CVS Caremark Makes Changes in Diabetes Coverage for 2025

Drugs to treat diabetes have been the focus of many efforts to bring down costs for both patients and payer. It’s not heard to see why. More than 38 million people are diagnosed with diabetes in the United States, and treatment costs continue to rise. People with diabetes now account for one of every four healthcare dollars spent, according to a report issued last year by the American Diabetes Association.

Pharmacy benefit managers (PBMs), including, CVS Caremark, say they’ve worked to ratchet down those costs — or, more precisely, the pace of the increases — by lowering the monthly out-of-pocket costs for insulin so they are at or below the $35 requirement for Medicare Part D plans imposed by the Biden Administration’s Inflation Reduction Act.

As far as formulary placement is concerned, CVS Caremark has switched up its diabetes coverage for 2025 (see Table below). The PBM, which is one of the "big 3" in the industry that manage the vast majority of prescriptions in the U.S., has removed several therapies to treat patients with diabetes in favor of newer products and generics, based on a review of the it's Performance Drug List – Standard Control for January 2025.

That list is CVS Caremark’s national formulary, a list of drugs that its provides clients. CVS Caremark’s clients, which include health plans and employers, can deviate from the formulary but as a practical matter the formularies have great sway over the drugs that health plans, employers, Medicaid managed care plans and other payers cover.

One notable change is the exclusion of the V-go Infusion Pump, an insulin delivery device that is worn like a patch and provides continuous subcutaneous insulin infusion. CVS Caremark instead prefers Omnipod products (Omnipod 5 and Omnipod Dash) or the Twiist infusion system.

The Twiist system was approved earlier this year and developed by a company cofounded by a former executive at CVS Health. Twiist was approved by the FDA in March 2024 and combines an automated insulin delivery with a continuous glucose monitoring (CGM) device for people ages 6 and up with type 1 diabetes. It uses Tidepool Loop technology, which enables the system to automatically adjust insulin delivery based on CGM readings and predicted glucose levels.

Twiist was developed by partners DEKA Research & Development and Sequel Med Tech, whose CEO and co-founder is Alan Lotvin, M.D., who held several high-ranking positions at CVS Health, including president of CVS Caremark from 2020 to 2023. DEKA was founded by Dean Kamen, the engineer who developed the Segway scooter.

CVS Caremark also has removed several of Merck’s products that treat diabetes, including the older Janumet/Janumet XR (sitagliptin and metformin) and Januvia (sitagliptin). Januvia was approved in 2006 and was the first dipeptidyl peptidase-4 (DPP-4) inhibitor to be marketed to treat patients with type 2 diabetes. It's wholesale acquisition cost (WAC) price is $573 for a bottle of 30 tablets. Janumet was approved in 2007, and Janumet XR in 2012. Both have WAC prices of $573 for a bottle of 60 tablets.

As an alternative for Janumet, CVS Caremark has suggested patients instead use Zituvimet (saxagliptin-metformin), another DPP-4 inhibitor, which the FDA approved in November 2023. It is manufactured by Zydus Lifesciences, a company located in India that was formerly known as Cadila Healthcare. An extended release version of Zituvimet was approved in July 2024.

Additionally, CVS has added to its national formulary saxagliptin, a generic of Onglyza, which is no longer available. Several generic versions of Onglyza were approved in 2023 to treat patients with diabetes. As an alternative for Januvia, CVS Caremark is recommending the generic saxagliptin or Zituvio, which was approved October 2023. WAC prices for Zituvimet and Zituvio are not readily available.

CVS Caremark has also added the unbranded biosimilar to Sanofi’s Lantus, which treats type 2 diabetes in adults and type 1 diabetes in both adults and children. Biocon Biologic’s Semglee (insulin glargine-yfgn) and an unbranded product launched in November 2021. At the time, they were the first interchangeable biosimilars to Lantus. Since then, a second interchangeable biosimilar has been approved, Lilly’s Rezvoglar (insulin glargine-aglr).

Last year, a report by the Biosimilars Council found that Semglee at a list price of $269 30-day supply only had a modest uptake. The Biosimilars Council found that in the commercial space, payer controls were limiting the new-to-brand prescription starts. Within Medicare, the analysis found that Semglee was not covered by 38% of Medicare payers.

At the same time, Sanofi last year launched an unbranded insulin glargine that was about 60% versus Lantus.

The global insulin glargine market is expected to grow from $5.45 billion in 2024 to $8.43 billion in 2031, according to data from Coherent Market Insights. Biosimilars and increasing incidence of diabetes are expected to boost market volume, the marketing intelligence and consulting company indicated.

CVS Caremark is removing Novo Nordisk’s Victoza (liraglutide), one of the much-talked about glucagon-like peptide 1 (GLP-1) drugs, and instead listing a generic version that was approved this year. Teva launched the first generic of Victoza in June 2024 with a WAC price of $469.60 for the two-pen package and $704.40 for the three-pen package. Victoza’s list price is $543.51 for two pens and $815.27 for three pens.

CVS Caremark is also suggesting that patients consider several other GLP-1s instead of Victoza, including Mounjaro (tirzepatide), Ozempic (semaglutide), Rybelsus (semaglutide) and Trulicity (dulaglutide).

Beyond diabetes

In other notable changes, CVS Caremark has added two HIV medications to its standard formulary: Apretude (cabotegravir), which is used for preexposure prophylaxis (PrEP), and Cabenuva (cabotegravir, rilpivirine), which is used to treat HIV infection in those age 12 and older. Both products are from ViiV Healthcare.

Additionally, CVS Caremark, had added two biosimilars to Herceptin (trastuzumab): Amgen’s Kanjinta and Pfizer’s Trazimera. Both treat patients HER2-overexpressing metastatic breast cancer, and both are preferred over Herceptin and other biosimilars, including Herzuma or Ogivri,

Among lung cancer drugs, CVS Caremark has added Augtyro (repotrectinib) to its formulary. It is a Bristol Myers Squibb drug that is used to treat patients with ROS1-positive non-small cell lung cancer and patients with solid tumors that have a NTRK gene fusion.

Within central nervous system disorders, CVS Caremark is including Zurzuvae (zuranolone), an oral therapy from Biogen/ Sage to treat women with postpartum depression. Zurzuvae launched in December 2023, and is a rapid-acting neuroactive steroid that targets the GABA-A receptor. It has WAC price of $15,900 for a 14-day course of treatment.

To treat patients with bipolar disorder CVS Caremark has added Abilify Asimtufii (aripiprazole); the PBM had previously included Abilify Maintena on its formulary. Both therapies are long-acting maintenance treatments from Otsuka and Lundbeck.

Interestingly, the CVS Caremark formulary does not include Abilify, which has the same active ingredient but not in the long-acting formulation. Abilify is approved as a treatment for a number of mental health disorders, including bipolar disorder, major depressive disorder and schizophrenia.