CVS Split Puts Aetna Ratings Under Review
Employers and pharmacy partners of Aetna and CVS should expect counterparty structures to shift as the healthcare and retail businesses separate.
Updated on Nov. 5, 2026 in Healthcare
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AM Best has placed the financial strength and credit ratings of several Aetna and CVS Caremark insurance entities under review with developing implications, following CVS Health's November 4, 2026 announcement that it intends to split into two independent, publicly traded companies. Businesses that rely on Aetna's 39 listed operating entities or CVS's pharmacy and health-services network should watch for how the split reshapes their payer and pharmacy relationships.
Why it matters
The rating actions follow CVS Health's announcement that it will separate its healthcare solutions business, which includes Aetna, CVS Caremark, CVS Specialty, Oak Street Health and Signify Health, from its retail CVS Pharmacy operations. For operators, the split raises questions about how insurer and pharmacy-benefit counterparties will be structured, priced and contracted once they sit under separate corporate parents.
AM Best's review covers Aetna Life Insurance Company's A (Excellent) Financial Strength Rating and "a" (Excellent) Long-Term Issuer Credit Rating, and CVS Caremark Indemnity Ltd.'s equivalent ratings, across an Aetna Health & Life Group of 39 listed operating entities. CVS Pharmacy will retain approximately 9,000 pharmacies.
The players
CVS Health
A large integrated healthcare company combining a national retail pharmacy chain with a pharmacy benefit manager, insurance business and care-delivery operations.
AM Best
An independent credit rating agency whose financial strength ratings assess the claims-paying ability of insurers, which affects how businesses view their carriers.
Aetna
A health insurer and managed-care organization that is a major provider of employer-sponsored and government-program health coverage.
The details
Under the planned structure, one company would hold the healthcare solutions segment, comprising Aetna, CVS Caremark, CVS Specialty, Oak Street Health and Signify Health, while a second company would consist of CVS Pharmacy, including roughly 9,000 retail locations, mail-order pharmacy, MinuteClinic and the Health100 technology services business. The separation still requires final approval from the CVS Health Board of Directors, effectiveness of a Form 10 registration statement filed with the SEC, and customary confirmation that the transaction receives tax-free treatment. AM Best said the ratings will remain under review as it receives more definitive direction from CVS management on pro forma financials and debt allocation.
Timeline
November 4, 2026: CVS Health announces intent to separate into two companies.
November 5, 2026: AM Best places Aetna and CVS Caremark ratings under review.
First half of 2028: Expected completion of the CVS Health separation.
Market Landscape
The planned split reverses the vertical integration CVS assembled when it acquired Aetna in 2018, which combined a national pharmacy chain with a major insurer and pharmacy benefit manager. Separating the businesses would put insurer, pharmacy-benefit and retail-pharmacy functions under distinct ownership, changing how they negotiate with one another.
Businesses that contract with Aetna or CVS Caremark should begin reviewing how the separation could change pricing, service terms and counterparty arrangements once the two companies operate independently. Employers and pharmacy operators should track the Form 10 disclosures and debt-allocation details, and any tax or contract questions should be routed to qualified counsel or an accountant.
The takeaway
Operators with health-plan or pharmacy-benefit contracts should calendar the Form 10 filing and AM Best's follow-up rating actions as the separation moves toward its first-half 2028 target. Watch how the split is capitalized and how the two resulting companies price their services to outside customers, and route contract and tax implications to qualified advisors.
What happens next
CVS Health's separation requires final board approval and effectiveness of its Form 10 registration with the SEC, with completion targeted for the first half of 2028.
Further reading
For broader context on how these shifts reshape provider and payer markets, browse our Healthcare coverage.
Source note: This article includes information reported by Ambest.
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