Prescription drug costs are becoming one of the hardest parts of employee benefits for employers to predict and control. A new survey from CVS Caremark and Employee Benefit News suggests that HR leaders increasingly expect pharmacy benefit managers (PBMs) to help navigate rising medication prices, specialty drugs, biosimilars and GLP-1 treatments while maintaining access to care.

CVS Caremark’s latest State of Pharmacy Management Survey offers a snapshot of how employers are approaching one of the most complicated areas of healthcare spending. The survey found that 91% of employers are concerned about high medication costs for employees, while 88% believe PBMs are particularly well positioned to reduce prescription-drug costs.

The findings come as employers face a pharmacy market being reshaped by expensive specialty therapies, rapidly growing demand for GLP-1 medications and the expanding availability of biosimilars.

The underlying issue is not simply the price of individual drugs. Employers also have to manage formulary decisions, utilization, employee access, manufacturer negotiations and the economics of specialty medications across large populations.

That is making pharmacy benefits an increasingly strategic HR and finance issue rather than a back-office benefits function.

PBMs take on a bigger role in benefits strategy

The survey indicates that 64% of employers see PBMs as having the greatest opportunity to improve access to affordable specialty medications.

Only 30% of respondents said they have significant influence over pharmacy costs, compared with 73% who said they have significant influence over the broader cost of maintaining a competitive benefits package.

That gap helps explain why employers are turning to PBMs for expertise and purchasing scale.

The model is also becoming more contested. PBMs such as CVS Caremark, Express Scripts and Optum Rx sit between employers, insurers, pharmacies and drug manufacturers, giving them considerable influence over formularies, rebates, networks and utilization management.

Employers increasingly want visibility into how those mechanisms affect the actual cost of medicines.

CVS Caremark is using the survey to highlight its TrueCost pricing model, which the company says gives clients visibility into acquisition-based drug costs and drug-level rebate values.

For employers, transparency is becoming as important as headline discounts. A lower negotiated price is difficult to evaluate if the underlying rebate structure, administrative fees or formulary incentives are unclear.

Biosimilars become a bigger cost-containment opportunity

Biosimilars are emerging as one of the most important tools in that equation.

The survey found that 49% of employers currently encourage biosimilar substitution, while another 40% are considering or exploring it. Only 12% said they educate employees about potential biosimilar savings.

That leaves a substantial gap between the availability of lower-cost alternatives and employee awareness.

Biosimilars are biologic medicines designed to be highly similar to an existing reference biologic, without clinically meaningful differences in safety or effectiveness. Their growing adoption has created an opportunity to reduce spending in therapeutic categories that historically have carried high costs.

CVS Caremark says its biosimilar strategy has generated more than $3.3 billion in gross savings related to Humira (adalimumab) for clients and members since April 2024.

The company also changed its commercial formularies on July 1, 2026, to favor the lower-cost interchangeable biosimilars Pyzchiva and Yesintek over Stelara (ustekinumab).

Those moves illustrate how formulary management can directly influence which treatments patients receive and how much employers spend.

For HR teams, however, the technology challenge is not just selecting a lower-cost drug. Employers also need communication and decision-support systems capable of explaining alternatives to employees and providers without creating confusion around treatment.

GLP-1 drugs complicate the benefits equation

GLP-1 medications present a different challenge.

The drugs have become a major component of employer healthcare strategy as demand for weight-management treatment has expanded. CVS Caremark’s survey found that 77% of employers are concerned about the cost of GLP-1 coverage, while 80% have either limited coverage for weight-loss use or are considering doing so.

That creates a difficult trade-off.

Employers want to control spending, but they also have to consider employee demand, clinical outcomes and the longer-term financial effects of treating obesity and related conditions.

This is pushing benefits managers toward more sophisticated approaches than simply covering or excluding a class of medications.

CVS Caremark says employers can combine utilization management with clinical and nutrition support. The company’s CVS Weight Management program, it says, has resulted in clients spending up to 26% less on GLP-1 medications for weight loss compared with clients that did not adopt the program.

Those figures are company-reported rather than an independent assessment, so employers evaluating similar programs will need to examine methodology, population differences and longer-term outcomes.

The broader trend is clear: GLP-1 management is becoming a benefits-design and population-health decision, not simply a formulary decision.

Digital pharmacy benefits move closer to the mainstream

Technology is another major theme in the survey.

CVS Caremark says 88% of employers believe digital tools and innovation are a permanent part of the healthcare experience.

That expectation is changing what employers want from pharmacy benefit platforms.

Digital tools can help members identify lower-cost options, navigate formularies, receive medication information and interact with clinical support. AI could take that further by personalizing recommendations or helping identify patterns in medication utilization.

But healthcare AI carries a higher bar for trust than many enterprise applications.

CVS Caremark says it invests more than $770 million annually in technology focused on member innovation and is a founding partner of the Coalition for Health AI, which is working on responsible AI practices in healthcare.

For employers, the important question will be whether digital innovation improves outcomes and affordability rather than simply adding another interface to an already complicated benefits ecosystem.

The bigger issue is control

The survey ultimately highlights a structural problem in employer healthcare.

Employers are responsible for providing competitive benefits, but they have limited direct control over many of the forces driving pharmacy costs. Drug pricing, specialty therapies, manufacturer negotiations, PBM contracts and utilization patterns all interact.

That makes pharmacy benefits different from many other areas of employee compensation.

The response is likely to be greater scrutiny of PBM performance, more aggressive use of biosimilars, closer management of high-cost therapies and increased demand for data.

The competitive landscape will also matter. CVS Caremark faces major PBM rivals including Express Scripts, part of The Cigna Group, and Optum Rx, part of UnitedHealth Group. Meanwhile, health insurers, benefits consultants, specialty pharmacies and healthcare technology companies are competing to control more of the data and member experience.

For HR leaders, the next phase of pharmacy management is therefore unlikely to be about finding a single cost-saving lever.

It will be about building a system that can connect drug pricing, clinical outcomes, employee access, utilization and benefits economics.

That shift gives PBMs a larger strategic role — while simultaneously putting more pressure on them to prove the value they deliver.

Market Landscape

The U.S. pharmacy benefits market is entering a period of structural change. Specialty drugs, biosimilars and GLP-1 medications are reshaping employer formularies, while PBM transparency and pricing models face greater scrutiny.

The competitive field includes CVS Caremark, Express Scripts and Optum Rx, alongside independent PBMs, benefits consultants and technology companies developing pharmacy analytics and navigation platforms.

The scale of the underlying healthcare-cost problem is significant. KFF’s 2025 Employer Health Benefits Survey found that average annual premiums for employer-sponsored family coverage reached $26,993, with employees contributing an average of $6,850.

The pharmacy market also has an increasingly important biosimilar dimension. FDA data show the number of approved biosimilars has expanded substantially in recent years, creating more opportunities for competition against high-cost biologic medicines.

For enterprise HR teams, the implication is that pharmacy management is becoming a technology and governance problem. Employers need better visibility into contracts, utilization, outcomes and employee experience — not simply lower list prices.

Top Insights

• 91% of employers surveyed are concerned about high medication prices, increasing pressure on PBMs to deliver measurable savings while preserving access to quality treatments.
• Biosimilars remain underused, with only 49% of employers encouraging substitution and just 12% educating employees about potential cost savings and treatment alternatives.
• GLP-1 spending is reshaping benefits strategy, as 77% of employers cite coverage costs as a concern and 80% have limited or considered limiting weight-loss coverage.
• Digital pharmacy technology is becoming mainstream, with 88% of employers saying digital tools and innovation are now a permanent part of healthcare delivery.
• PBM accountability is rising as employers with limited direct control over pharmacy spending increasingly demand transparency, analytics and evidence that negotiated savings reach their plans.

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