CVS Caremark, Express Scripts and Optum Rx — the three largest pharmacy benefit managers in the U.S. — each excluded more than 600 drugs from their 2025 formularies, according to an April 1 blog post from the Drug Channels Institute.
The analysis is based on a review of the 2025 formulary exclusion lists published by the three PBMs, along with pricing data and publicly available product information for biosimilars and branded drugs.
Notably, PBMs are prioritizing their own private-label biosimilars over both brand-name biologics and most other biosimilar competitors. For example, they excluded nearly all Humira biosimilars in favor of private-label versions this year.
Overall, the number of products on PBMs’ exclusion lists has sharply increased since 2012, though the rate of growth has slowed over the past few years.
“The growth in excluded products shows how competitive many therapy categories have become — and the undisclosed but presumably significant rebates generated by these products,” the Drug Channels Institute said.
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