CVS Caremark’s Diabetes Drug Formulary Change: What Employers & HR Teams Need to Know

Managing prescription drug costs is always a balancing act between affordability and access. CVS Caremark, one of the largest pharmacy benefit managers (PBMs) in the U.S., has announced significant changes to its formulary for January 2025, impacting many diabetes medications.

With more than 38 million Americans diagnosed with diabetes and treatment costs continuing to rise, these changes will directly affect employees managing the condition. According to the American Diabetes Association, diabetes now accounts for approximately 1 in 4 healthcare dollars spent—a staggering financial burden for patients, employers, and insurers alike.

So, what do these changes mean for HR teams and employers? Let’s break it down.

What’s Changing?

CVS Caremark is removing several widely used diabetes medications and supplies from its Performance Drug List – Standard Control, replacing them with alternative brands and generics. The most notable switches include:

Humalog (Eli Lilly) → replaced with Novolog

Apidra (Sanofi) → replaced with Fiasp

Lantus and Toujeo (Sanofi) → replaced with Basaglar, Levemir, or Tresiba

All blood glucose test kits & strips → replaced with OneTouch products

Jardiance (Boehringer Ingelheim) → replaced with Farxiga or Invokana

CVS Caremark, along with other PBMs, argues that these changes will help control rising drug costs, ensuring lower out-of-pocket expenses and aligning with the $35 insulin cap introduced by Medicare Part D under the Inflation Reduction Act.

However, non-medical switching—changing a patient’s medication for cost-saving reasons rather than medical necessity—has sparked concerns among healthcare providers, employees, and advocacy groups.

How Could This Impact Employees?

While cost control is a major priority, these formulary changes could cause disruptions in care for employees managing diabetes. Unlike generics for traditional medications, insulins and diabetes therapies are not interchangeable—meaning even small changes can lead to dosing adjustments, side effects, and new treatment challenges.

A recent NIH study found that patients who were switched from their preferred medication often experienced:

More frequent doctor visits

New or worsening medication side effects

Issues with new prescriptions not working as expected

For employees managing diabetes, this can lead to increased absenteeism, decreased productivity, and added stress, all of which can impact workplace well-being.

What Employers & HR Teams Can Do

Communicate Early & Often

Employees may not be aware of these formulary changes until they try to refill a prescription. Proactively communicating with employees about the changes can reduce confusion and frustration.

Encourage Employees to Speak with Their Doctor

Not all employees will react the same way to the medication switches. Encourage them to consult their healthcare provider to adjust their treatment plan accordingly.

Check Your Benefits Plan for Exceptions & Appeals

Some employees may require medical exceptions to stay on their current medication. Work with your benefits provider to understand the exception request process for employees who cannot safely transition to the new formulary options.

Consider Offering a Diabetes Support Program

If your organization has a diabetes management program or telehealth services, now is a great time to remind employees of those resources. Programs that offer pharmacist consultations, nutrition counseling, or virtual coaching can help employees adjust to new medications more smoothly.

The Bottom Line

As HR professionals and benefits leaders, staying informed about formulary changes like these ensures that you can support employees effectively while balancing cost-control measures. While PBMs are aiming to slow rising healthcare costs, employees need clear guidance and resources to navigate these medication shifts without unnecessary disruption.

By taking a proactive, employee-focused approach, HR teams can help ensure that those affected receive the care they need—without added stress or complications.

Have Questions About Your Plan?

If you're unsure how these formulary changes impact your workforce, connect with your benefits provider or pharmacy benefits manager to review your options and communicate next steps with employees.