(Bloomberg) -- After years of debt-fueled deals, share buybacks, rich dividends and stagnant earnings, CVS Health Corp. is slouching toward the brink of junk credit ratings, forcing the company to focus on fixing its balance sheet.

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Moody’s Ratings is looking at lowering the company’s grades by one notch in the coming months, a review that could bring CVS to just a step above high-yield status. S&P Global Ratings has signaled that a downgrade to the edge of high-grade is possible over about the next two years. The company had about $80 billion of long-term debt, including leases, as of June 30.

Any ratings cuts could boost CVS’s borrowing costs at a time when the health care company can scarcely afford it: its profits are under pressure and its debt levels have been climbing relative to its income. Wall Street analysts expect CVS this year to deliver its lowest adjusted earnings per share since 2017. The company is set to report results Nov. 6.

New Chief Executive Officer David Joyner is crafting a turnaround plan, forcing more hard choices after the company pulled its 2024 earnings guidance on soaring medical costs. He inherited the fallout from years of decisions that prioritized short-term stock gains at the expense of bondholders, as CVS transformed itself from a drugstore chain into a health-care conglomerate.

Activist investors at Glenview Capital are agitating for changes. They’ve helped push out Karen Lynch as CEO, and are seeking shifts to the board as well.

“Management’s credibility has eroded,” said Jean-Yves Coupin, Bloomberg Intelligence credit analyst, in an interview. “They haven’t been able to forecast the business’s profitability.”

As the company tries to revamp itself, it’s becoming less aggressive with its spending. CVS said in May that it didn’t plan to buy back more shares this year. And S&P said in August that it expects the company to avoid more large-scale acquisitions this year, and to focus on cutting its borrowings in the next year or two. The bond grader changed the company’s outlook to negative at the time.

CVS’s chief financial officer, Thomas Cowhey, said in August that the company is committed to maintaining its current high-grade ratings. A representative for CVS declined to comment for this story.