CalPERS names CVS Caremark as pharmacy benefits manager for select plans; transition begins Jan. 1, 2026

CalPERS announced that CVS Caremark will replace OptumRx as the pharmacy benefits manager for certain CalPERS basic and Medicare plans beginning Jan. 1, 2026, CalPERS officials said during a public webinar. The organization said the change follows a nationwide procurement and is intended to improve affordability, access and transparency for members.

Dr. Julia Logan, CalPERS chief clinical director, said the selection was guided by three objectives: “affordability, quality and access, and transparency.” She told webinar attendees that the new agreement aligns the pharmacy vendor’s financial incentives with CalPERS’s goals and gives the agency greater audit rights and contractual protections.

The change affects pharmacy benefits for multiple carriers’ basic and Medicare plans. CalPERS and CVS said CVS will administer pharmacy benefits for Anthem’s traditional and Select basic plans and Anthem’s Medicare Advantage plan; Health Net Salud’s PERS Gold and PERS Platinum basic and supplemental plans; Sharp’s basic plan; UnitedHealthcare’s Alliance and Harmony basic plans; and Western Health Advantage’s basic plan. Plans not affected include Blue Shield Access Plus and Trio HMOs, Blue Shield EPO, all Kaiser Permanente plans, Sharp’s Medicare Advantage plan and UnitedHealthcare’s Medicare Advantage plan.

CalPERS and CVS described key terms and member protections. CVS agreed to performance guarantees and financial risk tied to meeting cost‑control and clinical quality targets; CalPERS officials said the vendor will have $250,000,000 at risk if it fails to meet those goals. Officials also said CVS will provide increased transparency, stronger audit rights and other contractual protections not present in earlier PBM contracts.

CVS Caremark representatives outlined transition mechanics and member supports. David Locke of CVS Caremark said the company’s network includes roughly “64,000 pharmacies,” and stressed that members can usually continue using their current pharmacy and do not have to use a CVS retail location. CVS said most prescriptions and prior authorizations will transfer automatically from OptumRx; prior authorizations that extend into 2026 will be honored for the duration of that authorization or up to 12 months.

Both CalPERS and CVS described temporary protections for members affected by formulary changes. For members whose medications will be excluded or require a new prior authorization, CalPERS said CVS will mail notices 30 to 60 days before the change. Basic plan members who need more time can receive an extension to continue current medication coverage through March 31, 2026; Medicare members are entitled to a temporary supply through March 31, 2026, under Medicare rules and CalPERS’ transition policy. CalPERS staff and CVS emphasized that prescribers can request medical necessity exceptions if a previously covered medication is clinically required.

CalPERS also said it changed the benefit rules so basic plan members may obtain 90‑day supplies of maintenance medications at in‑network retail pharmacies (two co‑pays) beginning in January 2026; previously those 90‑day fills were limited to mail order. The agency said tier co‑pay amounts themselves are not changing: tier 1 (generics) $5, tier 2 (preferred brands) $20 and tier 3 (non‑preferred brands) $50 — but acknowledged that when a drug moves to a different tier on the new formulary a member’s out‑of‑pocket cost could change.

CalPERS gave members a timeline for communications: CVS will mail letters in November to basic members impacted by formulary changes; all members moving to CVS will receive a welcome kit and new ID cards in December; members will begin seeing CVS pharmacy information on their ID cards on Jan. 1, 2026. CalPERS said the webinar recording will be posted on its YouTube channel within about a week and that frequently asked questions from the event will be added to the CalPERS website by the end of the following week. CVS’s CalPERS site is caremark.com/calpers.

Speakers and staff on the webinar repeatedly urged members not to send personal medical information to the webinar inbox and described customer care options for individual clinical questions. Both CalPERS and CVS said members with questions about coverage or specific prescriptions should consult the published formularies, the Caremark cost‑tool and customer care lines for either CVS Caremark (basic plans) or SilverScript (Medicare plans). The agencies said they will contact prescribers directly when a prior authorization or formulary change may affect a patient’s medication.

The contract and transition plan described at the webinar centralize PBM administration for the listed plans under CVS Caremark and include contractual performance guarantees, automatic transfers of many prescriptions and prior authorizations, a 90‑day transition period for affected medications, expanded retail 90‑day fill options for basic members and promised improvements in transparency and audit rights.