep. High
growth markets. So by the mid 2000s, they were
a retail giant. But they were about to have this
realization that the real power in health care
wasn't just in selling the drug. It was in controlling
the system that pays for the drug. Exactly. And
that's where the story takes a dramatic turn.
Away from retail and toward vertical integration.
OK, so part one establishes CVS as this massive
coast to coast retail chain. The move that really
created the $372 billion company we see today,
it wasn't about buying more stores. No, it was
about buying the middleman. The pharmacy benefit
manager, the PBM. Right. And CVS had been dipping
their toes in this for a while. They launched
their own PBM called Pharmacare way back in 1994.
Just a small operation? Yeah, it was more of
a strategic test. But the moment that changed
everything was 2007. The merger with Caremark
Rx. A colossal merger. It created CVS Caremark
and it fundamentally altered the entire U .S.
health care landscape. OK, so we have to break
this down because this merger is really the engine
of the whole company, right? It's where the money
comes from, but it's also where a lot of the
controversy comes from. It is. By joining the
massive retailer CVS with the powerful PVM Caremark,
the new company controlled two critical links
in the chain. The place where you buy the drug
and the system that manages the payment for it.
Exactly. They now control not just where you
fill your prescription, but the entire mechanism
for how your insurance plan decides which drugs
it's going to cover and at what price. So how
does the PBM actually do that? How does it create
this internal profit machine? It's all about
something called formulary management and rebate
negotiation. The formulary is just the list of
drugs your insurance plan will cover. Caremark
goes to the big drug manufacturers and negotiates
massive rebates. We're talking billions of dollars
in exchange for giving a specific drug preferential
treatment on that list. So they get paid by Pfizer,
for example, to make sure Lipidor is on the list
instead of a competitor's drug. Precisely. They
then pass some of that rebate back to the health
plan, but they often keep a significant chunk
for themselves. That's called the spread. So
if they're managing the formulary for tens of
millions of people, they can steer patients toward
the drugs where they, care mark, get the biggest
kickback. Even if that drug isn't the cheapest
or maybe even the most effective option. That
feels like a huge conflict of interest. It's
baked right into the PBM model. They can influence
the doctor. by controlling what's covered, and
the pharmacist by controlling reimbursement rates.
And because of the vertical integration, the
retail pharmacy feeds the PBM, and the PBM steers
business right back to the retail pharmacy. It's
a closed loop, a very, very lucrative closed
loop. And this new identity as a healthcare giant
prompted a really public, really strategic move
in 2014. The tobacco decision. Right. They stopped
selling cigarettes. It was a brilliant move from
a branding perspective. September 2nd, 2014,
they pull all tobacco products from all 7 ,700
locations a month earlier than they had planned.
The CEO at the time, Larry Merlo, he said something
like, cigarettes and health care just don't go
together. Which sounds purely ethical. It was
a good thing to do. But it was also incredibly
strategic. Because it came right before their
biggest push into health care services. It was
essential. It cleaned up their image. It helped
establish the CVS brand as a legitimate health
care company, not just a convenience store that
happens to have a pharmacy in the back. And right
after the ban, they officially changed the corporate
name from CVS Caremark to CVS Health. Signaling
the new direction. The new direction. That the
future, the big money, was in services, not in
selling candy in magazines. Which brings us to
the final piece of the puzzle, the ultimate integration,
Aetna. The capstone. In December 2017, they announced
the deal to buy Aetna for roughly $69 billion.
And this was just, it was unprecedented. They
weren't just buying more pharmacies. They were
buying the system that pays for everything. Everything.
Before Aetna. They controlled the drug benefits
through Caremark. With Aetna, they got the whole
insurance mechanism, medical, dental, behavioral
health plans, everything for Aetna's 22 million
members. So now if you're an Aetna member, your
prescriptions are processed by Caremark and you
are, let's say, strongly encouraged to fill them
at a CVS. You are. They can keep all the profit
streams internal. They get the insurance premium
from you, they get the PBM spread from the drug
company, and they get the retail profit from
the sale. The whole system is designed to keep
every dollar inside the company. And you can
see this strategy change the actual stores almost
immediately. Oh, yeah. After the merger, stores
started these massive renovations to focus more
on health services and less on traditional retail.
And that's where the Health Hub idea comes from.
That's the genesis. It launched in Houston in
2019. And the plan was super ambitious. They
wanted 1500 health hubs by the end of 2021. The
pandemic slowed that down, obviously. So what's
the real difference? If I walk into a health
hub versus a regular CVS? It's a totally different
layout and staff. At least a fifth of the floor
space is dedicated to services. You'll see rooms
for health screenings, areas for managing chronic
conditions like diabetes, more medical equipment,
and a much bigger, minute clinic space. So they're
literally ripping out aisles of greeting cards
and seasonal candy to make room for clinical
care. That's exactly what they're doing, and
they're staffing up for it. Health hubs have
care concierges to help you navigate services.
The Minute Clinic has more support staff medical
assistants, RNS, to help the nurse practitioners
and physician assistants. They're turning the
corner drugstore into a front door for primary
care. That's the goal. Make the most of that
incredible physical footprint we talked about
earlier. So we have the big three care mark,
Aetna, and the retail pharmacies. But to really
get the full picture of CVS Health, You have
to look at all the other subsidiaries, all these
specialized companies they've acquired to make
their model, you know, almost bulletproof. Yeah,
when you connect all the dots, you see this ecosystem
that lets them manage and monetize a patient's
entire journey from start to finish. OK, so let's
start with the one everyone knows, CVS Pharmacy.
It's just massive. 9 ,600 stores, all 50 states,
D .C., Puerto Rico. The scale alone gives them
incredible power. And the reach is... It's just
unavoidable. They fill more than one out of every
five prescriptions written in the United States.
And 85 percent of the U .S. population lives
within 10 miles of a CVS. It's a piece of the
American landscape. OK, next up, the engine of
the whole thing. CVS Caremark, the PBM. We know
its job is managing benefits, but the scale is
what's important here. Caremark manages prescription
dispensing for more than 75 million people. 75
million. It does everything. Plan design, formulary
management, claims processing, mail orders, specialty
drugs. And here's the key part. It doesn't just
do this through CVS stores. Right. It has a network
of over 68 ,000 retail pharmacies, chains, independents.
So even if you go to your local neighborhood
pharmacy, chances are your payment is still being
run through the Caremark system. They get a piece
of the action no matter where you go. Pretty
much. And then the third pillar, Aetna, is the
one that pays the bills. Aetna provides the funding.
Medical, dental, pharmaceutical insurance. The
huge strategic advantage is that if you are both
the insurer and the PBM, You don't have to negotiate
with anyone. You set the prices internally. The
profit margins are all yours. Total control.
Total control. And then the front door for a
lot of people for simple things is Minute Clinic.
The walk -in clinic inside the store. It's the
lowest cost way for them to get you into their
system. Yeah. It's the biggest walk -in clinic
chain in the U .S., over 1 ,100 locations. Again,
super accessible. Half the population lives within
10 miles of one. And it's for, you know, minor
stuff, vaccinations, strip tests, things you
don't want to go to a doctor's office or an expensive
urgent care for. Exactly. It's a feeder system.
But beyond those main consumer parts, they have
these highly specialized divisions for the really
complex, really expensive conditions, which is
where the biggest profits are in health care.
And that's where CVS Specialty comes in. Right.
This is the largest specialty pharmacy in the
U .S. It handles the incredibly complex and expensive
drugs for things like cancer, rheumatoid arthritis,
genetic diseases. And these specialty drugs are
a huge chunk of all drug spending, right? A hugely
disproportionate amount. So by controlling this
segment, CVS Health makes sure all that high
margin business stays inside their system. What
about patients who need care at home, like IV
infusions? That's Quorum. They acquired Quorum
in 2014. It provides home infusion services to
about 140 ,000 patients a year. And the synergy
is brilliant. How so? Aetna, the insurer, can
say, we're not going to pay for this expensive
infusion in a hospital. You have to get it at
home from our company, Quorum. They lower their
costs and keep the profit, all under the CVS
health umbrella. And they're also deep inside
places like nursing homes. That's Omnicare. which
they bought in 2015. Omnicare is the pharmacy
service provider for thousands of skilled nursing
and assisted living facilities, so they manage
drug access for one of the most complex patient
populations out there. It's an incredible network,
and their latest moves show they're not done
building, they're going after primary care now.
This is their future. They want to control health
care from the very beginning. In 2022, they bought
Signify Health for about $8 billion. billion.
What does Signify do? They specialize in in -home
health evaluations, trying to manage care before
people get really sick. And then the huge one
in 2023, Oak Street Health. For $10 .6 billion.
This is a monumental move. Oak Street Health
is a network of primary care centers that focuses
on Medicare patients. This tells you that CVS
Health doesn't just want to fill your prescriptions
anymore. They want to be your doctor. They want
to be your primary medical home. They want to
manage your health from the yearly checkup all
the way through your cancer treatment and insurance
claims. And all the while, the retail stores
are still there, pumping out foot traffic and,
more importantly, data. That's the secret sauce.
The retail side isn't just about selling toothpaste.
It's about that massive data pipeline from the
extra care card, which they now monetize through
the CVS Media Exchange or CMX. It lets them sell
targeted advertising with surgical precision.
It's just another revenue stream built on top
of the whole structure. So we've laid out the
scale, the structure of CVS Health, but that
integration, especially with the PBM, has put
the company under just, I mean, constant legal
and public scrutiny. To really understand this
company, you have to spend time on the sheer
volume of these issues. You do. And it's critical
to see that the very thing that makes the PBM
so profitable, these complex, secret negotiations
over drug costs, is what repeatedly gets them
into trouble for fraud and deceptive practices.
Let's start at the beginning of the PBM. era.
Even before CVS bought them, Caremark had a history
of scandals, right? Oh, yeah. Back in the late
80s and early 90s, Caremark was involved in multiple
health fraud and Medicare fraud scandals. With
the government. Yes. And it resulted in settlements
costing the company more than $250 million. So
this pattern of regulatory trouble was there
from the very start. And that trouble followed
them, leading to a huge settlement in 2005 over
pharmaceutical kickback. Right. Caremark paid
$137 .5 million to settle federal... lawsuits.
The allegation was that a company they had just
bought, Advance PCS, was taking kickbacks from
drug makers. So basically, they were getting
paid to push certain drugs over others. Exactly.
To promote their products, even over cheaper
generics, in government programs like Medicare.
The decision about which drug you get was being
influenced by a corporate payment, not just what
was best for you or what was cheapest. And while
they didn't admit they did anything wrong, $137
.5 million settlement tells you how serious the
government thought it was. This same pattern
led to another big lawsuit in 2008, the one for
deceptive practices. This one was so revealing.
It was a multi -state lawsuit, and they settled
for $38 .5 million. It really exposed the mechanics
of how Caremark was profiting from something
called drug switching. What's that? Attorneys
general from 28 states alleged that Caremark
was telling doctors to switch patients to certain
brand -name drugs, and they were marketing it
as a way to save the patient or the health plan
money. But that wasn't actually true. Not always.
The investigation found that the switch often
led to tiny savings, or sometimes it even increased
the cost. But the real winner was always Caremark.
Because they were steering business to the drug
companies that gave them the biggest rebates.
The patient was just a pawn in the middle. A
pawn in a revenue game. The settlement was a
big deal, though. It put some real guardrails
in place. What kind of guardrails? CVS was explicitly
banned from telling a doctor to switch a drug
if it would cost the patient more. And they couldn't
suggest a switch if the original drug's patent
was about to expire, which was a classic trick
to squeeze the last bit of profit out of a brand
name before a cheap generic hit the market. And
beyond the financial issues, there's this recurring
problem with how CVS Health handles patient data.
It's the most sensitive information they have,
and they have repeatedly gotten in trouble for
it. The first big public blowup was way back
in 1998 with the Alensis incident. A real wake
-up call. CVS was caught sharing specific prescription
information with a marketing company called Alensis.
What was Alensis doing with it? They were using
it to send targeted mailings to people's homes.
You know, time to refill your heart medication
or promoting related products. People were outraged.
I remember the editor of a major medical journal
called it a gross invasion of privacy. The medical
community was furious that this intimate health
data was being used for marketing without any
real consent. So what happened? After a huge
backlash, CVS cut ties with lenses. They didn't
stop the practice. They just brought the whole
targeted mailing program in -house. So they kept
using the data. They just controlled it themselves.
Exactly. And this problem of protecting data
came up again big time in 2009. They settled
huge charges with both the Federal Trade Commission
and the Department of Health and Human Services.
The FTC and HHS. The FTC said they failed to
protect sensitive customer and employee information.
And they paid HHS $2 .25 million for violating
the big health privacy law. It just showed a
pattern of failing to meet the standard required
when you handle this kind of information at such
a massive scale. But of all the controversies,
I think the ones related to the opioid crisis
represent the biggest challenge to their image
as a health care company. Some of the details
are just they're damning. The DEA investigation
in 2011 in that one small town in Florida. Sanford,
population 53 ,000. The DEA found that the CVS
pharmacies there were ordering enough painkillers
to supply a city eight times its size. Eight
times? Around 400 ,000 people. The volume should
have been a massive red flag. Just break down
the numbers on that one store. One single CVS
in Sanford ordered 1 .8 million oxycodone pills
in one year. 1 .8 million? That's almost 138
,000 pills a month. The average for other pharmacies
in Florida was around 5 ,300 a month. It's just
an astronomical difference. It screams diversion.
And the investigators saw it happening with their
own eyes. They did. They noted that about every
third car in the drive -thru was picking up a
prescription for oxycodone or hydrocodone. And
pharmacists admitted that customers were coming
in using street slang for the drugs. Clear signs
they were being sold illegally. And this lack
of oversight wasn't just in Florida. Massachusetts
settled with them in 2016. For almost $800 ,000.
That settlement was about them failing to give
their pharmacists access to the state's prescription
monitoring program, the PMP. The database that's
supposed to stop people from doctor shopping
for pills. Right. By not checking it, they were
just fueling the crisis, filling prescriptions
without doing the basic due diligence required.
But the real legal earthquake was the federal
jury verdict in Ohio. November 2021. A federal
jury found CVS, along with Walgreens and Walmart,
liable for helping to create the opioid crisis
in two Ohio counties. And this is a huge deal
because it was the first time the pharmacy companies
themselves were held accountable in a trial.
So what was the legal argument? What did the
jury decide was their failure? The argument was
their failure to monitor. The law says pharmacies
have a responsibility to make sure prescriptions
are for a legitimate medical purpose. They're
supposed to flag and stop suspicious orders,
ones that are too big, too frequent, too many
cash payments. The jury decided that CVS's systems
completely failed to do this, and that failure
allowed the flood of pills to wreck these communities.
And the financial penalty for that was massive.
It was. In August 2022, the judge ordered CVS
and the others to pay $650 million in damages
just for that one lawsuit. It set this huge precedent
that pharmacies are co -liable for the epidemic.
It was a game changer. Beyond these huge systemic
issues, there's also been this steady drumbeat
of problems with just, you know, basic dispensing
accuracy. Which is supposed to be the one thing
a pharmacy never gets wrong. In 2005, an investigation
in Boston found 62 different errors or quality
problems over a few years. It was so bad the
state had to bring in a nonprofit to monitor
them for two years. And they've also got into
trouble for what they sell on their retail shelves.
Right. In 2018, the Center for Inquiry sued them
for consumer fraud over selling homeopathic medicines.
The argument being that these products don't
actually do anything. And that by putting them
on the shelf next to real medicine, CVS gives
them a credibility they don't deserve. The lawsuit
argued it was dangerous because people might
choose these ineffective treatments instead of
getting real medical care, which could make them
sicker or even lead to death. It's a real ethical
question for a company that calls itself health.
But these errors can have just catastrophic human
costs. The incident in 2023 was heartbreaking.
Just a terrible, tragic case of human error.
A patient, Tamika Thomas, was going through IVF.
She was supposed to be given medication to help
her pregnancy. Instead, the pharmacist gave her
misoprostol. An abortion pill. An abortion pill.
She lost both of the embryos she had transferred.
Her quote was just, they just killed my baby.
It's a devastating reminder of what's at stake.
And what were the consequences for CVS? The two
pharmacists were fined and put on probation.
And CVS Pharmacy, the corporation, got the maximum
fine. $10 ,000. $10 ,000. Wow. Let's just let's
also circle back to the pricing issues. They
were fine for misrepresenting Medicare prices,
too, weren't they? They were. In 2012, they paid
five million dollars to settle FTC charges that
they misrepresented the prices of certain Medicare
Part D drugs for things like breast cancer and
epilepsy. Again, it's a breach of trust with
a really vulnerable population, and it ties right
back to the PVM's control over pricing. So we've
gone through the transformation, the model, and
the decades of controversy. To finish up, let's
look at where the company is headed now and how
they try to balance all this power with being
a good corporate citizen. You can really see
their strategy in their operational decisions.
They are all in on the health hub and the Oak
Street primary care model, and they're moving
away from just being a retailer. That's behind
the store closures, right? Exactly. In 2021,
they announced plans to close 900 stores over
three years. Which is about 10 percent of all
their U .S. stores. It's a huge number. But they
justified it by saying consumer behavior has
changed and they need to focus on their future
in health care delivery. They're getting rid
of underperforming retail locations so they can
invest that capital into building out more clinical
spaces. But even as they're closing some stores,
they're finding new ways to make money off the
ones that are left and off their website. That's
where the CVS Media Exchange, CMX, comes in.
Their advertising network. It's their retail
media network launched in 2020. It's an increasingly
common way for big retailers to monetize their
customer data. They use all that extra care card
information to let other companies like, you
know, a cereal brand or a soda company target
ads with incredible precision on CVS websites
and apps. Just another high margin revenue stream.
And despite these changes, the sheer financial
scale of the company is just, it's still immense.
The 2024 numbers are still hard to believe. $372
.8 billion in revenue, $253 .2 billion in assets.
When a company is that big, their decisions just
fundamentally impact the cost and delivery of
health care for everyone. So on the other side
of the coin, how does the company try to project
a positive image? What are they doing in terms
of philanthropy and social commitments? They
do have some longstanding initiatives. The CVS
Samaritan Vans, for example, have been providing
free roadside assistance since 1978. And their
charity Golf Classic has raised millions for
nonprofits. And they've responded to consumer
pressure on issues like animal welfare. They
have. In 2016, they made a public promise to
source 100 % cage -free eggs. And to their credit,
they actually did it ahead of schedule by the
end of 2022. It shows they can execute on these
kinds of public promises when they want to. And
their most recent big commitment is in an interesting
area, affordable housing. Right. It shows they're
thinking about the social determinants of health.
In 2024, they committed almost $35 million to
help build two affordable housing developments
in Hawaii. Creating hundreds of new homes. Exactly.
It's an acknowledgment that a person's health
is about more than just what happens in a pharmacy
or a clinic. It's about addressing these bigger
structural issues. So we've covered this incredible
journey from a single consumer value store to,
you know, the second largest healthcare company
in the world. It's a really powerful story of
corporate growth. Built on that retail expansion
in the 90s and then the huge strategic shift
with the Caremark merger in 2007 and the Aetna
acquisition in 2017. What's clear is that the
face of the company is the store, but the engine
is the PBM. It's the thing that drives the revenue
and at the same time is the source of all these
controversies over costs and kickback. Yeah.
The key takeaway for you is that CVS Health isn't
just a bunch of different businesses. It's one
highly centralized system that controls your
prescription insurance. your drug benefits, your
local pharmacy, your specialty care. And now
they're coming for your primary care doctor with
Oak Street Health. They are. This concentration
of power just makes them this undeniable force
that shapes the health care experience for basically
every American. So we'll leave you with a final
thought on all this. CVS Health says its mission
is to improve the future health of Americans.
But its history is filled with massive settlements
for deceptive practices and a federal jury literally
finding them co -responsible for the opioid crisis.
Can a corporation that controls so much of the
system and carries that much baggage truly earn
the public trust it needs to be your primary
care provider? Think about that tension. That
conflict between optimizing for profit and being
a trusted health care partner. Think about it
the next time you're in a health hub or your
prescription is run through Caremark or you use
your Aetna insurance card. That complexity is
modern American medicine. Until the next E -Dive,
stay curious.