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    CVS
    Earnings call· Mar 2026(Q1 FY26)

    CVS HEALTH Q1 FY26 earnings call CVS

    May 6, 2026 Source

    Executive summary

    CVS Health Q1 FY26 — Aetna margin recovery drives raised full-year EPS guidance

    CVS entered 2026 with broad-based momentum and raised full-year adjusted EPS guidance on the strength of Aetna's margin recovery, framing the quarter as validation of its 'say-do' guidance philosophy. Medicare still runs below target margins but is on a disciplined multi-year path to target margins, while the PBM and pharmacy pivot toward net-cost, transparent pricing (TrueCost/CostVantage) amid shifting federal and state regulation and heavy AI/technology reinvestment.

    Highlights

    5
    • Adjusted EPS of $2.57, up over 14% YoY, and adjusted operating income of ~$5.2B, up over 12% YoY

    • Raised full-year 2026 adjusted EPS guidance to $7.30-$7.50 from $7.00-$7.20 (+$0.30 / >4%)

    • Health Care Benefits MBR of 84.6%, a substantial YoY improvement, with over $1B of YoY AOI improvement at Aetna

    • Enterprise revenue over $100B, up over 6% YoY with growth across all operating segments

    • Pharmacy & Consumer Wellness same-store scripts up nearly 7% and retail pharmacy script share over 29%

    Concerns

    5
    • Health Services adjusted operating income ~$1.5B, down ~7% YoY on continued pharmacy client price improvements; PCW AOI ~$1.2B, down ~9% YoY

    • Medicare business still generated an adjusted operating loss in 2025 and the April Final Rate Notice remains insufficient to offset medical cost trends

    • Medical cost trends remain above historical levels, pressuring the industry

    • Tennessee PBM legislation (effective mid-2028) expected to raise state costs and threaten pharmacy access

    • Medical membership declined ~600,000 sequentially, driven by the Individual Exchange business exit

    Guidance & targets

    12
    CategoryTargetConfidence
    Full-year 2026 adjusted EPS
    $7.30 to $7.50
    high materiality
    High
    Full-year 2026 total revenues
    at least $405B
    high materiality
    High
    Full-year 2026 cash flow from operations
    at least $9.5B
    medium materiality
    High
    Full-year 2026 Health Care Benefits adjusted operating income
    approximately $4.0B to $4.34B
    high materiality
    High
    Full-year 2026 Health Care Benefits MBR
    90.5% plus or minus 50 basis points
    high materiality
    High
    Full-year 2026 Pharmacy & Consumer Wellness adjusted operating income
    at least $6.18B
    high materiality
    High
    Full-year 2026 Health Services adjusted operating income
    Reiterated (unchanged from prior guidance)
    medium materiality
    Medium
    Full-year 2026 enterprise adjusted operating income
    $15.53B to $15.87B
    high materiality
    High
    First-half vs second-half 2026 earnings split
    roughly 60-40 split
    medium materiality
    Medium
    Medicare Advantage target margins
    reach target margins (~3% ballpark) in 2028, with meaningful progress in 2027
    high materiality
    Medium
    Enterprise adjusted EPS CAGR through 2028
    mid-teens EPS CAGR
    high materiality
    Medium
    AHIP prior-authorization standardization (industry commitment)
    standardize services representing over 50% of PA volume by end of year
    low materiality
    Medium

    Segment performance

    4
    SegmentRevenueYoYQoQMargin
    Health Care Benefits (Aetna)
    Revenue growth driven by government business, partially offset by the Individual Exchange exit; membership decline from that exit partly offset by commercial fee-based growth. MBR beat expectations on favorable prior-year development (primarily government) plus core outperformance from strong medical cost management. Strong performance across all lines — commercial, Medicare, Medicaid (rates aligning with acuity).
    Medical benefit ratio (MBR): 84.6%Medical members: ~26 millionSequential membership change: -~600,000Commercial members: 18 millionAetna AOI YoY improvement: over $1 billion
    ~$36Bover 3%~$3B adjusted operating income; MBR 84.6%
    Health Services
    Revenue growth driven by pharmacy drug mix and brand inflation, partly offset by continued pharmacy client price improvements; AOI decline from client price improvements, partly offset by improved purchasing economics and drug mix. Q1 included early recognition of value previously expected in Q2; ex-pull-forward, HSS still modestly exceeded expectations.
    Rebate-guarantee execution: tracking broadly in line with expectationsSpecialty share of pharmacy benefit revenue: ~50%
    over $48B11%~$1.5B adjusted operating income (down ~7% YoY)
    Health Care Delivery
    Total revenues grew over 15% YoY, primarily driven by Oak Street Health; management encouraged by progress and executing on value-based-care actions (right membership, disciplined growth, V28 adaptation, payer contracts, clinical-led model).
    Revenue growth driver: Oak Street Health
    over 15%broadly in line with expectations
    Pharmacy & Consumer Wellness
    Revenue drivers (drug mix, higher scripts, brand inflation) offset by regulatory-related price reductions, recent generic introductions and reimbursement pressure. AOI pressured by milder seasonal illness and greater weather disruption vs last year, but strong underlying performance exceeded expectations, funding incremental investments.
    Same-store total revenue: +~3%Same-store pharmacy sales: +over 3%Same-store prescription volumes: +nearly 7%Same-store front-store sales: +120 bpsRetail pharmacy script share: over 29%
    ~$32Brelatively consistent with prior year~$1.2B adjusted operating income (down ~9% YoY)

    Operational metrics

    6
    Adjusted operating income (enterprise)
    ~$5.2Bup over 12% YoY
    Q1 FY26

    Enterprise adjusted operating income; primarily driven by HCB (Aetna) improvement.

    Cash at parent and unrestricted subsidiaries
    ~$2.2B
    end of Q1 FY26

    Parent-company liquidity at quarter end.

    Dividends paid to shareholders
    ~$850M
    Q1 FY26

    Only capital return this quarter; buyback restart to be evaluated later in 2026 alongside leverage improvement.

    GLP-1 category share growth
    +200 bpsimprovement in share growth in the category
    Q1 FY26 (period as stated)

    Driven by DTC access and workflow/tech stack driving prices down; ~9,000 community pharmacies serving members.

    Branded-drug cost concentration
    over 90% of clients' costs from 10% of branded drugs
    Q1 FY26 (as stated)

    Shah's framing of client cost pressure and the PBM's role in driving competition; GLP-1s and specialty are the biggest trend drivers.

    Insulin affordability program access
    $25 per month across over 60,000 pharmacies (including 9,000 CVS)
    Q1 FY26 (as stated)

    Affordability/access initiative highlighted in prepared remarks.

    Industry KPIs

    10
    MetricValueDetails
    Utilization trendsin line with expectations
    Stars rate environmentleading Star scores; April Final Rate Notice a 'step in the right direction'
    Medical loss care ratio84.6%%
    Client retention new winsexecuting well against 2026 rebate-guarantee commitments; strong commercial retention and new wins
    Pharmacy scripts specialtysame-store prescription volumes +nearly 7%; retail pharmacy script share over 29%%
    Membership covered lives by line~26 million medical membersmembers
    Prior year reserve development pdrfavorable prior-year development
    Adjusted EPS EBITDA leverage guidanceadjusted EPS $2.57; leverage ratio 3.84xUSD / turns
    Prior authorization operational metricsover 95% of eligible PAs approved within 24 hours; over 80% approved in real time%
    Medical cost trend vs pricing assumptionmedical cost trends remain above historical levels

    Product announcements

    2
    ProductTypeDetails
    Health100roadmap
    STELARA biosimilar formulary conversionupdate

    Deals & partnerships

    2
    NovoCare (Novo Nordisk)partnership

    Part of CVS's direct-to-consumer GLP-1 solution as coverage shifts from on-benefit to off-benefit; CVS Pharmacy positioned as a distribution channel for the category.

    Oak Street Healthacquisition (value-based care, prior/closed)

    Referenced as the right value-based-care asset; 2026 performance broadly in line with expectations, supported by disciplined membership growth, V28 adaptation and payer contracting.

    Risks & headwinds

    7
    Medicare Advantage rate inadequacy vs medical cost trend2026-2028 (target margins by 2028)

    April Final Rate Notice insufficient to offset medical cost trends, which remain above historical levels; CVS Medicare business generated an adjusted operating loss in 2025

    Mitigation: Disciplined AEP execution improving geographic/product mix, leading Star scores, constructive CMS engagement on risk-model changes; margin-over-growth prioritization

    Rebate-guarantee pressure in Health ServicesFY26

    Assumed 2025 trends persist and create incremental pressure in 2026; Health Services AOI down ~7% YoY

    Mitigation: Disciplined execution against rebate-guarantee commitments; shift to drug-level pricing guarantees under TrueCost; full-year guide reiterated with 'no surprises'

    State PBM legislation (Tennessee)effective mid-2028

    Not quantified; expected to raise state costs, threaten pharmacy access, and add complexity for specialty pharmacy; not contemplated at December Investor Day

    Mitigation: Evaluating options including potential legal action (as in other states); federal CAA/FTC coverage; management states scale/diversification can absorb the impact and still deliver mid-teens EPS CAGR through 2028

    Pharmacy reimbursement pressure and regulatory price reductions (PCW)FY26 ongoing

    Not quantified; offset revenue gains alongside recent generic introductions and regulatory-related price reductions on select drugs (IRA/MFN); PCW AOI down ~9% YoY

    Mitigation: Higher script volumes, drug mix, improved purchasing economics, CostVantage cost-plus model neutralizing prior GLP-1 margin headwind

    GLP-1 cost trendongoing

    One of clients' biggest trend drivers; only about half of clients cover GLP-1s for weight loss

    Mitigation: Formulary competition introduced last year, wrap-around weight-management solutions, DTC channel (NovoCare), CostVantage margin model

    Seasonal illness and weather disruptionQ1 FY26

    Not quantified; milder seasonal illness and greater weather disruption vs prior year impacted PCW results

    Mitigation: Strong underlying business performance exceeded expectations, providing flexibility for incremental investments

    Medical membership declineQ1 FY26

    Medical members declined ~600,000 sequentially to ~26 million

    Mitigation: Driven by intentional Individual Exchange business exit, partially offset by commercial fee-based membership growth

    Q&A highlights

    8

    Views on the 2027 MA rates and how they fit the path to ~3% MA margins by 2028.

    Management stressed two consecutive years of prioritizing margin over growth, appreciated CMS progress from Advance to Final Notice despite the shortfall to trend, cited leading Star scores and disciplined AEP, and reaffirmed meaningful progress in 2027 and confidence in hitting target margins in 2028.

    I'll just reaffirm our confidence in hitting target margins in 2028.

    asked by Justin Lake · answered by Steven Nelson

    3 min read8 chapters

    Detailed Narrative

    01

    Aetna margin recovery drives the guidance raise

    Health Care Benefits generated nearly $36B revenue (up over 3% YoY) and ~$3B adjusted operating income, with an MBR of 84.6% — a substantial improvement from the prior year and better than expectations. The beat was driven by favorable prior-year development, primarily in the government business, plus pockets of core outperformance from strong medical cost management (the latter not reflected in updated guidance). Management drove over $1B of YoY AOI improvement at Aetna and reaffirmed the multi-year path to target margins by 2028, with meaningful progress expected in 2027.

    02

    Medicare Advantage rate and cost-trend backdrop

    The April Final Rate Notice was characterized as a step toward sustainability but insufficient to offset underlying medical cost trends, which remain above historical levels. CVS's own Medicare business improved significantly in 2025 but, like most of the industry, still generated an adjusted operating loss. Management emphasized constructive engagement with CMS on risk-model changes and value-based-care recognition, leading Star scores carried into 2027, and disciplined AEP execution that improved geographic and product mix.

    03

    Health Services, rebate guarantees and PBM model evolution

    Health Services revenue grew 11% YoY to over $48B, while adjusted operating income fell ~7% to ~$1.5B on continued pharmacy client price improvements, partially offset by improved purchasing economics and drug mix. Q1 included early recognition of value previously expected in Q2; excluding that pull-forward📎, the segment still modestly exceeded expectations, and rebate-guarantee performance tracked in line. Management is shifting from rebate guarantees toward drug-level pricing guarantees under TrueCost, reinforcing net-cost, transparent pricing ahead of CAA and FTC-settlement changes.

    04

    Pharmacy & Consumer Wellness resilience amid reimbursement pressure

    PCW revenue was roughly flat at nearly $32B as pharmacy drug mix, higher scripts and brand inflation were offset by regulatory-related price reductions, generic introductions and reimbursement pressure. Same-store total revenue rose ~3%, same-store pharmacy sales grew over 3% on a nearly 7% same-store script increase, and front-store sales rose 120 bps; retail script share exceeded 29%. Adjusted operating income fell ~9% to ~$1.2B, pressured by milder seasonal illness and weather, though underlying strength funded incremental investments.

    05

    Technology, AI and the Health100 platform

    Management framed CVS as moving from a consumer-based health care company to a consumer-based health care technology company. It plans to launch Health100 later in 2026 — an AI-native platform allowing any payer, PBM, pharmacy or provider to connect as the consumer's 'front door.' AI investment spans three buckets at Aetna (cost/efficiency, workforce enablement via an AI academy, and member experience tools like Informed Choice, Smart Compare and Care Pathways). At the Caremark client forum, 500 of the largest customers responded to the technology roadmap with 'what took you so long?'

    06

    Regulatory landscape: FTC, CAA, and state PBM laws

    CVS is working toward an FTC settlement and views the CAA and federal changes as clarifying the net-cost direction it began with TrueCost over two years ago, providing durable reimbursement relief for independent pharmacies. It criticized Tennessee's PBM legislation (effective mid-2028) as raising state costs and threatening pharmacy access, and is evaluating options including potential legal action, as it did in other states. The insulin $25/month program spans over 60,000 pharmacies including 9,000 CVS locations.

    07

    GLP-1 economics and biosimilar strategy

    GLP-1s remain clients' biggest trend driver, with only about half of clients covering them for weight loss. CVS built a direct-to-consumer solution (including a NovoCare partnership) and drove a 200 bps improvement in GLP-1 category share growth. The CostVantage cost-plus model has neutralized what was previously a margin headwind — 'not losing money, but not overearning.' On biosimilars, CVS will exclude branded STELARA from commercial template formularies on July 1, 2026, applying the HUMIRA playbook (over 90% conversion) to target similar rates with most customers paying $0 out of pocket.

    08

    Balance sheet, cash flow and capital return

    Q1 cash flow from operations was ~$4.2B, and CVS returned nearly $850M via its quarterly dividend, ending with ~$2.2B of cash at the parent and unrestricted subsidiaries. The leverage ratio improved to 3.84x, with further improvement expected in 2026. Management is prioritizing deleveraging over resuming share repurchases; a buyback restart is not baked into the 2026 guide but will be evaluated later in the year alongside capital-deployment opportunities.

    AI-generated summary of the company’s earnings call. Not investment advice.