CVS Weighs Spinning Off 9,000 Pharmacies to Partly Unwind the $78B Aetna Deal Before Q3 Earnings
Aetna, Caremark, Signify Health and Oak Street Health would remain together, and an announcement could come with Wednesday's Q3 results, but the structure is not settled.
CVS Health (CVS) is considering splitting up its roughly $117 billion healthcare business by spinning off its retail pharmacy chain as a separately listed company, according to people familiar with the discussions. The move would partly unwind the $78 billion Aetna acquisition of 2018 as regulators and lawmakers press to separate pharmacy benefit managers (PBMs) from pharmacies. No separation has been formally announced, and the structure and timing remain undecided. CVS shares rose in after-hours trading on Tuesday, and the company reports third-quarter results before the open on Wednesday.
What is under discussion
| Item | Details in the report |
|---|---|
| Business spun off | Retail pharmacy chain of about 9,000 stores, listed separately |
| Businesses kept together | Aetna, Caremark, Signify Health and Oak Street Health |
| Revenue weight of the stores | About one-third of roughly $417B in annual revenue |
| Timing | An announcement could come with Q3 results; structure and timing are not settled |
| Company status | No separation has been formally announced |
By our calculation, one-third of $417 billion is about $139 billion of revenue for the pharmacy business, which would leave roughly $278 billion with the insurance, benefits and care businesses. Those are our own arithmetic on the report's round figures, not company disclosures.
Regulatory pressure on PBM-pharmacy ownership
| Where | Measure | Status |
|---|---|---|
| Arkansas | Law barring PBMs from owning pharmacies | Blocked by a federal court; appeal pending before the Eighth Circuit |
| Tennessee | Fair RX Act, passed in May 2026, barring PBM pharmacy ownership | Challenged in federal court by Caremark, Express Scripts and the PCMA trade group; the report puts the effective date in 2028 |
| U.S. Senate | Patients Before Monopolies Act | Reintroduced in May 2026 by Senators Josh Hawley and Elizabeth Warren |
Under the federal bill, a company that owns both a PBM or insurer and a pharmacy business would have one year after enactment to divest the pharmacy business, with penalties for failing to do so. Caremark, CVS's PBM, is among the plaintiffs challenging the Tennessee law.
Where CVS stands
CVS reported second-quarter revenue of $106.1 billion, up 7.3%, and adjusted EPS of $2.58 versus $1.81 a year earlier. It raised 2026 adjusted EPS guidance to $7.90 to $8.10 from $7.30 to $7.50 and set revenue of at least $414 billion. The company's three segments are Health Care Benefits, Health Services, and Pharmacy & Consumer Wellness. The report says CVS's market value has more than doubled from its December 2024 low under Chief Executive David Joyner, helped by better Aetna profitability, cost controls and higher Medicare payments. CVS has scheduled its third-quarter earnings call for 8:00 a.m. ET on Wednesday, Nov. 4.
What to watch
- Wednesday's release and call. Whether CVS confirms, denies or declines to discuss a separation, and any timeline.
- Structure. How debt, the Caremark contracts and the stores' role in Aetna and Caremark networks would be divided.
- Courts and Congress. The Eighth Circuit appeal in Arkansas and the Tennessee case, plus the fate of the federal bill.
- Related coverage. See our reports on Omega Healthcare, IDEXX and QuidelOrtho.
Sources: CVS Health's third-quarter 2026 conference call notice and its second-quarter 2026 results on SEC EDGAR; Senator Hawley's announcement of the Patients Before Monopolies Act. The spin-off discussions come from a published report citing unnamed people, and CVS has not confirmed them. The share move comes from market data and may differ by source. Items labeled by our calculation are our own arithmetic. This article is informational only and is not investment advice.
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