2025 CVS Caremark Formulary Updates

An effective formulary strategy is the foundation of cost containment. Our approach prioritizes coverage for clinically appropriate, cost-effective medications for members while ensuring low net cost for our clients. And as of January 1, 2025, we’re improving access further – without impacting client financials – with more inclusions to our Standard Control Formulary than last year.

Delivering significant savings, with minimal member impact

Hyperinflation management – removing drugs with hyperinflated prices from our formularies, that have readily available, clinically appropriate, and cost-effective alternatives – is embedded within our managed template formularies to prevent wasteful spend.

Our hyperinflation strategies saved clients:

Member access, affordability, and convenience are paramount

Ensuring that medications are affordable for members is one of our main goals, and we also work hard to maximize their experience with minimal disruptions. With our 2025 formulary updates, 99.4% of members won’t experience any impact.¹

For members that are affected, we reach out proactively in ways they prefer – including by text, email and direct mail – to clearly explain what is changing, review their options, and walk them through next steps so that they stay on track with therapy. We also notify prescribers if a plan member is affected by a change and provide details about the associated medication.

Looking ahead – more opportunities for significant savings with biosimilars

In a constantly evolving pharmaceutical environment, biosimilars represent one of the biggest opportunities for reducing drug costs for payors and patients. Up to eight biosimilars for Stelara® are expected to launch in 2025, representing a significant cost reduction opportunity.

With each new entrant, we will evaluate it consistently within our formulary process, with a review of clinical, economic, and market factors, to ensure we get to the optimal outcome for our clients.