If you have an Aetna health insurance plan, there is a good chance CVS Caremark manages your pharmacy benefits — and that is no coincidence, because CVS Health owns both companies. The CVS Caremark Aetna relationship is one of the most visible examples of vertical integration in American healthcare. But it is easy to blur the two together, so the most important thing to understand up front is this: Aetna and CVS Caremark are distinct entities with distinct functions, even though they share a parent company. Knowing which one does what helps you use your benefits, reach the right department, and understand what you pay.
How CVS Caremark and Aetna Are Connected
CVS Health acquired Aetna in 2018 in a deal widely reported at approximately $69 billion, creating a company that combines a health insurer, a pharmacy benefit manager (PBM), a large retail pharmacy chain, and a specialty pharmacy under one corporate roof.
Within that structure, the two brands have separate roles:
- Aetna is the health insurer. It sets premiums, designs medical benefit plans, processes medical claims, and manages provider networks. Aetna is the name you associate with doctor visits, hospital stays, and medical coverage.
- CVS Caremark is the pharmacy benefit manager. It maintains the formulary (the list of covered drugs), processes prescription claims, operates mail-order and specialty pharmacy services, and negotiates drug pricing and rebates with manufacturers.
When you have an Aetna plan that uses CVS Caremark for the drug benefit, you are dealing with two divisions of the same parent company. Your medical card typically says Aetna; your pharmacy benefit information points to CVS Caremark. Both ultimately roll up to CVS Health.
An Important Distinction: The Two Are Not Interchangeable
It is a common misconception that CVS Caremark and Aetna are the same thing, or that being an Aetna member automatically means Caremark handles your prescriptions and vice versa. Neither is quite right:
- Not all Aetna members use CVS Caremark. Some Aetna plans — particularly certain employer-sponsored or Medicare plans — may be administered differently. Your plan documents state which PBM manages your drug benefit.
- Not all CVS Caremark members have Aetna. CVS Caremark provides pharmacy benefit management for many employers and health plans that have nothing to do with Aetna. You can be a Caremark member through a completely different insurer.
Because of this, the only reliable way to know how your own benefits are structured is to read your plan materials and check your member ID card(s), not to assume the relationship applies to you.
What This Means for Your Pharmacy Benefits
When an Aetna plan does use CVS Caremark, the integration has several practical effects on how prescriptions are handled.
Formulary alignment. Aetna plans that use CVS Caremark generally rely on a CVS Caremark formulary for drug coverage decisions — which drugs are covered, at what tier, and with what restrictions. Review your plan’s formulary before filling a new prescription so you understand your coverage and any step-therapy or quantity limits.
Preferred pharmacy networks. Many Aetna/CVS Caremark plans offer lower copays at CVS Pharmacy retail locations than at some other in-network pharmacies, and a few go further by steering certain maintenance or specialty medications toward CVS-owned pharmacies. This preference for the parent company’s own pharmacies has drawn criticism from competing chains and independent pharmacists.
Specialty drug channeling. Plans administered by CVS Caremark often require specialty medications to be filled through CVS Specialty, the company’s specialty pharmacy. If your clinician prescribes a biologic or another complex medication, it may be routed to CVS Specialty. For background on how these pharmacies work, see our guide to specialty pharmacy services.
Coordinated data. Because Aetna and CVS Caremark share a parent, they can, at least in principle, coordinate medical and pharmacy data more closely than fully independent companies. Proponents say this can support medication therapy management, adherence outreach, and chronic disease programs; critics question how the data is used.
How to Use Your Aetna/CVS Caremark Benefits
Navigating a plan with two interconnected companies mostly comes down to knowing which entity handles what — and, crucially, finding the right contact information from an official source.
For Medical Claims and Coverage
Contact Aetna. Use the phone number printed on your Aetna medical ID card, or sign in to Aetna’s official member website, for questions about doctor visits, hospital stays, lab work, and medical procedures. The Aetna member portal handles medical claims, provider searches, and benefits summaries.
For Prescription Drug Questions
Contact CVS Caremark. Use the number on your CVS Caremark pharmacy benefit card, or the official CVS Caremark member site, for questions about drug coverage, copays, formulary tiers, mail-order prescriptions, and prior authorization. The CVS Caremark member portal handles pharmacy-specific tasks.
For Specialty Medications
If your medication is dispensed through CVS Specialty, use the specialty pharmacy contact information provided on your welcome materials, your prescription paperwork, or the official CVS Specialty website. Rather than relying on a phone number found elsewhere, always confirm the current number from your own plan documents or the official site, since contact numbers can differ by plan and can change.
Potential Benefits the Company Cites
CVS Health has promoted several advantages of combining an insurer and a PBM.
Care coordination. When an insurer and PBM share data, it can be easier to flag patients who are not filling their medications, who might benefit from a lower-cost alternative, or who need clinical follow-up — for example, someone filling a diabetes drug but not seeing the right specialist.
Cost management. By overseeing both insurance and PBM functions, CVS Health argues it can better manage total healthcare costs, using pharmacy data to help prevent expensive medical events such as avoidable hospitalizations.
Convenience. The integration creates a connected ecosystem — Aetna for insurance, CVS Caremark for the drug benefit, CVS Pharmacy for retail prescriptions, CVS Specialty for complex drugs, and clinics such as MinuteClinic for basic care. For members who stay within the CVS Health family, that can simplify some tasks.
Concerns and Criticisms
The CVS Caremark Aetna combination has not been without controversy, and reasonable observers disagree about it.
Reduced competition. When one company controls insurance, PBM, and pharmacy operations, independent pharmacies and rival PBMs may be disadvantaged. The Federal Trade Commission has, in recent years, scrutinized PBM practices — including arrangements that steer patients toward PBM-owned pharmacies — through study and reports.
Conflicts of interest. CVS Caremark makes formulary decisions that affect which drugs Aetna plans cover. When a PBM also has a financial stake in dispensing drugs through its own pharmacies, critics ask whether formulary and steering decisions always prioritize patient outcomes over corporate revenue. Similar tensions exist at other vertically integrated companies.
Patient choice. Plans that favor or require CVS Pharmacy or CVS Specialty can limit where patients fill prescriptions. Members who prefer an independent pharmacy or a competitor may face higher copays or coverage limits for certain drugs.
Transparency. The complexity of the corporate structure can make it hard for consumers to see who is making coverage decisions and why, since rebate negotiations, formulary placement, and pharmacy reimbursement all happen within the same corporate family. For more on how PBMs operate, see our article on PBM services.
How the Aetna/CVS Caremark Structure Compares
CVS Health is not the only company combining insurance and PBM functions. Vertical integration has produced several large healthcare conglomerates, for example:
- CVS Health: Aetna (insurer) + CVS Caremark (PBM) + CVS Pharmacy + CVS Specialty
- The Cigna Group: Cigna (insurer) + Express Scripts (PBM) + Accredo (specialty pharmacy)
- UnitedHealth Group: UnitedHealthcare (insurer) + Optum Rx (PBM) + Optum specialty pharmacy services
Each structure raises similar questions about competition, transparency, and patient choice, and the trend has prompted legislative and regulatory attention at both the state and federal levels, with proposals ranging from PBM licensing and transparency rules to limits on PBM ownership of pharmacies.
Tips for Aetna/CVS Caremark Members
Know which card to use. Present your CVS Caremark information at the pharmacy and your Aetna card at the doctor’s office. If you have a single combined card, the pharmacist or provider can identify the correct benefit.
Check for preferred pharmacy savings. Your plan may offer lower copays at CVS Pharmacy; compare the cost there against other in-network pharmacies before deciding where to fill.
Use the official digital tools. Both Aetna and CVS Caremark offer member portals and apps. Use the Caremark tools for pharmacy tasks and the Aetna tools for medical benefits, claims, and provider searches.
Review your plan during open enrollment. Check the formulary each year, since tier placements and coverage rules change. If a medication moves to a higher tier, explore alternative plan options your employer or the marketplace may offer.
Frequently Asked Questions
Is CVS Caremark part of Aetna?
No — but they share an owner. Both CVS Caremark and Aetna are owned by CVS Health. CVS Caremark manages pharmacy benefits (the PBM function), while Aetna provides health insurance. They operate as distinct businesses within the same parent company.
Do I have to use CVS Pharmacy if I have Aetna and CVS Caremark?
Not necessarily, but you may pay less at CVS Pharmacy if your plan designates it as preferred. Check your plan’s pharmacy network details for specifics.
Who do I contact for a prescription issue — Aetna or CVS Caremark?
Contact CVS Caremark for prescription-related issues, including drug coverage, copays, formulary questions, and mail order. Contact Aetna for medical coverage, provider networks, and non-pharmacy claims. Use the phone number on the relevant ID card.
What is the phone number for CVS Caremark or Aetna?
Use the number printed on your member ID card or the official Aetna or CVS Caremark member website. Contact numbers vary by plan and can change, so relying on your own card or the official site is the most reliable approach.
Does the CVS Caremark Aetna relationship affect my drug costs?
It can. Formulary decisions, preferred-pharmacy designations, and specialty-drug channeling all influence what you pay. Understanding your plan’s structure helps you minimize costs.
Navigate the CVS Health Ecosystem
The CVS Caremark Aetna relationship means that, for many members, medical and pharmacy benefits are managed by sister companies within CVS Health — related but distinct, with different jobs and different contact points. Use that knowledge to your advantage: check your formulary, compare preferred-pharmacy savings, and reach the right division for each type of question. For a broader look at how corporate structures shape patient care, visit our healthcare policy guide.
TL;DR: CVS Health owns both Aetna (a health insurer) and CVS Caremark (a pharmacy benefit manager), but they are distinct entities with distinct jobs. Aetna handles medical coverage; CVS Caremark handles the drug benefit — formulary, copays, mail order, and specialty routing. Many Aetna plans use Caremark, but not all Aetna members do, and many Caremark members have a different insurer, so check your own plan documents. Use your Aetna card for medical questions and your Caremark card for prescriptions, and always get phone numbers from your ID card or the official sites. The arrangement raises debated questions about competition, choice, and transparency.
This article is general informational content, not legal, financial, or insurance advice, and it is not affiliated with, sponsored by, or endorsed by CVS Health, Aetna, or CVS Caremark. Plan details differ by employer and region and change over time — verify current benefits, networks, and contact information with your own plan documents and the official company websites.
Sources
- CVS Health — About CVS Health (cvshealth.com)
- Aetna — Member resources (aetna.com)
- CVS Caremark — Member site (caremark.com)
- U.S. Federal Trade Commission — PBM study and reports (ftc.gov)