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      Case study: How a large national employer chose integration over disaggregation

      Briefing

      In 2025, one of our longtime clients, a large communications company with over 100,000 members, was up for pharmacy benefit renewal. The company was happy with our services, but faced an increasingly common decision about where to take their strategy next:

       

      Should they keep pharmacy benefits under one roof, or separate them across different providers?

       

      The challenge: Integration vs. disaggregation

      The company was hearing more about disaggregation, or unbundling pharmacy benefits into smaller contracts with different vendors. They considered whether splitting up pharmacy services could help reduce fiduciary risk and limit regulatory exposure. They also wondered if a small, mainly tech-focused pharmacy benefit manager (PBM) could be a platform to bring multiple providers together.

      To explore disaggregation, the company sent out two requests for proposal — one for a fully integrated pharmacy benefit and another to carve out mail order and specialty pharmacy.

      Our initial approach: Outcomes over assumptions

      During the finalist meeting, CVS Caremark® focused on outcomes and trade-offs, helping the company think about their decision from every angle. We talked through what disaggregation can look like in practice instead of on paper, and where assumptions don’t always hold up.

      We addressed the myth that splitting pharmacy dispensing services equals more value. In reality, integration connects the dots between pharmacy, medical and lab data to give a comprehensive view of overall member health, leading to:

      • Lower costs
      • More personalized support
      • Fewer unnecessary emergency visits and gaps in care

       

      Employers with $1M annual drug spend see up to $12,800 savings with integration*

       

      We also talked in depth about member and client experience. When formulary management and retail, mail and specialty pharmacy work together, members get a more consistent experience with fewer handoffs and surprises, and clients gain better visibility across the benefit.

      Digging deeper into priorities

      After the finalist presentation, the company asked us to host additional sessions to take a closer look at their priorities. Their main focus was whether to unbundle pharmacy dispensing services, but we also talked about the value of integration more broadly. Each time the company asked for more information, we were happy to schedule time to go over any concerns in detail.

      The meetings centered on several aspects influencing the current pharmacy benefit landscape.

      • Regulatory risk. We brought in an expert from our legislative affairs team to address the company’s regulatory concerns. We discussed how an integrated model supports stronger oversight and consistency, and why splitting services doesn’t actually reduce regulatory risk.
      • Company-specific needs. Other conversations focused on practical details like contract setup and underwriting. During a whiteboard session, the company collaborated with us on areas of improvement and to explore innovative solutions like CVS Caremark TrueCost™ that can help lower overall cost of care while maximizing value for members.
      • Technology. The company was considering a smaller PBM that promoted a new platform for both medical and pharmacy claims. While the technology sounded appealing, there were questions about whether it could scale and perform reliably over time. We emphasized the safety, stability and proven performance of our solutions and platform, including myPBM™.

      Factoring in member satisfaction

      Our high member satisfaction rates played another key role in the renewal decision. The company noted that our scores show how integration supports a consistent, dependable experience across services.

       

      94% overall member satisfaction*

      97% satisfaction with retail*

      96% satisfaction with mail order*

      95% satisfaction with specialty*

       

      The final decision: Continuity of care with clarity and confidence

      After weighing their options, the company chose to renew their integrated pharmacy benefit with us for five years, effective Jan. 1, 2026. They plan to add components of TrueCost to bring even more visibility to drug pricing.

      For them, integration offered clarity. It delivered the transparency, predictability and consistency they were looking for without adding unnecessary complexity.

      It’s true disaggregation can sound appealing on the surface. But this case study underscores an important reality: splitting pharmacy services can introduce complications and risks that are harder to manage over time. 

      Want to see what integration can do for your pharmacy strategy?

      Let's talk

      • *FOR EMPLOYERS WITH $1M ANNUAL DRUG SPEND SEE UP TO $12,800 SAVINGS WITH INTEGRATION SOURCE: CVS Health Analytics, 2023. Data that was used was sourced from our 2023 iTools reporting and overall spend by the carrier for 2023. Represents employer clients with Drug Savings Review in 2022 and 2023, exclusive of outliers. (Outliers are defined as clients whose member totals were less than 5,000 and interventions count was less than 100 or client spend was less than $1,000,000.) Actual results may vary depending on benefit plan design, member demographics, programs implemented by the plan and other factors. P1015950324

      • *FOR 94% OVERALL MEMBER SATISFACTION SOURCE: CVS Caremark Member Experience Survey, 2025. P1009480721

      • *FOR 97% SATISFACTION WITH RETAIL, 96% SATISFACTION WITH MAIL ORDER AND 95% SATISFACTION WITH SPECIALTY SOURCE: Member satisfaction scores based on 2024 survey results.