CVS Health

Insurance pricing is set annually and constrained by regulators and competition; pharmacy reimbursement trends are deflationary; PBM unit economics are under pressure from client price improvements and scrutiny of rebate structures.

CVS can shape mix (for example, formularies preferring certain GLP‑1s) and capture scale efficiencies, but true take‑it‑or‑leave‑it pricing is limited.

The company’s 2025 shift to prefer Wegovy for weight management while removing Zepbound on many Caremark formularies illustrates some formulary leverage, but it also created pushback such as Eli Lilly moving its own employees off Caremark, underlining the limits of pricing power.