CVS Health CEO David Joyner fires back at AOC’s monopoly criticism

CVS Health President and CEO David Joyner took the brunt of Rep. Alexandria Ocasio-Cortez’s viral broadside on health insurers three weeks ago.

The New York City Democrat called out CVS Health’s corporate strategy to “monopolize patient care” during a hearing in the Health Subcommittee of the Committee on Energy and Commerce.

Joyner responded Tuesday morning. During a fourth-quarter and full-year earnings call update for Wall Street analysts, Joyner devoted a significant portion of his prepared remarks to addressing the legislative criticism of CVS’s “vertical integration.”

While never mentioning Ocasio-Cortez, Joyner said CVS Health’s control of the health insurer, medical provider, pharmacy benefit manager, drug manufacturer and pharmacy – meaning its members rarely leave a CVS-owned health business – saves the patient money.

“We can provide a connected solution for consumers that delivers better experiences and improves health outcomes at lower cost,” Joyner said. “Aetna members who have a combined medical and pharmacy offering have lower medical costs. Aetna members who consistently use CVS Pharmacy have higher medication adherence and lower ER utilization.”

During the Jan. 22 hearing, Ocasio-Cortez noted that CVS Caremark, a PBM, processes nearly 30% of all prescriptions in a given year and helps determine what millions of patients pay for needed drugs.

She described a fictional patient named “Kate,” who has an Aetna health insurance plan, goes to a CVS Pharmacy, and is connected to an Oak Street Health medical clinic. That led to a snarky exchange when Ocasio-Cortez pointed out the financial benefits for CVS.

“I would suggest it’s a model that works really well for the consumer,” Joyner said.

“Yeah. I think it works very well for CVS,” Ocasio-Cortez shot back.

Joyner was joined at the hearing by the CEOs of UnitedHealth Group, Cigna, Elevance Health and Ascendiun. The executives shifted blame for high health costs to hospitals and drug makers. Joyner picked up on that theme on Tuesday.

So far in 2026, branded drug manufacturers raised prices on more than 750 drugs, Joyner said, adding $25 billion in costs to the health care system.

“We need to collectively have a transparent and honest dialogue about what is and what isn’t driving up health care costs,” he said. “Branded drug manufacturers raise prices, hospitals raise prices. CVS Health lowers cost and drives affordability. We create competition and negotiate with providers and drug manufacturers, which directly leads to lower costs for consumers.”

In Other News

Medicare Advantage rates. CVS officials addressed last month’s announcement by the Centers for Medicare & Medicaid Services to raise MA payment rates by 0.09% in 2027. That proposal falls well below analysts’ expectations of a 4-6% increase, according to The Wall Street Journal.

Last year, the CMS announced a 5.06% increase that will go into effect this year, beating forecasts. The latest minuscule increase comes on the heels of President Donald Trump’s public criticism of insurance companies. The president wants insurers to “make less, a lot less” and added that they are “making so much money.”

“The proposed rate simply does not match the level of medical cost trend in the industry,” Joyner said. “We are advocating for more appropriate funding to ensure adequate access, as well as the stability and sustainability of a program relied on by more than half of the seniors in this country.”

While the MA rate notice is “disappointing,” the CEO added, Aetna remains “laser focused” on improving financial margins on its Medicare business.

PBM reform. Joyner also commented on PBM reform measures included in a government funding package signed by President Donald Trump last week.

Regulators and lawmakers have increasingly criticized PBMs, arguing that the middlemen drive up the cost of drugs and steer patients toward affiliated pharmacies at the expense of independently owned drugstores.

The three largest PBM companies, owned by insurers, account for 80% of the market. They are Cigna subsidiary Express Scripts, United Health’s Optum Rx and CVS Caremark. Critics argue their effective monopoly discourages inclusion of independent pharmacies as preferred providers.

The PBM changes include several price transparency measures, to which Joyner said CVS will be able to adapt.

“The role the PBM, I think, remains more important now than ever, especially when you have (new drug) launch prices … of over $350,000,” Joyner said. “Somebody needs to play the role, to continue to be the competition and be the entity that lowers costs for the consumer.”

Quarterly Snapshot

• Operating income decreased 45.3% for the year primarily due to a $5.7 billion goodwill impairment charge related to the Health Care Delivery reporting unit and approximately $1.2 billion of legacy litigation charges.
• Medical membership of 26.6 million decreased by 112,000 members from Q3 and 503,000 for the full year, reflecting declines in the individual exchange.
• Prescriptions filled increased 6.3% and 5.4% on a 30-day equivalent basis for the fourth quarter and full year, respectively. Same-store prescription volume increased 9.7% and 8% for the quarter and full year.
• Total pharmacy segment revenues increased 12.4% and 11.9% for the quarter and full year, respectively, primarily driven by pharmacy drug mix and increased prescription volume.

Management Perspective

“Our Aetna business has the fewest medical services subject to prior authorization, about half as many as our nearest competitor. Additionally, 95% of eligible prior authorizations are approved within 24 hours, with many completed instantaneously.”

CEO David Joyner

By The Numbers

• Total Revenues: $105.7 billion ($97.7 billion in Q4 2024)
• Net Income: $2.9 billion ($1.6 billion in Q4 2024)
• Earnings Per Share: $1.09 ($1.19 in Q4 2024)
• Share Repurchases: none
• Dividend Declared: $845 million
• Stock Price Movement: Shares rose nearly 3% to $77.88

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