CVS Health pushes faster biosimilar switching through CVS Caremark, indicating cost focus in pharmacy plans

CVS Health is indicating a more aggressive approach to biosimilars, the closely matched, lower-cost versions of biologic medicines, as it tries to widen patient access while managing pharmacy drug costs. In a recent market report, CVS said its CVS Caremark unit is accelerating biosimilar adoption through formulary decisions, which determine which drugs are preferred and typically how much patients pay at the pharmacy counter.

At the center of the move is adalimumab brand therapy, marketed as Humira, a widely used treatment for conditions including inflammatory diseases. The report says CVS Caremark is removing Humira from its formularies and shifting toward lower-cost biosimilar options, a change that can materially affect prescribing and pharmacy purchasing patterns because PBMs influence which products clinicians and patients can access most easily.

Biosimilars are not generic drugs in the traditional sense. They are made for biologic medicines, which are complex therapies produced through living cell processes, and biosimilars are designed to achieve comparable clinical results. From a PBM perspective, switching to biosimilars is often viewed as a way to reduce net drug spending, especially as biologic patents expire and multiple competing alternatives enter the market.

Formularies are a core lever for PBMs, and the report suggests CVS is using that lever to increase biosimilar uptake. In practice, formulary placement can come with different levels of patient cost sharing, prior authorization requirements, or restrictions on non-preferred alternatives. Those tools, while not the only factor in treatment decisions, can speed the transition away from more expensive branded biologics.

CVS Caremark’s action also fits a broader industry pattern. PBMs across the United States have been shifting more aggressively toward biosimilars in recent years, particularly as more biosimilar products have become available for major biologics. That trend reflects mounting pressure to control pharmacy costs for employers, health plans, and government programs that rely on PBM pricing and management strategies.

CVS did not provide, in the market report, additional quantified details on how quickly it plans to expand biosimilar coverage beyond the referenced formulary change. It also did not disclose specific timelines, the full list of affected products, or the size of expected cost or utilization impact, at least within the information available in the reported segment.

For patients and providers, the practical effect of such formulary switches often depends on how quickly prescribers adjust and whether biosimilars are clinically interchangeable for a given patient. The report framed CVS’s move as part of a cost-management and access strategy, but it did not discuss specific patient safeguards, transition protocols, or exception pathways.

What to watch next is whether CVS Caremark follows this indicating step with additional formulary updates for other major biologics, and how quickly enrollment and prescribing patterns shift as a result. In similar moves, the market response can show up in drug mix, patient cost-sharing levels, and the pace at which competitors expand coverage through contracted pricing.