CVS Health operates one of the largest retail pharmacy chains in the United States alongside Aetna, a major health insurer it acquired, and a pharmacy benefit manager that negotiates drug prices on behalf of employers and health plans. That combination puts CVS on multiple sides of the healthcare dollar: filling prescriptions, insuring patients and negotiating what insurers pay for medications. The retail pharmacy business faces pressure from front-of-store retail competition and from reimbursement rates that have squeezed pharmacy margins, pushing CVS to lean more heavily on its insurance and pharmacy benefits segments for growth. Its scale across these different healthcare businesses gives CVS negotiating leverage that smaller, single-segment competitors don't have, though integrating such different businesses under one roof has its own complexity.