CVS Plans to Split Off Its Retail Pharmacies, Keeping Specialty Operations

CVS Health plans to separate approximately 9000 retail pharmacies and its mail-order pharmacy business into a publicly traded company in the first half of 2028, according to a November 3 Wall Street Journal report. Aetna, Caremark, and CVS’s specialty drug business would remain together.¹

Where CVS chose to draw that line deserves pharmacists’ attention.

We suspect CVS sees a way to preserve the value of its retail network through contracts while retaining a closer financial interest in how specialty drugs are covered and dispensed. The proposed structure supports that interpretation, although CVS’s plans do not establish its motive.

For pharmacies and patients, the more immediate question is whether the separation will change who can fill a prescription, what the pharmacy gets paid, or what the patient owes. On all 3, it is too early to tell.

Why specialty pharmacy would stay with Caremark

Consider what happens when an oncologist prescribes a specialty medication. A pharmacist at the treating health system may work with the physician to secure prior authorization, counsel the patient, and prepare to coordinate the first dose. When the pharmacist submits the claim, the plan may direct the prescription to a designated specialty pharmacy. The patient has coverage for the medication, but the pharmacy that helped obtain that coverage cannot dispense it.

The proposed separation leaves intact the corporate relationship most relevant to that patient. Caremark would continue to manage pharmacy benefits, and the specialty drug business would remain under the same parent. For CVS, there may be value in retaining both roles. A formulary decision can influence which product a patient receives, while a network requirement can determine which pharmacy earns the dispensing revenue. Aetna, Caremark, and the specialty side of the business would remain positioned to participate in those decisions, depending on the plan and its terms.

READ MORE: PBMs Must Now Disclose Fees to Employer Plans Under Final DOL Rule

CVS’s investment in biosimilars offers another reason to pay attention to specialty pharmacy. In 2023, CVS launched Cordavis to work with manufacturers to commercialize or co-produce biosimilars. That investment gave CVS a commercial interest in certain drug products in addition to its interests in benefit management and dispensing. The reporting on the split does not identify where Cordavis would sit after the separation or establish that it prompted the transaction. It does, however, put the decision to retain specialty pharmacy in context. CVS has spent several years building a business around specialty drugs that extends beyond filling prescriptions.²

What might change at the community pharmacy counter

Caremark can negotiate preferred retail participation with a separately owned CVS pharmacy chain. It can also contract with that company for mail-order services. One of the first things we would look for is whether the 2 companies enter into a long-term agreement covering those services and, if so, whether independent pharmacies can compete for the same prescriptions on comparable terms.

A 90-day maintenance prescription illustrates the issue. A patient may be able to fill it at either CVS or an independent pharmacy but face a higher copay at the independent. If the plan retains that copay difference after the split, the patient has the same financial reason to use CVS. For the independent pharmacist, the meaningful development would be an opportunity to offer the preferred copay at a rate that covers the cost of acquiring and dispensing the medication. Access to the prescription and adequate reimbursement are separate questions. A pharmacy needs both.

There is a potential benefit for community pharmacies worth watching. A stand-alone CVS pharmacy company would have a direct interest in pressing PBMs, including Caremark, for sustainable retail reimbursement. Independent pharmacy owners have made that case for years. A chain with approximately 9000 stores, however, can offer nationwide coverage in a single negotiation. If it secures better rates, pharmacy owners should look closely at their own network offers and remittance statements before concluding that reimbursement has improved elsewhere.

What pharmacists and plan sponsors should watch

For a pharmacist fielding a patient’s call about a transferred prescription, the most useful evidence is often the claim response or member notice. A paid claim with a higher copay, a rejection limiting the days’ supply, and a direction to use a designated specialty pharmacy can all result in a lost prescription; each calls for a different response. Keeping the specific reason gives the pharmacist a basis to explain the patient’s options, seek a network exception where available, or challenge a restriction that appears inconsistent with the plan’s terms.

Self-funded employers can influence what those patients experience. At renewal, an employer can ask its PBM to price the same drug, strength, quantity, and days’ supply at a local pharmacy, a preferred chain, and through mail order. The comparison should show the member’s cost and the plan’s net cost after applicable rebates and fees. A lower copay explains why a patient might switch pharmacies. The claims data should show whether the switch also saves the employer money.

For now, CVS has identified the businesses it intends to separate. The next meaningful development for pharmacists will be the terms on which those businesses agree to work together. A community pharmacist will want to know whether a longtime patient can stay and pay the preferred copay. A health-system pharmacist will want to know whether an approved oncology prescription can be filled where the patient receives care.

Until the network agreements and benefit designs answer these questions, it is premature to promise patients more choice, or pharmacies better reimbursement.

READ MORE: Law and Regulations Resource Center

REFERENCES

1. Mathews AW. CVS will break off its namesake pharmacies. The Wall Street Journal. November 3, 2026. Accessed November 4, 2026. https://www.wsj.com/health/healthcare/cvs-will-break-off-its-namesake-pharmacies-9c7dd05e

2. CVS Health launches Cordavis. CVS Health. News Release. August 23, 2023. Accessed November 4, 2026. https://www.biospace.com/cvs-health-launches-cordavis