Employers Look to PBMs for Lower Drug Costs and Better Access | iPharmaCenter

A new CVS Caremark and Employee Benefit News survey shows that employers are increasingly relying on pharmacy benefit managers to control prescription drug spending, improve access to specialty medicines, and manage the growing cost of GLP-1 treatments.

The State of Pharmacy Management Survey found that employers see three major opportunities for pharmacy benefit management: expanding biosimilar use, developing sustainable GLP-1 strategies, and using digital tools to create a simpler member experience.

Why Employers Are Relying on PBMs?

Prescription drug affordability has become one of the biggest challenges for employers that provide health benefits.

The survey found that:

• 91% of employers are concerned about high medicine costs for employees.

• 88% believe PBMs are well positioned to reduce prescription drug spending.

• 64% say PBMs have the greatest opportunity to improve access to affordable specialty medicines.

The findings suggest that employers want PBMs to provide more than prescription processing. They are also seeking support with benefit design, medicine pricing, specialty pharmacy management, and patient access.

Biosimilars Could Lower Pharmacy Spending

Biosimilars are emerging as an important cost-saving opportunity for employers and health plans. These medicines are designed to provide comparable clinical outcomes to their reference biologic products while potentially lowering treatment costs.

However, employer adoption remains incomplete. The survey found that:

• 49% of employers currently encourage biosimilar substitution.

• 40% are considering or evaluating biosimilar strategies.

• Only 12% educate employees about potential biosimilar savings.

CVS Caremark reported that its biosimilar formulary strategy generated more than $3.3 billion in gross savings related to Humira biosimilars since April 2024. The company said it plans to expand biosimilar use across additional therapeutic areas.

In July 2026, CVS Caremark moved Stelara off its most commonly used commercial formularies and began preferring lower-cost interchangeable biosimilar alternatives, including Pyzchiva and Yesintek.

GLP-1 Costs Create Benefit Challenges

GLP-1 medicines used for weight management have become a major issue in employer-sponsored health plans.

According to the survey, 77% of employers are concerned about the cost of covering GLP-1 medicines for weight loss. In addition, 80% have either limited coverage or are considering restrictions.

• Employers are evaluating several approaches to manage GLP-1 spending while maintaining access for eligible members. These strategies may include:

• Prior authorization and utilization management.

• Clinical monitoring.

• Nutrition and lifestyle support.

• Personalized treatment guidance.

• Negotiated medicine pricing.

CVS Caremark said employers using its weight management program spent up to 26% less on GLP-1 medicines for weight loss than employers that did not use the program. The company also reported improved weight loss outcomes among members who received clinical support focused on diet and lifestyle changes.

These findings reflect CVS Caremark’s own reported program results and should not be interpreted as independent evidence of outcomes across all employer plans.

Digital Health Tools Become Standard

Digital technology is becoming a core part of pharmacy benefit management. The survey found that 88% of employers believe digital tools and innovation are now a permanent part of the healthcare experience.

Employers are looking for digital services that help members:

• Understand medicine coverage.

• Compare treatment costs.

• Find lower-cost alternatives.

• Access clinical support.

• Navigate pharmacy benefits.

• Obtain medicines with fewer delays.

CVS Caremark said it invests more than $770 million annually in technology focused on member innovation. The company combines digital services with human support to help members, providers, and plan sponsors manage pharmacy benefits.

The company is also participating in efforts focused on the safe and ethical use of artificial intelligence in healthcare.

Pharmacy Costs Are Hard to Control

Employers reported having less influence over pharmacy costs than over the overall cost of their benefits packages.

Only 30% said they have significant influence over pharmacy spending, while 73% said they have significant influence over the broader cost of maintaining competitive employee benefits.

This gap may explain why employers are seeking greater support from PBMs in areas such as:

• Specialty medicine affordability.

• GLP-1 coverage management.

• Biosimilar adoption.

• Rebate and pricing transparency.

• Member communication.

• Pharmacy network management.

CVS Caremark Promotes Pricing Transparency

CVS Caremark said its TrueCost pricing model provides clients with acquisition-based drug costs and medicine-level rebate information.

The company says the model is designed to improve:

• Pricing transparency.

• Budget predictability.

• Benefit sustainability.

• Employer oversight.

• Member affordability.

The survey indicates that employers are looking for pharmacy benefit strategies that can address rising costs without reducing access to clinically appropriate care.

What the Survey Means for Employers

The findings point to a wider role for PBMs in employer healthcare strategy. Employers are no longer focused only on prescription claims administration. They are also evaluating how PBMs can help manage expensive therapies, encourage biosimilar use, improve digital access, and support members with complex treatment decisions.

Biosimilar adoption, GLP-1 benefit design, specialty medicine access, and transparent pricing are likely to remain central issues in pharmacy benefit planning.

The survey was conducted by Employee Benefit News in partnership with CVS Caremark. Because CVS Caremark is a participant and sponsor of the research, readers should consider the findings in that context.

Frequently Asked Questions

What is a pharmacy benefit manager?

A pharmacy benefit manager is an organization that helps health plans and employers manage prescription drug benefits. Its activities may include negotiating medicine prices, developing formularies, managing specialty medicines, and administering pharmacy claims.

Why are employers focused on biosimilars?

Biosimilars may provide clinically comparable treatment options at lower costs than some reference biologic medicines. Employers are evaluating them as a way to improve affordability and manage pharmacy spending.

Why are GLP-1 medicines a concern for employers?

GLP-1 medicines used for weight management can create substantial pharmacy benefit costs. Employers are reviewing coverage rules, clinical support programs, and pricing strategies to manage spending.

How can digital tools improve pharmacy benefits?

Digital tools can help members understand coverage, compare costs, identify treatment options, access support, and complete pharmacy-related tasks more easily.