2026 Formulary Changes: CVS Caremark

The following is an analysis of the CVS Caremark 2026 formulary changes for the Standard Control with Advanced Control Specialty Formulary (SCF/ACSF), effective January 1, 2026. PSG’s clinical team evaluated the changes, including an impact analysis based on our book-of-business dataset, to provide an overview of the most important considerations.

Notable CVS Caremark Formulary Changes

• The member and financial impact of CVS Caremark’s 2026 exclusions are similar to that of its 2025 formulary exclusions.
• Shifts in preferred formulary products for the treatment of dry eye disease will have more member impact than other exclusions.
• Brand Stelara will remain on the formulary despite the entrance of several Stelara biosimilars to the market in 2025.
• CVS removed Zepbound from its formularies in July and will not be making any changes to coverage of GLP-1s for the new year.

CVS Caremark Formulary Change Impact

CVS will add 13 drugs and remove 14 drugs from its Standard Control with Advanced Control Specialty Formulary, the most utilized formulary among CVS clients. Overall, the percentage of members and drug spend impacted by the 2026 formulary changes is similar to the 2025 impact, which was much smaller than that of the 2024 changes.

Eye Dryness Drugs

Several changes are coming in 2026 to the drugs used to treat dry eye disease. A widely recognized drug, Xiidra (lifitegrast), is being removed from the formulary and will be replaced by two preferred alternatives: Restasis and Vevye, both cyclosporin-containing eye drops. Restasis remains on the formulary, and Vevye will be added effective 1/1/2026. Vevye was FDA-approved in 2023 and may offer improved tolerability, enhanced efficacy, and faster onset of action when compared to Restasis. Miebo (perfluorohexyloctane) is another drug approved for the treatment of dry eye disease, but it is currently excluded from coverage.

Utilization of therapies for dry eye disease is rising, driven by increasing prevalence, greater disease awareness, and the introduction of new treatment options. As utilization grows and drug costs remain high, plans may see increased spend in this category. For context, the list prices for Miebo, Xiidra, and Vevye are approximately $937, $854, and $928, respectively. However, manufacturer coupons can significantly reduce costs bringing Vevye to around $300 and Xiidra to about $700.

Stelara Remains on the Formulary

As one of the more notable formulary strategies, brand Stelara (ustekinumab) will remain on the formulary at parity with 2 biosimilars (Pyzchiva and Yesintek). CVS attributes this decision to concerns of “supply chain instability” and that ongoing litigation may trigger shortages. This is an unexpected strategy, given that CVS was the first large PBM to remove brand Humira in April 2024 to cover biosimilars. This came more than a year before other large PBMs removed Humira in July 2025. CVS’ Humira biosimilar strategy afforded its clients earlier access to biosimilar savings, which leads one to question if the delayed Stelara biosimilar strategy will impact biosimilar savings opportunities. Several PBMs have already removed brand Stelara or will do so effective 1/1/2026.

GLP-1 Coverage

CVS removed Zepbound (tirzepatide) from its formularies in July 2025 and will not be making any changes to coverage of GLP-1s effective 1/1/2026, stating the change is “delivering meaningful results” and that more than 95% of members have moved to a preferred formulary product as a result of the July change.

Oncology Changes

Other notable changes include the removal of brand Revlimid (lenalidomide), an oncology drug used to treat multiple types of cancers, with the generic serving as its alternative. However, the market supply of generic Revlimid has been limited by volume restrictions stemming from legal settlements with the brand manufacturer, Bristol Myers Squibb (formerly Celgene). These limitations were put in place as a result of settlements with multiple generic manufacturers, but are expected to expire on January 31, 2026. Generic companies that entered these settlements were granted licenses to sell the generic version, but only within specific volume limits and timeframes. This has allowed the continued use of brand Revlimid and has impacted the savings available from lower-cost generics. Removal of the brand should increase the use of generics and result in plan savings.

Biosimilar Changes

Lastly, a few changes are coming for biosimilars. The brand Xgeva (denosumab), which is FDA-approved for the prevention and treatment of serious bone diseases, will be excluded from coverage. Its biosimilar, Osenvelt, will serve as an alternative. In contrast, another formulation/dosage of denosumab, Prolia, will remain on the formulary, and its biosimilar will be excluded. Prolia is FDA-approved for the treatment of osteoporosis in individuals at high risk of fractures. These products are primarily covered under the medical benefit, so there should be limited impact to the pharmacy benefit.

Neulasta (pegfilgrastim) is a medication that helps reduce the risk of infection in patients receiving chemotherapy by stimulating the production of white blood cells. A biosimilar, Fylnetra, will be excluded, however, other biosimilars, Fulphila and Nyvepria, will be preferred. These drugs are also typically obtained through the medical benefit.

Final Thoughts

Similar to CVS’ 2025 formulary changes, the member and financial impact of this year’s formulary changes will be minimal. However, categories such as dry eye disease and oncology may be worth monitoring in the future. Additionally, it will be important to observe the impact of Brand Stelara utilization in 2026.

Need help navigating 2026 formulary changes? PSG has the unbiased clinical and market expertise you need. Contact us today to learn more.