CVS Health announced a formulary change that will remove Amgen’s Prolia and Xgeva and Eli Lilly’s Forteo from its preferred drug lists effective April 1, 2026. The change replaces these branded bone‑health biologics with lower‑cost biosimilar and generic alternatives, such as the denosumab biosimilar and generic teriparatide.
The move is part of CVS’s broader strategy to control drug‑benefit costs for its 87 million PBM members and the Aetna health‑plan population. By shifting to biosimilars and generics, CVS expects to lower out‑of‑pocket expenses for patients and reduce overall drug‑benefit expenditures across its integrated care ecosystem.
CVS’s TrueCost and CostVantage pricing models, which link pharmacy reimbursement to the actual acquisition cost plus a dispensing fee, will help pass the savings to consumers. The company has previously used similar formulary adjustments to promote cost‑effective therapies, such as the inclusion of Humira biosimilars.
While the announcement does not disclose specific savings figures, industry analysts anticipate that the switch could generate tens of millions of dollars in annual savings for the PBM and Aetna plan sponsors. The change may also influence prescribing patterns, encouraging clinicians to favor the lower‑cost alternatives when appropriate.
The formulary adjustment reflects a broader industry trend toward biosimilar adoption, driven by regulatory approvals and cost pressures. CVS’s integrated model positions it to implement such changes quickly and to monitor the impact on patient access and cost containment.
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