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      Formulary management for smart coverage, smarter savings

      One of our clients’ top priorities is managing drug spend while making sure members get the care they need. Our CVS Caremark formulary strategy is designed to do both.

      Managing drug spend without compromising care

      As the leading pharmacy benefit manager (PBM), we help clients deliver clinically sound, cost-effective medication coverage that supports their goals and their members’ health. Our approach to formulary management is proactive, not reactive. We have a long track record of making bold moves to help make care more affordable and accessible. 

      We stay ahead of market shifts — anticipating changes, evaluating impact and uncovering opportunities to save money and improve outcomes — because a formulary is more than just a list of covered drugs. CVS Caremark has led the industry by:

      • Introducing formulary exclusions to eliminate wasteful spend.
      • Spearheading hyperinflation management to remove overpriced medications.
      • Pioneering formulary optionality.
      • Supporting significant use of biosimilars through our commercial template formularies.

       

      Clients can expect:

      $4.46B client savings anticipated from our formulary strategy in 2026*

      99% of members will not be affected by formulary removals*

       

      Our formulary strategy in action

       

      We focus on:

      • Enabling access to clinically appropriate medications while driving client savings
      • Using independent clinical reviews to guide decisions and uphold integrity
      • Securing best pricing by leveraging competition — across generics, biosimilars and brands
      • Supporting smooth member transitions to minimize disruption and keep care consistent

      We help clients stay ahead by:

      • Tracking regulatory changes and anticipating their impact
      • Combating hyperinflation by removing overpriced drugs
      • Reviewing new-to-market drugs to evaluate clinical appropriateness and value to determine formulary eligibility

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      CVS Caremark.

      Employer Case Study: Simplicity and savings for a state employer.

      Situation.

      Help state government with a large union reduce spend on high-cost, low-value drugs

      Solution.

      Implement formulary solution that substitutes lower-cost, clinically appropriate therapies, all while adhering to union contract and avoiding collective bargaining.

      Results.

      Preserved access to clinically appropriate therapies.

      $45.60 per member per year projected annual savings.

      No member disruption and high member satisfaction.

      [Music fades, video ends.]

      Reducing spend with the right formulary approach

      CVS Caremark implemented a formulary solution for a government employer seeking to reduce spend on high-cost, low-value drugs.

       

      Biosimilars: not a one‑size‑fits‑all approach

      Biosimilar drugs can provide clinically appropriate alternatives to original biologics, often at a lower cost. But effective formulary management is about more than going with the lowest‑priced option.

      We evaluate biosimilars for efficacy, safety, stability and supply‑chain confidence to determine where they fit within our approach to specialty drug management and broader formulary strategy. Our goal is to support savings while maintaining consistent access and continuity of care.

       

      Delivering over $3.3 billion*

      in gross savings related to Humira® (adalimumab)

       

      GLP-1s: More options, more demand, more challenges

      GLP‑1s, specifically those approved for weight management, have rapidly changed the pharmacy benefit landscape. As utilization grows, plan sponsors face complex decisions around access, affordability and long‑term sustainability for this therapeutic class.

      We apply disciplined formulary management solutions to GLP‑1s, grounding our recommendations in clinical evidence and real‑world utilization insights. Our approach supports appropriate coverage while helping manage the financial impact of these high‑demand therapies across CVS Caremark formulary templates.

       

      15% reduction in per prescription net cost for GLP-1s from 2025-2026*

       

      Formulary decisions shape access, affordability and long‑term plan performance. We support those decisions with clinically grounded guidance and flexible formulary strategies to bring clarity and consistency to a complex market.

      Let’s work together to find a formulary approach that works for you.

      Contact us

      • 2025 CVS Caremark formulary updates

        See how we're maximizing value for clients and members with an innovative approach.

        Read our report

      All statistics are generated from CVS Health Enterprise Analytics unless otherwise noted. This article contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Health.

       

      • *FOR $4.46B CLIENT SAVINGS and 99.9% OF MEMBERS WON’T EXPERIENCE DISRUPTION: CVS Health Trade Finance, Q1 2025. Client savings are determined using cumulative value over a 3-year period (upcoming year, current year and prior year). All data complied 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

      • *99.9% OF MEMBERS WILL NOT BE AFFECTED BY FORMULARY REMOVALS: CVS Health Trade Finance, Q2 2025. S1018110925

      • *FOR $3.3B IN GROSS SAVINGS RELATED TO HUMIRA: CVS Health Analytics, 2026 for April, 2024 – December 2025. CVS Commercial clients.  All data sharing complies with applicable law, our information firewall and any applicable contractual limitations. 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.

      • *FOR ~15% REDUCTION IN PER PRESCRIPTION NET COST FOR GLP-1S IN 2026: CVS Health Analytics, 2026.