Affordability is under pressure. Pharmacy strategies can help.
Life costs more than it used to.
Consumers feel it at the grocery store, gas station and with their monthly bills. Health care is different. It’s not just another hit to your budget. It’s a necessity you can’t always plan for. And when employees feel that pressure, employers feel it, too. You’re not just managing rising costs, you want to provide benefits your employees can rely on. And the stakes are high.
More than half of Americans worry about affording health care.*
When your employees can’t afford their medications, they delay filling prescriptions. Bills pile up. Adherence goes down. And confidence in their benefits starts to slip.
Affordability, in other words, isn’t just about budgets. It’s about trust.
What’s driving pharmacy spend?
Pharmacy costs aren’t rising in a vacuum.
They’re rising at the same time everything else is. For employers, that can mean hard trade-offs.
“Shifting costs to employees or limiting access often falls short because it doesn’t address the root cause of rising spend: drug manufacturer pricing. More effective strategies focus on formulary competition, transparency and clinically informed decision making.”
Joshua Fredell
Senior Vice President & Head of PBM & Specialty Product Innovation
Several forces are driving that pressure
New therapies, evolving guidelines and policy changes are expanding what’s possible in care.
Together, GLP-1 demand, rising costs and a constantly shifting landscape create a market that’s harder to predict and even harder to manage alone.
How can you get ahead of rising pharmacy costs?
Pharmacy benefit management is less about administration and more about guidance. Pharmacy benefit managers (PBMs) are the only link in the pharmaceutical supply chain that exists to lower costs. You don’t just need someone to manage claims. You need a partner who helps you understand what's happening. That’s why we provide real-time insights into what’s driving your pharmacy spend, so decisions don’t come as a surprise. From there, we take action.
We move the market
We were the first PBM to remove Humira® from major commercial formularies and transition to lower-cost biosimilars. And we’ve continued that approach as of June 1, 2026, preferring biosimilars over Stelara® on our commercial template formularies.
It's a balancing act
For other high-impact categories like GLP-1s — we balance access, choice and cost management to help you stay ahead.
-
June 1, 2026
Removed the new-to-market block on Foundayo™, an oral GLP-1 therapy.
-
Oct 1, 2026
Adding Zepbound® to our commercial template formularies.
-
Helping clients achieve double-digit savings year-over-year, with an additional 12% expected in the anti-obesity medication category.
How does CVS Caremark help lower your costs?
-
Clients receive 99%+ of negotiated rebates through CVS Caremark TrueCost.™
-
We drive adoption of lower-cost options, with 9 out of 10 prescriptions filled as generics.*
We drive these outcomes by combining:
Scale and purchasing power
Formularies that prioritize lower-cost options like generics and biosimilars
Forward-thinking sourcing and pricing models
Integrated clinical and care management
Why having the right PBM makes all the difference
Affordability doesn’t happen by accident. It takes constant attention to market shifts. A willingness to make tough decisions that balance access and cost. And a partner who consistently advocates for you and your employees.
“Employers that adopt smarter pharmacy strategies can demonstrate that access to cutting-edge care, member affordability and long-term sustainability are not competing goals — they’re achievable together.”
Joshua Fredell
Senior Vice President & Head of PBM & Specialty Product Innovation
Building strategies
We’ll help you build pharmacy benefit strategies that work today and hold up over time. Because when everything costs more, getting pharmacy benefits right matters more than ever.
Want to learn more?
The source for data in this document is CVS Health Enterprise Analytics, unless otherwise noted. Adherence and savings results may vary based upon a variety of factors such as plan design, demographics and programs adopted by the plan. Client-specific modeling available upon request. CVS Health uses and shares data as allowed by applicable law, and by our agreements and information firewall.
-
*FOR 66% OF AMERICANS SOURCE: Employers brace for 2026 premium hikes | Employee Benefit News
-
*FOR 55% OF EMPLOYERS SAY SOURCE: Employers are challenged to keep healthcare affordable as costs soar: Survey results
-
*FOR HEALTH BENEFIT COSTS ARE EXPECTED TO RISE ANOTHER 5-6% IN 2026 SOURCE: Employers brace for 2026 premium hikes | Employee Benefit News
-
*FOR GLP-1 LIST PRICES OFTEN EXCEED $1,000/MONTH SOURCE. FOR UTILIZATION IS SURGING, PUSHING UP TOTAL SPEND BY ~50% AND ACCOUNTING FOR ~20% OF TOTAL DRUG COSTS IN 2025 SOURCE. FOR COMBINED COST OF PREMIUMS AND DEDUCTIBLES IS OVER 10% OF MEDIAN HOUSEHOLD INCOME SOURCE. “Is employer coverage affordable? How the states stack up.” Commonwealth Fund. February 11, 2026. https://www.commonwealthfund.org/blog/2026/is-employer-coverage-affordable-how-states-stack-up.
-
*FOR MOST MEMBERS WILL PAY $0 OUT-OF-POCKET FOR STELARA BIOSIMILARS CLAIM: CVS Health Analytics, 2026.
-
*FOR PROJECTED ANNUAL NET COST CLIENT SAVINGS OF $155M CLAIM: Based on current modeling assumptions applicable to the commercial template book of business, removal of Stelara is projected to result in estimated annual net cost savings of approximately $155M. This estimate reflects aggregate modeling and may not be representative of any individual client’s experience. CVS Health Rebate Performance Management. All data sharing complies with applicable law, our information firewall and any applicable contractual limitations. Actual results may vary depending on benefit plan design, member demographics, programs implemented by the plan and other factors.
-
*FOR BIOSIMILAR STRATEGIES HAVE GENERATED $3.3B IN GROSS SAVINGS CLAIM: CVS Health Analytics, 2026 for April 2024 - December 2025. CVS commercial clients. Savings projections are based on CVS Caremark data. Actual results may vary depending on benefit plan design, member demographics, programs implemented by the plan and other factors. P1017640325
-
*FOR DOUBLE-DIGIT YEAR-OVER-YEAR SAVINGS FOR TEMPLATE CLIENTS AND AN ADDITIONAL 12% SAVINGS IN THE AOM SPACE SOURCE: CVS Health Rebate Performance Management. All data sharing complies with applicable law, our information firewall and any applicable contractual limitations. Actual results may vary depending on benefit plan design, member demographics, programs implemented by the plan and other factors.
-
*FOR MEMBER OUT-OF-POCKET COSTS DECREASED BY 7% SINCE 2024 CLAIM: CVS Health book of business, commercial cohort clients, first quarter of 2026. P1016220524
-
*FOR MEMBERS PAID AN AVERAGE OF $8.38 FOR A 30-DAY SUPPLY CLAIM: CVS Health book of business, commercial cohort clients, first quarter of 2026. P1016220524
-
*FOR 9 OUT OF 10 PRESCRIPTIONS FILLED AS GENERICS CLAIM: Over 90% of generic substitution for mature launches. CVS Specialty Finance, reporting period Jan. - Sept. 2025. For CVS Caremark PBM members only. "Mature" defined as launch >12 months prior; excludes Copaxone® due to brand on formulary.
