Market Check and Pricing for 2027

One of the many functions National CooperativeRx performs for its members is an annual market check. A market check is a mid-contract review that compares pricing in the current contract against industry pricing benchmarks. Industry dynamics and drug prices are constantly changing, and a market check is one way to derive benefit from those changes. A market check also updates pricing to account for new-to-market drugs, developing trends, and changes in utilization.

Until recently, market checks have typically leveraged significant savings primarily due to rebate value. This dynamic has changed and continues to change due to regulatory pressures and calls for greater transparency.  Greater generic availability and evolving biosimilar markets have also impacted rebate invoicing opportunities for PBMs. Consequently, a PBM’s ability to show year-over-year contract value has tightened. While our market check for 2026 pricing did not yield additional savings, incremental improvements remained.

National CooperativeRx’s market check process for 2027 began in March of 2026 with the support of an independent consultant. Extensive data and communication were exchanged amongst the PBM, consultant, and National CooperativeRx staff. As we worked through pricing benchmarks and industry changes, a great deal of time was spent analyzing CVS Caremark’s new drug-level rebates (DLR) approach. DLR is the next step CVS Caremark is taking to better align performance for rebates and the drug mix utilization driving those opportunities while moving away from cross subsidization. Our work was focused on gaining a strong understanding of their new rebate model, understanding the impact to plan sponsors, and locking down contract language to ensure rebate value continues to pass through to member groups at 100%. While we understand and support this new approach to rebate payments, current member groups remain on the existing contract and rebate payment methodology for 2027.

The 2027 market check process achieved savings for our member groups. This savings adds to additional contract value already scheduled to take place in our existing contract. Total pricing improvements for 2027 equals 2.58%. This is an average across all of National CooperativeRx and depends on plan design and utilization. These improvements will automatically go into effect on January 1, 2027, for member groups with CVS Caremark. With the support of our clinical oversight programs, this savings will help mitigate trend, which is expected to continue to be above average for 2027.

Access to Data

While much of the industry rhetoric focuses on transparency and the lack of information shared by large PBMs, National CooperativeRx members have long benefited from access to data on pharmacy spend. This data allows us to analyze trends, conduct benchmarking, identify fraud, waste, and abuse, and make recommendations that drive higher value healthcare. CVS Caremark expanded National CooperativeRx’s access to data as part of this market check. We will gain greater visibility into drug pricing decisions made by CVS Caremark and how their decisions impact our members.

Enforcing Current Contract Value

Access to data also allows our team of pharmacy benefit experts to provide ongoing oversight over the administration of the PBM contract. As part of the market check process, we identified discrepancies and have been successful in proactively resecuring $3.9M in value from CVS Caremark rather than waiting to address as part of a lengthy audit process. We are happy to be able to provide this value in a more timely manner because of these efforts.

2028 RFP

National CooperativeRx is closely monitoring the evolving PBM marketplace. As our current contract with CVS Caremark ends December 31, 2027, we are in a strong position to explore options that could provide additional value to our members. We have engaged an independent pharmacy benefits consultant and expect to send our purchasing power to market in late October of 2026. We look forward to analyzing evolving models from key PBMs who can provide the best price and value to our members. Our 2027 market check process gave us a head start on these strategic efforts.

Fiduciary Duty

Federal action has strengthened the fiduciary duty responsibilities of plan sponsors to appropriately manage their health benefits plan. Having a PBM market check conducted is an important step towards achievement of fiduciary duties. National CooperativeRx’s annual market checks, periodic full RFPs, and ongoing monitoring support member groups in fulfilling their fiduciary duty. For further information on everything National CooperativeRx does to support plan sponsors in their fiduciary duties, please contact your account representative to receive a copy of our Demonstrating Fiduciary Duty Compliance document.

National CooperativeRx is proud to deliver this value to membership. We will continue to monitor this evolving marketplace, always looking out for the best interests of our members and working to drive higher value healthcare.