I recently received notice from Aetna (the insurance company which is owned by CVS Health) that on July 1, 2025, its Pharmacy Benefit Manager (PBM) known as CVS Caremark was making some changes to the drugs covered under its pharmacy benefits plan (specifically for the formulary known as Advanced Control Plan-Aetna). However, because I live in New York State, it also means those drug coverage changes will not affect me personally until my plan's actual renewal date, which is on June 1, 2026. By that time, my insurance carrier may have changed anyway.
CVS Caremark lost its rein as the biggest PBM to rival Cigna's Express Scripts this year. The reason is because in 2025, CVS Caremark lost Centene as a major insurance client (to Cigna's Express Scripts). That loss contributed to Express Scripts (see https://www.drugchannels.net/2025/03/the-top-pharmacy-benefit-managers-of.html for more on that market-share switch among PBMs) overtaking Caremark in PBM market share (it doesn't take much to change rankings given how consolidated the PBM industry is).
For me, the most notable among the change in the Advanced Control Plan-Aetna formulary is that OneTouch-branded blood glucose testing supplies (including either Verio or Ultra test strips; the Lifescan business selling the OneTouch brand of testing supplies has been owned by the private equity firm known as Platinum Equity since 2018) are being reclassified by Caremark as "Non-formulary; not covered" and instead, Caremark will instead "prefer" Roche Accu-Chek testing supplies instead. Over the years, I've been non-medically switched by PBMs to different brands of testing supplies, as well as different brands of insulin. Insulin changes are a major pain in the @$$, but testing supply change are less of a hassle. As a result, the switches have been less intrusive as they once were as I already have meters for all the major brands. All I need is fresh batteries for the old meter, and voila: I'm ready.
But one other element which is worth acknowledging is that on November 14, 2022, as part of a partnership with Roche Diabetes Care (see the announcement at https://www.accu-chek.com/news/roche-and-mark-cuban-cost-plus-drug-company-team-deliver-affordable-access-diabetes-testing for details), the Mark Cuban Cost Plus Drug Company started carrying Accu-Chek diabetes testing supplies. Most of the company's major pharmacy retailers are with supermarket chains which still operate pharmacies in-store (and there happens to be one which is not really too far away from me, although I am also OK with mail order to acquire testing supplies, just not so much on insulin; as shipments are sometimes known to sit in hot 100+ degree or literally freezing warehouses for several days and those extreme temperatures can destroy insulin). The Cost Plus Drug Company partnership also means I'll be able to use preferred formulary brand products, but I'll be able to buy them for cash for much less money until my deductible has been satisfied.
I have also discovered that even when PBMs switch their "preferred" brands but there is some unique state law exemptions (as is my case), the PBM is often more-than-happy if a patient actually switches to the PBM's new "preferred" brands. On test strips, it really does not really matter very much to me, although among meters themselves, I actually prefer the Accu-Chek "Guide" system (not the "Guide Me" system which is the PBMs' default Accu-Chek meter because it costs them half as much money), but the more costly "Guide" meter has an illuminated LED light where the strips are inserted making it easier to use.
Roche Accu-Chek has a few different meters (along with test strips for each) which would be covered, but my preference is to use the Accu-Chek "Guide" meter (as opposed to the default "Guide Me" meter which costs about half as much money) because the "Guide" meter features a lighted test strip port & backlit display, making it more convenient to test in low-light situations.
Of course, the cases for the Accu-Chek "Guide" meter are made of flimsy nylon, but they are also small that they take-up considerably less space in the bag I carry around. On the upside: one nice thing is the package for Accu-Chek Guide test strips is easier for patients to remove test strips from the package they come in, so that's a plus. That was the result of a conversation Roche had with patients (including me) with the company back in 2009 (catch my coverage of that at https://blog.sstrumello.com/2009/07/my-spin-on-roche-summit.html). I never thought much would come from those conversations, and yet this is a concrete example that the company actually listened to patients at the event!
Another thing which occurred at the Roche-patient meetings was the realization among company executives that the rebate-contracting sales model promoted by the big PBMs was actually harming patients. Apparently, that realization led to the aforementioned Roche-Mark Cuban Cost Plus Drug Company initiative.
Of course, the consolidated commercial healthcare insurance companies and the PBMs they own and operate are doing their own thing, often at the expense of patients, for example, in its most recent announcement, CVS Caremark reclassified many drugs as "specialty" pharmaceuticals when there is nothing which is special about those cheap generic drugs. The U.S. Federal Trade Commission Second Interim Report on PBM Business Practices documented that sleazy PBM practice. The good news is that for certain of those drugs, patients can buy them for more than 1000% LESS than CVS Caremark's Specialty Pharmacy. A great example is the prostate cancer drug known as Abiraterone Acetate (the generic for Zytiga). A report by HealthUnlocked cited one patient's experience where their insurance was charged $9,650 per month for generic Abiraterone Acetate through CVS Caremark's "Specialty" Pharmacy. By comparison, Mark Cuban Cost Plus Drug Company charges just $51 for the exact same medication. The FTC is suing CVS Health (as well as United Healthcare-OptumRx and Cigna-Evernorth/Express Scripts) over these corrupt business practices, although as I documented, the case is currently "on hold" until there are judges who can rule on the case
For me, the change in the PBM's preferred test strip brand is a minor inconvenience. Because I have struggled to get a prior authorization for a larger quantity of test strips for longer than 6 months, I have already been bypassing insurance to buy Accu-Chek testing supplies anyway. But such routine non-medical switching has become an annoyance. Fortunately, I've dealt with it previously and know the game better than CVS Caremark at this point.
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