What is CVS? 'We are ... working through that very question'

The question of what defines cvs health corporation (CVS) has never been more critical. During its Q1 2025 earnings call, CEO David Joyner candidly stated, "We are ... working through that very question," acknowledging the complexity of balancing its sprawling, vertically integrated healthcare business. With operations spanning pharmacies, health insurance, and clinical services, CVS is at a crossroads—redefining its identity to navigate regulatory headwinds, cost pressures, and market shifts. Let’s dissect its strategy, performance, and risks to determine its investment potential.

The Strategic Pivot: Shedding Non-Core Assets

CVS’s first-quarter results underscored its shift toward core strengths. The company announced plans to exit its individual Affordable Care Act (ACA) exchange business by 2026, citing persistent losses of $350–$400 million in 2025. This move, while painful, reflects a pragmatic focus on high-margin segments like Medicare, commercial, and Medicaid. Medicare Advantage Star Ratings rose, bolstered by operational efficiencies, and the pharmacy division’s 18% same-store sales growth (driven by prescription volume and flu vaccines) signals resilience in its retail network.

Ask Aime: What is the future of CVS Health's Medicare Advantage business?

Financial Fortitude Amid Challenges

Despite exiting underperforming businesses, CVS delivered robust Q1 results. Adjusted EPS rose to $2.25, with full-year guidance raised to $6.00–$6.20, up from $5.75–$6.00. The pharmacy and consumer wellness segment, which includes its 9,000 retail locations, saw revenue jump 11% to $32 billion, fueled by GLP-1 drug demand and script share gains. However, elevated medical cost trends—particularly in inpatient and specialty pharmacy—remain a concern, with Oak Street Health’s Medicare business facing early-stage cost pressures.

Risks on Multiple Fronts

1. Regulatory Scrutiny: The U.S. Department of Justice (DOJ) lawsuit targeting Aetna’s Medicare Advantage enrollment practices—alleging illegal kickbacks—adds legal and reputational risk. While CVS denies wrongdoing, settlements could strain margins.
2. State-Level Policy Battles: Arkansas’s decision to exclude CVS pharmacies from its Medicaid network threatens access to specialty medications, disproportionately harming vulnerable populations. CVS has framed such actions as anticompetitive, but resolving these disputes will require political capital.
3. Cost Inflation: Though medical cost trends showed “early signs of stabilization,” sustained inflation in pharmacy and hospital costs could pressure profitability, especially in Medicare Part D.

Operational Innovations: Building Trust Through Integration

CVS is leveraging its integrated model to drive differentiation:
- Prior Authorization Overhaul: Bundled approvals for cancer care imaging (e.g., MRIs) cut administrative delays, with 95% of requests now resolved within 24 hours. Expansion to cardiology and musculoskeletal services is planned by year-end.
- GLP-1 Access Expansion: A partnership with Novo Nordisk introduced Wegovy at reduced prices through CVS pharmacies, paired with clinical support programs. This combines the pharmacy’s scale with care management, enhancing customer loyalty and adherence.
- Digital Tools: The CVS Health app now offers AI-driven health recommendations, such as personalized cost comparisons and care pathway guidance, to improve member engagement.

Leadership Transitions and Long-Term Vision

The appointment of Brian Newman as CFO and Amy Compton-Phillips as Chief Medical Officer signals a focus on fiscal discipline and clinical innovation. Joyner’s emphasis on becoming “America’s most trusted healthcare company” hinges on executing these moves while managing risks. The $450 million premium deficiency reserve for ACA losses, while a drag on near-term results, underscores the need to prioritize profitable segments.

Data-Driven Outlook

CVS’s Q1 cash flow from operations surged to $4.6 billion, supporting a raised $7.0 billion full-year target. Medicare and commercial segments, which now account for over 80% of health benefits revenue, are critical growth engines. However, the stock’s 2024 underperformance (down ~12% vs. a 10% rise in the S&P 500) reflects investor skepticism about its ability to navigate regulatory and operational hurdles.

Conclusion: A Work in Progress, but Worth Watching

CVS’s Q1 results and strategic clarity under Joyner suggest progress in its identity crisis. The exit from ACA, operational wins in Medicare, and innovations like GLP-1 access partnerships highlight a sharpened focus. Yet, risks remain—from legal battles to cost inflation—that could test execution.

Investors should weigh the positives: a top-ranked pharmacy network, rising Medicare Star Ratings, and a $7.0 billion cash flow outlook. Against that, the DOJ lawsuit and state-level policy threats loom large. For long-term investors seeking exposure to the U.S. healthcare sector, CVS’s scale and integration remain compelling—if its leadership can solidify its “trusted” brand promise.

In short, CVS is still “working through” its identity, but the pieces are falling into place. Stay tuned for Q2 updates on cost trends and regulatory outcomes to gauge whether its strategic bets pay off.