Three’s Company: Thoughts Ahead of Caremark Contract Expiry

Research evidence excerpt

Three’s Company: Thoughts Ahead of Caremark Contract Expiry

18 June 2026

Healthcare Technology & Distribution

Drug Supply Chain

to a much more granular system with many different pricing tiers, including specific

pricing for individual drugs, which ensures that no single line of business within the

contract is unprofitable. This successful restructuring with CVS has served as the

template for subsequent renewals, and is being progressively rolled out to other

large strategic accounts. From CVS's perspective, the company is aware that the

revised structure materially improved the economics for MCK, creating the

potential for a more contentious negotiation in the upcoming renewal cycle. Also,

since the last renewal, MCK has added the large mail business from UNH’s

OptumRx, breaking the trend of none of the three wholesalers serving more than

one of the large mail units of the big three PBMs.

What We Expect in the Next Renewal: For McKesson, retaining CVS is important

to volume throughput, purchasing leverage with manufacturers, and maintaining

a negative working capital model. For CVS, distributor diversification is limited at

scale, making continuity valuable despite periodic pricing resets. That said, we

would expect CVS to view the renewal as a competitive process with a broader

strategic review rather than a routine pricing negotiation. While CVS characterized

discussions as ongoing and emphasized that no decision has been finalized, the

company indicated it continues to evaluate all available alternatives and specifically

highlighted Cencora as a more viable option than in prior years given its reduced

strategic alignment with Walgreens. We also note that COR's new CFO previously

spent more than a decade in senior leadership positions at CVS and Caremark,