CalPERS told employers and members in a Sept. webinar that CVS Caremark will replace OptumRx as the pharmacy benefits manager for many CalPERS health plans effective Jan. 1, 2026. Rob Jarzombek, chief of the Health Plan Research and Administration Division, said the switch will affect outpatient pharmacy administration for a list of basic and Medicare plans administered by several carriers.

The change affects certain Anthem basic plans, Health Net Salud y Más basic and Medicare plans, Sharp’s basic plan, UnitedHealthcare Alliance and Harmony basic plans, and Western Health Advantage basic plan. “CVS Caremark is replacing OptumRx as the pharmacy benefits manager for many of our health plans starting 01/01/2026,” Jarzombek said. CalPERS said Blue Shield HMOs, Kaiser plans and some Medicare Advantage plans will not be affected.

CalPERS told members that pharmacy access will remain similar for most people and that most members will be able to continue using their current pharmacy. The agency warned there will be some formulary changes and possible copay differences for a subset of members and said plans are preparing transition processes to cover prescriptions affected by formulary changes and to transfer approved prior authorizations automatically.

For Medicare members enrolled in Anthem Medicare Preferred and the PERS Gold and PERS Platinum Medicare supplements, Jarzombek said pharmacy benefits will be administered by SilverScript, an affiliate of CVS. “SilverScript and CVS work together, and really the only difference is branding and the appearance of the materials members receive,” he said. CalPERS said it mailed an introductory letter to impacted Medicare members and was updating online FAQs.

CalPERS posted a PBM webinar for employers and members for Sept. 18 to explain the transition and communications. The agency directed employers to calpers.ca.gov/cbs for additional information and said members should watch for separate communications from CVS (for basic plans) and SilverScript (for Medicare plans).

Discussion-only items included questions about automatic mail-order transfers and 90-day retail fills. CalPERS said most mail-order prescriptions will transfer automatically but members can change fulfillment channels after the transition. Officials also said both basic and Medicare formularies will be posted on CVS and CalPERS websites for members to review during open enrollment.

CalPERS recommended that employers and members review the posted formularies and communications and attend the Sept. 18 webinar to learn how the change may affect costs or pharmacy access. No formal action (motions or votes) was taken during the webinar; the session provided information and a Q&A only.