Humira, Diabetes Drugs Are Among Therapies Excluded by Big Three PBMs in 2025

One of the most notable drugs missing from the three largest PBMs’ standard commercial formularies this year is Humira (adalimumab), AbbVie’s blockbuster drug for treating autoimmune conditions that has seen significant biosimilar competition in the U.S. since 2023.

Overall, The Cigna Group's Express Scripts removed 21 medications from its 2025 National Preferred Formulary, while CVS Health Corp.’s Caremark and UnitedHealth Group’s Optum Rx cut 16 and 12 drugs from their Standard Control Formulary and Premium Standard Formulary, respectively, according to Pharmaceutical Strategies Group’s analysis.

Since 2016, the three PBMs have steadily increased the number of excluded drugs, but the growth rate of exclusions has slowed in the past few years.

For 2025, CVS Caremark has the most new specialty drug exclusions at nine, compared with seven by both Express Scripts and Optum Rx. The exclusions of three diabetes medications — Januvia (sitagliptin), Janumet (sitagliptin/metformin) and Victoza (liraglutide) — may have the most significant impact on patients. Caremark also removed Dulera (mometasone/formoterol), a branded product to treat asthma, and favored multiple lower-cost generic equivalents.

Meanwhile, Caremark added 18 drugs to its standard formulary, e­ffective Jan. 1, 2025. Among them, 11 are specialty drugs, including two oncology biosimilars to Herceptin (trastuzumab) — Kanjinti (trastuzumab-anns) and Trazimera (trastuzumab-qyyp) — which were previously excluded in 2024.

Express Scripts excluded 21 new medications from 11 therapeutic categories in 2025. Like Caremark, Express Scripts also removed some diabetes medications. Two sodium glucose co-transporter-2 (SGLT-2) inhibitors, Steglatro (ertugliflozin) and Segluromet (ertugliflozin/metformin), are now excluded. The PBM removed Saxenda (liraglutide), the first GLP-1 agonist approved for weight loss, in favor of the newer GLP-1s Wegovy (semaglutide) and Zepbound (tirzepatide).

Optum Rx cut 12 drugs from its Premium Standard Formulary in 2025. Similar to Caremark, Optum Rx also excluded diabetes medication Victoza and preferred alternatives Mounjaro (tirzepatide) and Ozempic (semaglutide), among four others. It was the first PBM to add Wegovy for cardiovascular risk reduction, which was a new indication approved by the FDA in March 2024. To date, other PBMs have maintained coverage of Wegovy for weight loss only.

Graphics below list notable medications that were excluded by the "Big Three” PBMs due to 2025 formulary changes and their market access among national major commercial formularies under the pharmacy benefit, according to MMIT Analytics. (MMIT is the parent company of AIS Health.)

As of 2025, all three PBMs excluded AbbVie’s immunosuppressive drug Humira from their major national commercial template formularies. Instead, each PBM favored one or more of the biosimilars marketed by their own private label businesses of an affiliated company, according to a Drug Channels Institute analysis.

This infographic was reprinted from AIS Health’s biweekly publication Radar on Drug Benefits.