Aetna Inc.

CVS Health, today’s largest PBM owner, also runs the country’s biggest retail pharmacy and controls Aetna, a giant among health plans.

Aetna’s 2026 national commercial formulary delivers a harsh blow to Eliquis (apixaban), dropping the blockbuster from its preferred tier just as generic competition prepares to flood the market.

Aetna’s sweeping step therapy expansion, slated for January 2026, has pulled more than $7 billion in annual specialty drug claims under new controls.

When CVS finalized its $69 billion Aetna acquisition, most headlines focused on the deal’s sheer scale.