WOONSOCKET, R.I. — Rising prescription drug costs, growing demand for GLP-1 weight-loss medications, and the potential savings from biosimilars are driving employers’ reliance on pharmacy benefit managers to control pharmacy spending, according to a new survey by CVS Caremark and Employee Benefit News.
The State of Pharmacy Management Survey found that 91% of employers are concerned about high medication prices for employees, and 88% believe PBMs are especially well positioned to reduce prescription drug costs for their organizations. Nearly two-thirds (64%) said PBMs have the greatest opportunity to improve access to affordable specialty medications.
The findings come as employers face mounting pressure to maintain access to increasingly expensive therapies while keeping pharmacy benefits financially sustainable.
“This data reveals the urgency behind employers’ need for PBM partners who can address cost, first and foremost,” said Ed DeVaney, president of CVS Caremark. “There’s a clear opportunity to help employers navigate the evolving pharmacy benefits landscape while driving sustainable benefits for clients and members.”
One area with potential savings is the growing biosimilars market. The survey found that 49% of employers currently encourage biosimilar substitution, while another 40% are considering or exploring the strategy. However, only 12% said they are educating employees about the potential cost savings from biosimilars.
CVS Caremark said its biosimilar formulary strategy has generated more than $3.3 billion in gross savings for clients and members related to Humira since April 2024.
The PBM expanded that strategy on July 1, removing Stelara from its most common commercial template formularies in favor of the lower-cost interchangeable biosimilars Pyzchiva and Yesintek. CVS Caremark said most affected members will pay $0 out of pocket for these therapies.
GLP-1 medications are another major concern for benefit managers. Seventy-seven percent of surveyed employers said the high cost of GLP-1 coverage is a concern, and 80% have either limited coverage of the drugs for weight loss or are considering doing so.
CVS Caremark has expanded GLP-1 coverage options while using utilization management, clinical support and nutrition programs to help clients manage spending. According to the company, clients participating in its CVS Weight Management program spent up to 26% less on GLP-1 medications for weight loss than clients that did not participate.
Technology is also becoming an increasingly important part of pharmacy benefit management. Eighty-eight percent of employers said digital tools and innovation in the health care experience are “here to stay.”
CVS Caremark said it invests more than $770 million annually in technology focused on member innovation, including tools that simplify access to medications and personalize the member experience. The company is also a founding partner of the Coalition for Health AI, which is developing standards for the responsible use of artificial intelligence in health care.
Despite employers’ focus on controlling benefit expenses, the survey indicates that pharmacy spending remains particularly difficult to manage. Only 30% of employers reported having significant influence over pharmacy costs, compared with 73% who reported having significant influence over the overall cost of maintaining a competitive employee benefits package.
CVS Caremark said the findings underscore employers’ growing expectations that PBMs use their negotiating scale, formulary strategies, technology and clinical programs to balance affordability and access to treatment.
The company has also been expanding pricing transparency through TrueCost, its acquisition-cost-based pricing model, which provides clients with drug-level rebate values and greater visibility into pharmacy costs.
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