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- The FTC reached a settlement with CVS Caremark requiring the PBM to adopt significant business practice changes aimed at lowering patient out-of-pocket costs and increasing transparency. - The agreement locks in up to $8.5 billion in consumer savings over 10 years and unlocks up to $4.5 billion in additional savings from point-of-sale rebates. - Caremark must cease discriminating against low-cost drugs on its standard formularies and delink PBM fees from drug list prices. - The settlement includes a novel provision preventing Caremark from interfering with independent pharmacies' access to hub pharmacy service providers.
- Florida Attorney General James Uthmeier has launched an investigation into CVS Health and its PBM Caremark over concerns of anticompetitive conduct that may disadvantage independent pharmacies. - The probe will examine whether CVS steers patients toward its own pharmacies, reimburses affiliated stores at higher rates, and imposes burdensome audits on smaller competitors. - CVS must produce thousands of records and sworn testimony by July 28, 2026, covering reimbursement practices, contracts, audits, rebates, and patient steering. - CVS Health disputes the claims, stating that drugmakers alone set prescription prices and that blaming PBMs is "like blaming an umbrella for the rain."
- Danaher's Biotechnology segment reported 7% year-over-year core revenue growth in Q1 2026, fueled by strong bioprocessing business performance and higher sales in Western Europe and China. - Orders for bioprocessing equipment surged more than 30% in the quarter, with solid demand from large pharmaceutical customers for monoclonal antibodies (mAbs) and consumables. - Danaher projects high single-digit core revenue growth for the bioprocessing business in 2026, with mid-single-digit growth anticipated for the overall Biotechnology segment in Q2 2026. - Challenges persist from lower demand for medical filtration and research consumables in the discovery and medical business, along with declining equipment demand.
- The bipartisan Patients Before Monopolies Act would force healthcare conglomerates like Cigna, CVS Health, and UnitedHealth to divest their retail and specialty pharmacies within one year. - Specialty pharmacy has grown to 35% of PBM revenues by 2023, making mandated divestiture a far greater threat to industry profitability than existing federal reforms. - Current reforms under the Consolidated Appropriations Act require 100% rebate pass-through and delink PBM compensation from drug list prices, but won't be fully implemented until 2029. - Experts warn that without breaking up vertically integrated structures, PBMs will continue finding ways to offset lost revenue and maintain opaque, anticompetitive practices.
- Ember LifeSciences raised $27 million in Series A funding with strategic investments from Amgen Ventures and TDF Ventures to scale its cold chain logistics platform. - The company launched commercial availability of the Ember Cube 2, an award-winning reusable shipping solution designed to address billions of dollars in annual pharmaceutical losses from temperature excursions. - Existing customers include major pharmaceutical distributors CVS Health, Cardinal Health, Chartwell and USADA, positioning the company to expand its global footprint in healthcare delivery.
- CVS Health announced it will transition from Johnson & Johnson's psoriasis drug Stelara to lower-cost biosimilar alternatives starting July 1, 2024. - The pharmacy benefit manager Caremark will prefer biosimilar versions including Sandoz's Pyzchiva and Biocon Biologics' Yesintek, with most members paying $0 out-of-pocket. - This formulary change represents CVS's broader strategy to expand biosimilar coverage across specialty categories including multiple sclerosis and rare blood disorders. - The move aims to deliver significant cost savings for clients while maintaining access to proven therapies through FDA-approved biosimilar alternatives.
- CVS Health's Caremark unit will replace Amgen's Prolia and Eli Lilly's Forteo with lower-cost biosimilar and generic alternatives on major commercial formularies starting April 1, 2026. - The formulary changes are expected to reduce prescription costs by more than 50% compared to branded drugs, building on CVS's successful biosimilar strategy that has generated $1.5 billion in gross savings. - This move follows CVS's previous decision to exclude AbbVie's Humira from formularies in favor of biosimilars, with 96% of Caremark members successfully transitioning to cheaper alternatives. - The strategy targets osteoporosis treatments after key patents expired for Prolia in 2025 and Forteo in 2019, opening the market to biosimilar competition.
- Ember LifeSciences secured $16.5 million in Series A funding led by Sea Court Capital to advance cold chain technology for pharmaceutical distribution. - The global pharmaceutical cold chain ecosystem loses $35 billion annually due to temperature excursions and generates 330 billion pounds of waste from single-use packaging. - The funding will support the launch of Ember Cube 2, featuring vacuum insulation and bio-based phase change materials for temperature-sensitive therapies. - Leading healthcare organizations including CVS Health, Chartwell, and USADA are already adopting Ember LifeSciences' cold chain technology.
- Eli Lilly is terminating CVS Health's drug benefit plan for its employees after CVS stopped covering Lilly's weight-loss drug Zepbound in favor of Novo Nordisk's rival medication Wegovy. - Beginning January 1, Lilly employees will be automatically enrolled in coverage through pharmacy benefit manager Rightway, which offers competitive fees and services. - CVS's Caremark unit dropped Zepbound as a preferred product from its reimbursement list in July after negotiating more favorable pricing for Novo Nordisk's Wegovy. - The move highlights the competitive dynamics in the obesity drug market and how formulary decisions can impact business relationships between pharmaceutical companies and healthcare providers.
- CVS Health, the largest U.S. pharmacy benefit manager, will not add Gilead's new HIV prevention drug Yeztugo to its commercial plans, citing clinical, financial, and regulatory factors despite the drug's proven 99.9% effectiveness. - The decision reflects concerns over Yeztugo's $28,000 annual list price, with CVS stating it's inappropriate for manufacturers to manipulate guidelines with clinically similar products priced far higher than existing options. - AIDS activists call the decision a "grave disappointment" and missed opportunity, as Yeztugo could be transformative in ending the HIV epidemic that infects 1.3 million people annually. - Gilead remains confident in securing 75% U.S. insurer coverage by year-end and 90% by June 2026, with government programs and several state Medicaid plans already providing coverage.
