By Amina Niasse

Feb 10 (Reuters) - CVS Health CVS.N reported a decline in fourth-quarter profit on Tuesday but beat Wall Street estimates, helped by strength in its pharmacy benefit unit and strong prescription volume at its retail pharmacies.

CVS said adjusted quarterly profit fell to $1.09 per share from $1.19, above analysts' average estimate of 99 cents per share, according to data compiled by LSEG.

"I talk about a Say-Do ratio," said Chief Financial Officer Brian Newman. "Where we put out realistic targets and we try to deliver or exceed on expectations."

Newman said the pharmacy business' profit had been declining annually about 5% for the past five years, but grew 5% in 2025, helped by its purchase of some assets of pharmacy Rite Aid, which filed for bankruptcy.

For 2026, the healthcare conglomerate maintained a full-year adjusted profit forecast between $7.00 and $7.20 per share, unchanged from the previous quarter. Analysts expect the company to book $7.17 per share, according to LSEG data.

CVS, which operates one of the largest U.S. pharmacy chains, Aetna insurance and the CVS Caremark pharmacy benefit manager, cut costs and restructured in 2025 after it underperformed several quarters in a row in 2024 and replaced its management.

REVENUE RISES ON PRESCRIPTIONS

Total revenue rose to $105.7 billion for the fourth quarter from $97.7 billion, driven in part by the Rite Aid deal. Prescriptions filled increased 6.3% from the same quarter in 2024.

Revenue in the Health Services segment, which includes the company's Caremark pharmacy benefit management unit, rose to $51.2 billion in the fourth quarter from $47 billion a year earlier.

CVS's Aetna insurance business reported a medical loss ratio, or the percentage of premiums spent on medical services, of 94.8%, compared with analysts' estimate of 95.5%, hurt by regulation introduced by the Inflation Reduction Act.

Newman said the Biden-era law caused medical costs in its Medicare Advantage business to rise more sharply in the latter part of the year.

Insurers focused on Medicare, the U.S. government program for older adults and people with disabilities, have been pressured by increased demand for medical services and changes in government reimbursement that have affected revenue.

Last month, the Trump administration proposed a much smaller than expected increase to 2027 Medicare Advantage payment rates, which drove down shares of CVS, UnitedHealth UNH.N and Humana HUM.N.

CVS announced in 2025 it would stop offering the plans established by the Affordable Care Act, saying the business was unsustainable.

(Reporting by Amina Niasse in New York and Christy Santhosh in Bengaluru; Editing by Caroline Humer and Matthew Lewis)

((Christy.Santhosh@thomsonreuters.com;))