Unlocking value through formulary and network strategy

As a plan sponsor, you already know it takes more than good intentions to help your members achieve better health, especially as drug prices continue to climb. It takes bold strategy, deep expertise and a willingness to challenge the status quo on cost.

That’s where our approach stands out. We combine a proactive formulary strategy with a smart, flexible pharmacy network design. Together these strategies help you get more value from every pharmacy dollar — and your members get broad access to cost-effective, clinically appropriate therapies.

We’ve built a long record of balancing clinical integrity with effective cost management, anticipating market changes so you stay ahead, and your members stay supported.

What makes a formulary strategy valuable?

A formulary isn’t just a list of covered drugs. It’s a powerful tool for controlling costs, improving clinical quality and supporting member satisfaction. At CVS Caremark, we take a comprehensive approach to selecting and managing prescription drugs.

A national pharmacy and therapeutics committee — made up of 21 independent experts, including physicians, pharmacists and a patient representative — guides our process. They carefully review every drug before it goes on our formulary.

We help ensure safety and efficacy by carefully evaluating each drug class — including specialty medications — using both internal expertise and external therapeutic class reviews. Every recommendation is informed and verified through rigorous clinical evaluation, so you can be confident that our formulary covers clinically appropriate medications.

Innovative models that deliver more value

We don’t just follow industry trends — we set them. CVS Caremark pioneered formulary exclusions in 2012 to drive competition and lower costs for high-impact drugs like insulin. More recently, we’ve used this strategy for biosimilars and GLP-1s, helping clients save millions and encouraging manufacturers to offer more options and better pricing. 

We also lead in hyperinflation management, identifying overpriced medications and employing strategies such as tiering, exclusions and preferred drug placement to protect clients from sudden cost spikes. Our utilization management (UM) helps ensure claims align with coverage criteria in a way that is quick and efficient for prescribers and members.

New therapies are always coming to market, and we work to stay ahead. Through our new-to-market (NTM) drug review process, we carefully assess the clinical and financial value of emerging treatments to determine if they’re a good fit for our formularies.

Our approach is flexible — letting you align coverage with your organization’s goals and adapt to market changes — and the impact is real. Our managed formularies have saved clients hundreds of millions of dollars, supported using biosimilars and delivered competitive pricing from manufacturers. And most members won’t experience any disruption in their coverage.

How network strategy delivers savings and access

Pharmacy network design is another powerful way to manage costs without sacrificing member access. We build networks that focus on reducing redundancy, not limiting choice. Our network includes more than 64,000 pharmacies, 40% of which are independent. This broad reach means members have options, while our scale helps us negotiate better prices.

By leveraging the buying power of 89 million plan members, we secure discounts from drug manufacturers and connect members with affordable choices like generics and biosimilars. The result? Greater savings and reliable access.

Flexibility to fit your needs

Every organization is different, so we offer a range of formulary and network options to fit your goals — whether you’re an employer group, health plan or government program. Our principles stay the same: balancing clinical rigor with cost management.

We use claims and utilization data to refine our strategies, making adjustments as your needs change. And we actively monitor and advocate on regulatory developments, so you have the flexibility to design plans that suit your needs, and so you can be confident your coverage is always compliant.

You get tailored solutions backed by experience, data and a commitment to helping your members get the most from their pharmacy benefit.

Better value from your pharmacy benefit isn’t just possible — it’s what we deliver every day. Our team combines clinical expertise, market insight and a proactive approach to help you get more for your pharmacy spend, while supporting your members’ health.

Ready to see how our strategies can work for you? Contact your CVS Caremark account team to learn more about how we can help you achieve better value and stronger outcomes for your organization.