CVS Caremark Survey Highlights Employers’ Growing Reliance on PBMs to Build Sustainable Pharmacy Benefit Strategies
CVS Caremark, the pharmacy benefits services business of CVS Health, has released findings from a new survey conducted in partnership with Employee Benefit News, highlighting the growing challenges employers face in managing prescription drug spending while ensuring employees continue to have access to high-quality and affordable care.
The findings from this year’s State of Pharmacy Management Survey point to a pharmacy benefits environment increasingly shaped by rising medication prices, costly specialty treatments, expanding use of GLP-1 medications for weight management, and the growing availability of biosimilars. Against this backdrop, employers are increasingly turning to pharmacy benefit managers (PBMs) for expertise, purchasing scale, clinical capabilities and cost-management strategies.
The survey indicates that employers view prescription drug costs as one of the most difficult components of their overall benefits strategy to control. While employers continue to seek ways to maintain competitive health and pharmacy benefits, many say they lack the influence and resources necessary to independently manage the rapidly changing pharmaceutical market.
Rising Prescription Drug Costs Remain a Major Employer Concern
One of the strongest findings from the survey is the extent to which medication costs are affecting employer-sponsored benefits programs. According to the research, 91% of employers are concerned about the high prices of medications for their employees.
The concern reflects a broader challenge facing employers as prescription drug spending becomes increasingly complex. Traditional medications remain an important component of pharmacy spending, while specialty drugs, biologics and newer therapies can carry significantly higher costs.
Employers must therefore balance several competing priorities. They need to provide employees with access to clinically appropriate treatments while also protecting the financial sustainability of their benefits programs. For many organizations, simply reducing pharmacy spending is not a sufficient strategy if cost reductions result in restricted access or poorer health outcomes.
The survey found that 88% of employers believe PBMs are particularly well positioned to reduce prescription drug costs for their businesses. This suggests that employers increasingly recognize the role PBMs can play in negotiating prices, developing formularies, managing utilization and identifying lower-cost alternatives.
“Employers need PBM partners who can address cost, first and foremost,” said Ed DeVaney, President of CVS Caremark. He added that the findings demonstrate an opportunity for PBMs to help organizations navigate an increasingly complex pharmacy benefits environment while creating sustainable benefits for employers and their members.
Specialty Medications Create Additional Pressure
Specialty medications are another major area of concern for employers. These treatments are often used for complex or chronic conditions and can involve significantly higher costs than traditional prescription drugs.
The survey found that 64% of employers believe PBMs have the greatest opportunity to improve access to affordable specialty medications.
This reflects the difficult balance employers face when managing specialty drug benefits. New treatments can provide important clinical benefits, but their prices can place substantial pressure on employer-sponsored health plans.
PBMs can help employers manage these challenges through formulary development, manufacturer negotiations, utilization management, specialty pharmacy services and identification of alternative therapies.
As the specialty pharmaceutical market continues to expand, employers are likely to place greater emphasis on strategies that can control spending without unnecessarily limiting access to medically appropriate treatments.
Biosimilars Represent a Significant Cost-Saving Opportunity
The survey also highlights biosimilars as an important but underused opportunity for reducing prescription drug costs.
Biosimilars are highly similar versions of biological medicines and can provide alternatives to certain higher-cost biologic therapies. Their growing availability has created opportunities for employers and health plans to reduce spending while maintaining access to clinically appropriate treatments.
However, the survey suggests that many employers have not yet fully embraced biosimilar substitution.
Only 49% of employers said they are currently encouraging biosimilar substitution, while another 40% are considering or exploring the approach. Meanwhile, only 12% reported that they are educating employees about the potential cost savings associated with biosimilars.
These figures indicate a substantial opportunity to increase awareness among both employers and employees.
Education can be particularly important because employees may not always understand the difference between reference biologic products and biosimilar alternatives. Employers and benefits providers can help explain how biosimilars are used, their potential affordability advantages and the role they can play in maintaining access to treatment.
CVS Caremark has made biosimilar adoption an important component of its pharmacy benefit strategy. According to the company, its biosimilar formulary strategy has helped clients and members generate more than $3.3 billion in gross savings related to Humira (adalimumab) since April 2024.
The company has also said it intends to expand the use of lower-cost biosimilars across additional therapeutic categories.
Stelara Biosimilars Become Part of CVS Caremark’s Strategy
The company’s biosimilar strategy continued to expand in 2026.
On July 1, 2026, CVS Caremark transitioned from Stelara (ustekinumab) on its most common commercial template formularies and began preferring lower-cost, interchangeable biosimilar alternatives, including Pyzchiva and Yesintek.
According to CVS Caremark, most members will have $0 out-of-pocket costs for their therapy.
The move illustrates how formulary decisions can be used to encourage the adoption of lower-cost alternatives while maintaining access to treatment.
For employers, strategies such as these can be particularly important as they seek ways to manage rising pharmaceutical expenditures without eliminating coverage for expensive therapies.
GLP-1 Medications Are Reshaping Employer Pharmacy Strategies
Another major issue identified in the survey is the growing cost of GLP-1 medications used for weight management.
GLP-1 therapies have rapidly become a significant component of the healthcare benefits conversation. While these medications can provide meaningful health benefits for eligible patients, their cost has created new challenges for employers considering whether and how to include weight-management treatments in their benefit plans.
The survey found that 77% of employers are concerned about the high cost of GLP-1 coverage.
At the same time, 80% of employers have either already limited GLP-1 coverage for weight loss or are considering introducing limitations.
These findings demonstrate the difficult decisions employers face. Demand for GLP-1 medications continues to grow, but employers must evaluate the long-term financial impact of covering these therapies.
Rather than relying solely on coverage restrictions, employers are increasingly examining strategies that combine access with clinical oversight and cost management.
CVS Caremark has expanded coverage options for GLP-1 weight-management medications while working with clients to develop strategies tailored to individual employee populations. These strategies can include utilization management, clinical support, nutrition guidance and other interventions designed to encourage appropriate use.
Whole-Person Weight Management Becomes More Important
The survey findings also reinforce the growing importance of approaches that extend beyond medication alone.
CVS Caremark’s CVS Weight Management program uses a lifestyle-first model that combines clinical support with nutrition and behavioral guidance. The company’s approach is designed to help members achieve sustainable weight-management outcomes while potentially reducing overall pharmacy spending.
According to CVS Caremark, clients participating in the program spent up to 26% less on GLP-1 medications for weight loss compared with clients that did not participate.
The company also reported that members who were previously taking anti-obesity medications nearly doubled their pre-program weight loss while working with program clinicians on diet and lifestyle changes.
For employers, these types of programs demonstrate how pharmacy benefit strategies can evolve from simply paying for medications toward broader approaches focused on health outcomes, adherence, prevention and long-term cost management.
Digital Innovation Is Becoming a Permanent Part of Pharmacy Benefits
Technology is another area highlighted by the survey.
As healthcare becomes increasingly digital, employers are looking for pharmacy benefit partners that can make the healthcare experience easier to navigate. Digital tools can help members find information, understand their benefits, identify appropriate care options and manage medications.
The survey found that 88% of employers believe digital tools and innovation are “here to stay” as part of the healthcare experience.
This reflects the changing expectations of healthcare consumers. Employees increasingly expect healthcare services to offer the same convenience and personalization found in other areas of their digital lives.
CVS Caremark says it invests more than $770 million annually in technology focused on member innovation. The company’s strategy combines digital capabilities with human support, with the goal of helping members access medications and services more efficiently.
Artificial intelligence is also becoming an important part of the healthcare technology discussion. CVS Caremark has participated in efforts focused on responsible and ethical AI adoption in healthcare, including through its role as a founding partner of the Coalition for Health AI.
For employers, the value of digital innovation extends beyond convenience. Technology can potentially improve engagement, simplify benefits navigation and provide members with more personalized support.
Employers Have Less Control Over Pharmacy Costs
Despite their responsibility for managing employee benefits, many employers believe they have limited influence over pharmacy spending.
Only 30% of employers said they have significant influence over pharmacy costs, compared with 73% who said they have significant influence over the overall cost of maintaining a competitive benefits package.
The gap illustrates why employers are increasingly looking to external partners for specialized pharmacy expertise.
Prescription drug pricing can involve manufacturers, wholesalers, pharmacies, insurers, PBMs and other participants. Employers may therefore find it difficult to influence individual components of the pharmaceutical supply chain on their own.
PBMs can use purchasing scale and industry expertise to negotiate with manufacturers, develop formularies and establish strategies intended to manage medication costs.
Greater Transparency Becomes a Priority
Alongside cost control, transparency is becoming increasingly important for employers.
Employers want greater visibility into the prices they pay for prescription drugs and the mechanisms that influence pharmacy spending. This can help benefits administrators evaluate the effectiveness of their pharmacy strategies and make more informed decisions.
CVS Caremark has introduced its TrueCost pricing model as part of its approach to pricing transparency. The model provides clients with visibility into acquisition-based drug costs and drug-level rebate values.
Greater transparency can help employers better understand pharmacy spending and evaluate the sustainability of their benefits arrangements.
For employers dealing with unpredictable drug prices and rapidly changing treatment options, greater visibility can also support longer-term benefits planning.
The Future of Employer Pharmacy Benefits
The findings from the CVS Caremark and Employee Benefit News survey demonstrate that employers are confronting a pharmacy landscape that is becoming more complex.
High prescription drug prices, expensive specialty medications, biosimilars, GLP-1 therapies, digital healthcare and emerging technologies are all influencing pharmacy benefit strategies.
At the same time, employers must continue providing competitive benefits that help attract and retain employees. Cutting pharmacy coverage too aggressively could negatively affect employee satisfaction and access to care, while unrestricted coverage can create significant financial pressures.
This is creating greater demand for sophisticated strategies that balance affordability, access and quality.
PBMs are increasingly positioned as strategic partners in that process. Their purchasing scale, clinical expertise, formulary management capabilities and technology infrastructure can help employers address some of the challenges associated with pharmacy spending.
The survey suggests that employers are particularly interested in solutions that can deliver measurable value while preserving access to appropriate treatments.
As pharmaceutical innovation continues to introduce new therapies, the role of pharmacy benefit management is likely to evolve further. Biosimilars may become more widely adopted, GLP-1 coverage strategies may continue to change, and digital and AI-enabled tools could increasingly influence how employees interact with their pharmacy benefits.
For employers, the central challenge will remain finding sustainable ways to provide access to effective medicines without allowing pharmacy costs to undermine the affordability of their overall benefits programs.
The latest survey results suggest that many employers believe they will need specialized partners to achieve that balance. For CVS Caremark, the findings reinforce the company’s strategy of combining purchasing power, clinical programs, digital innovation, formulary management and pricing strategies to help employers navigate the changing pharmacy benefits landscape.
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