Expect the proposed Aetna/Humana merger to be a full employment act for antitrust lawyers over the next few months. Multiple states, as well as the federal Department of Justice, are looking into whether the mammoth merger would create unfair competition in certain markets.

Until those folks sort it out, it's instructive to dig into the data to see why Aetna's courtship of Humana makes so much sense in markets where Aetna is not a household name, especially among the over-65 set. Analysts at Decision Resources Group's Data Operations team recently ran the numbers to see which markets would give a combined Aetna/Humana the biggest boost.

Those markets are medium-to-small places such as Winchester, Va., Gulfport, Miss., Baton Rouge, La., and Knoxville, Tenn., where Humana had a solid base of Medicare Advantage members. In Knoxville, where Humana purchased a homegrown Medicare Advantage carrier years ago, there are more than 40,000 Humana members, versus just 347 for Aetna. In Baton Rouge, it's a similar story with more than 41,000 for Humana and 638 for Aetna.

If you?re an account manager, the deal definitely changes the way you do business?chief among them contracting for prescription drugs. It's impossible to know whose formulary would dominate in a combined company, but it's a safe bet that Aetna would defer to Humana in most matters related to Medicare.

Over the past few years, Humana has focused its energies on building a solid Medicare Advantage and Part D presence. It's the second-largest Part D and Medicare Advantage vendor, behind UnitedHealth Group. The Aetna/Humana combination becomes No. 1 in both cases.

Aetna has also built its Medicare business differently than has Humana. Aetna has acquired a number of group retiree accounts, while Humana has mostly built the business individual by individual. That fact is obvious by digging into the Part D data. Humana has a total 3.1 million Medicare Advantage members and 87 percent of them also get their Part D benefit through Humana. Aetna, on the other hand, has 1.2 million Medicare Advantage members and 68 percent have Part D embedded, according to DRG data.

The merger would be a game changer on a number of levels. Aetna/Humana, UnitedHealth, and Anthem would be giants and could exert a lot of control with vendors like biopharma.  And that's not even accounting for the possibility of an Anthem/Cigna marriage.

Should Aetna/Humana ultimately get hitched, it will be one heck of a wedding. Account managers may not have a front-row seat, but the reception line for scraps will be long.

Follow Jane DuBose on Twitter @JaneGDuBoseDRG

A novel approach to treating neurodegenerative disease

View Now