HealthIntel Weekly: Express Scripts Drives Biggest 2026 PBM Formulary Shakeup as CVS, Optum Hold Steady
Welcome to HealthIntel Weekly. Every week, we pull together the latest health care reports, research, and upcoming webinars so you don’t have to dig for them.
What’s New:
Formulary changes for 2026 vary significantly among the largest pharmacy benefit managers, with Express Scripts implementing the most substantial exclusions, according to PSG’s analysis. Its 2026 exclusions more than double those of 2025, driving higher member and financial impact. The diabetes category is most affected, including the removal of OneTouch diabetes supplies and Humalog vials. Express Scripts will also phase out Stelara in favor of biosimilars, beginning with removal of the intravenous formulation in January 2026 and full subcutaneous removal by July 2026. CVS Caremark and Optum Rx’s 2026 exclusions largely mirror their 2025 changes. CVS will shift preferred dry eye therapies, continue to cover Stelara despite biosimilar entry, and make no new changes to GLP-1 coverage after removing Zepbound in 2025. Optum will exclude 12 drugs, primarily Copaxone 40 mg and several brand products for which generic alternatives are available.
The 340B Drug Pricing Program saw continued growth, reaching a record of $81.4 billion in purchases in 2024, a 23% increase from 2023, according to an Avalere Health analysis. Disproportionate share hospitals accounted for the majority of purchases, with smaller shares by health centers and children’s hospitals. Among government funded programs, 340B drug spending is now second only to Medicare Part D, with total 340B purchases exceeding net prescription drug spending in Medicare Part B and Medicaid. Data from the Health Resources & Services Administration show that the top 10 drugs accounted for roughly one-third of all 340B purchases in 2024, led by the oncology drug Keytruda, which totaled $8.16 billion.
American workers in 2025 report slightly higher concerns about physical, mental and workplace well-being, while financial well-being concerns have eased since 2022, according to the Employee Benefit Research Institute’s 2025 Workplace Wellness Survey. Workers rated concern about overall well-being at 5.8 out of 10, while financial concern declined from 6.9 to 6.3. Economic anxiety remains high, with 80% worried about a recession’s impact on their finances. Inflation, health care costs and health insurance costs cited as top concerns. Job satisfaction remains relatively strong, with 56% very or extremely satisfied. Work-life balance and meaningful work are key drivers of workplace well-being. While satisfaction with benefits remains stable, workers seek greater employer contributions and more flexible benefits. Health insurance and retirement savings plans continue to be the most valued benefits. Employees show cautious openness to AI tools for benefits and financial management, tempered by concerns about bias and job displacement.
Next Up:
The Latest on Drug Policies
Health Affairs, Jan. 21, 2026, 1:30 p.m. (ET)
Panelists:
Joey Mattingly, PhD, Vice Chair of Research and Associate Professor of Pharmacotherapy at University of Utah College of Pharmacy
Laura Tollen, Health Affairs
The Future of Accountable Care
Health Affairs, Jan. 27, 2026, 4 p.m. (ET)
Panelists:
Hongmai (Mai) Pham, President, Institute for Exceptional Care
Gary Bacher, Chief Strategy Officer, CMMI
Frank McStay, Assistant Research Director, Duke-Margolis Institute for Health Policy
Hope Glassberg, president of Decipher Health Strategies (Moderator)
Employers Beware: Hidden Risks of 340B Shared Savings Models
National Alliance of Healthcare Purchaser Coalitions, Feb. 3, 2026, 3 p.m. (ET)
Panelists:
Shawn Gremminger, President & CEO, National Alliance
John Cerulli, Senior Manager, Health Policy & Strategic Communications, Reservoir Communications Group