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      Using formulary design to drive cost savings in health care

      June 27, 2025 |2 minute read time

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      Key points

      • Our formulary strategy is centered around providing cost-effective, clinically appropriate prescription coverage 

      • We remove barriers to care, increase access to new treatments and make them more affordable to consumers CVS Caremark® goes head-to-head with drug manufacturers to negotiate discounts for our customers. 

      • Innovation in health care brings us new treatments that help people live healthier lives. However, one of the barriers to people accessing these treatments is affordability. When patients are able to afford their medications, they’re more likely to take their medications as prescribed, helping to improve health outcomes.

      Through a commitment to improving health outcomes for our patients, CVS Health® makes life-changing treatments accessible to more people. 

      As a pharmacy benefit manager (PBM), CVS Caremark goes head-to-head with drug manufacturers to negotiate discounts for our customers. Through a comprehensive formulary strategy, we remove barriers to care, increase access to new treatments and make them more affordable to consumers. 

      Our formulary strategy is centered around providing cost-effective, clinically appropriate prescription coverage and constantly evolves to meet the health care needs of our clients, following these core principles:

      • Maintain clinically appropriate coverage

      • Secure best pricing by leveraging competition

      • Provide robust support for members and prescribers

      1.5B

      in savings for our clients from our biosimilars formulary strategy1

      The actions we’ve taken have proven to work. For example:

      • Taking action for insulin affordability 
        In 2012, we recognized a need to act on escalating insulin prices. We used our formulary strategy to bring insulin prices back to affordable levels for our members. Other PBMs followed our lead.

      • Moving the needle on biosimilar adoption 
        In 2024, we became the first PBM to remove Humira, preferring instead the biosimilar Hyrimoz at a $0 copay for many members. A proactive plan helped to ensure members and prescribers had the support they needed for this transition. This move yielded $1.5 billion in gross savings for our clients and members.1

      • Creating a path to GLP-1 access 
        The GLP-1 therapeutic class is where our formulary strategy can make a big impact. In 2025, we made the decision to prefer Wegovy on our commercial template formularies. This decision drives competition in the market to lower drug pricing and enables wider, more affordable coverage for weight management drugs. As a result of this change, clients who use our template formularies could save an estimated 10-15 percent year-over-year in the anti-obesity medication space. 

         

      CVS Caremark is more than a provider of pharmacy benefits: We are partners with our customers. Our work is powered by innovative technologies and solutions that provide affordable coverage and help drive better health outcomes.

      Learn more about the value PBMs like CVS Caremark bring to patient care and access: 101 infographic (PDF)

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      • 1. CVS Health Analytics, 2024. 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. P1017640325