Formulary strategies that deliver smart coverage and smarter savings
Our clients’ top priority is managing drug spend while making sure members get the care they need. Our formulary strategy is designed to do both.
Managing drug spend without compromising care
As the leading pharmacy benefit manager (PBM), we deliver clinically sound, cost-effective coverage that supports clients’ goals and their members’ health. We stay ahead of market shifts — anticipating changes, evaluating impact and uncovering opportunities to save money and improve outcomes. Our approach to formulary management is proactive, not reactive:
- Introduced formulary exclusions to eliminate wasteful spend.
- Spearheaded hyperinflation management to remove overpriced medications.
- Pioneered formulary optionality.
- Supporting significant use of biosimilars through our commercial template formularies.
Delivering over $1.5 billion
in gross savings related to Humira® (adalimumab)
Our formulary strategy in action
We focus on:
- Providing 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 value and determine formulary eligibility.
Advancing our 2026 formulary strategy — and how it benefits you
On January 1, 2026, we’ll be adding 13 drugs and removing 13 from the Standard Control with Advanced Control Specialty Formulary (our most popular). We’re anticipating minimal member impact.
Clients can expect:
$4.46B savings1
$137.95 savings PMPY1
Stelara will stay on the formulary, for now
We’ve seen supply chain instability in the past and it’s challenging for clients and their members.
- Ongoing litigation may limit biosimilar options, triggering shortages and making transitions risky.
- Some competitors are waiting until they’re more confident in the supply chain.
- Without lower-cost alternatives, removing Stelara too early would drive up costs.
Exceptions would cost $30k every 8-12 weeks per member.3
If biosimilars are unavailable, clients pay the full cost.
GLP-1s: No changes doesn’t mean no impact
We’re holding steady with no new GLP-1 formulary changes in January. Our decision to remove Zepbound from coverage in July is delivering meaningful results:
>95% of weight-loss category utilization was with a preferred formulary product4
Anti-obesity medication
$500-600M anticipated savings in the year following our change5
These updates help us stay ahead of market trends, keeping costs in check and care accessible.
[Instrumental background music plays. No other audio is present in the video. Text description follows.]
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.]
-
2025 CVS Caremark formulary updates
See how we're maximizing value for clients and members with an innovative approach.
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.
-
-
2 99.9% members not impacted: CVS Health Trade Finance, Q2, 2025. S1018110925
-
3 $30,000 every 8-12 weeks: Stelara Wholesale Acquisition Pricing.
-
4 >95% of weight-loss category utilization was with a preferred formulary product: CVS Health, 2025. Pharmacy paid claims for Zepbound, Wegovy and Saxenda for Commercial clients fully aligned with Template Formulary (with exclusions), Jul '25 - Sep '25. P1018180925
-
5 $500-600M projected savings: CVS Health Book of Business data, 2025. Pharmacy paid claims for Zepbound, Wegovy, Mounjaro for Commerical BoB (excludes restricted clients), Jul '24 - Apr '25. For template formulary only. P1018150925
