CVS Health’s Strategic Shift: Aetna Exits ACA, Bets Big on Wegovy

The healthcare landscape is in flux, and CVS Health (CVS) is making a bold move to position itself for the future. The company’s decision to exit the Affordable Care Act (ACA) exchanges by 2026 and double down on expanding access to its weight-loss drug Wegovy marks a critical pivot toward profitability and strategic focus. This article examines the rationale behind these moves, their financial implications, and what investors should watch next.

The ACA Exit: Cutting Losses, Sharpening Focus

Aetna, CVS’s insurance subsidiary, will stop offering ACA plans by the end of 2025, impacting approximately 1 million members in 17 states. While this segment has struggled—reporting a $448 million premium deficiency in 2025—the broader financial picture is strong. CVS’s Q1 2025 results show net income surged 60% to $1.8 billion, with revenue up 7% to $94.6 billion. Aetna’s Medicare business, a key growth driver, saw improved star ratings and enrollment stability, offsetting ACA losses.

The move aligns with CEO David Joyner’s focus on “trusted health care” services. reveals a 12% gain in 2025, outpacing peers, suggesting investor confidence in the strategy.

Wegovy: A High-Stakes Gamble on Growth

Wegovy, a GLP-1 drug for weight management, is central to CVS’s future. Starting July 2025, the drug’s cash price drops to $499/month—a 60% discount—and will be prioritized on Caremark’s formularies. The initiative combines medication access with lifestyle support via CVS’s Weight Management program, leveraging its 9,000 pharmacies.

The drug’s potential is staggering. With Novo Nordisk’s (NVO) U.S. sales hitting $6.5 billion in 2024, Wegovy’s expanded access could fuel demand further. shows a 300% increase over two years, underscoring its momentum. CVS’s PBM and retail network are poised to capture a significant slice of this market.

Risks and Challenges

The ACA exit isn’t without risks. Over 1 million members will need new coverage by 2026, and political uncertainty looms. The ACA’s tax credits, which drove record enrollment of 24 million in 2025, expire in December 2025. If Congress fails to renew them, enrollment could drop, straining the broader insurance market.

Additionally, Aetna’s Medicare Advantage business faces rising utilization costs. While its MLR improved to 87.3% in Q1 2025, competitive pressures and regulatory scrutiny remain risks.

Conclusion: A Calculated Risk, Backed by Data

CVS’s strategic shift makes sense. By exiting a margin-eroding ACA segment and doubling down on Wegovy’s potential, the company is prioritizing high-margin opportunities. The math is compelling:

• Financial resilience: Q1’s 7% revenue growth and $1.8B net income highlight operational strength.
• Wegovy’s scale: The drug’s discounted pricing and integrated support could drive millions in new revenue, especially with 9,000 pharmacies as distribution hubs.
• Market focus: Medicare and PBM segments now account for 95% of CVS’s membership, allowing cost efficiencies and scalability.

Risks remain, but the decision aligns with broader industry trends. Insurers like Anthem (ANTM) and Cigna have also scaled back ACA exposure, while GLP-1 drugs are becoming a multibillion-dollar category. With raised 2025 earnings guidance of $6.00–$6.20 per share, CVS is betting its moves will pay off.

Investors should watch two key metrics:
1. Wegovy’s prescription growth post-July 2025.
2. ACA enrollment stability as subsidies expire.

For now, the strategy reflects a disciplined approach to capital allocation—one that could position CVS as a leader in both pharmacy and managed care. The question is whether the markets will reward this pivot.

The numbers suggest confidence. The execution will determine the outcome.