Merck Lowered the Price of Januvia—Insurers Dropped It from Formularies

In a move that should have been great news for patients, Merck significantly reduced the price of its blockbuster diabetes drug, Januvia (sitagliptin). However, instead of benefiting from the savings, many insured patients are discovering that their insurance plans no longer cover it.

The culprit? Pharmacy Benefit Managers (PBMs)—powerful intermediaries that negotiate drug prices on behalf of insurance companies—have removed Januvia from their formularies. Those same powerful intermediaries are the latest in the hot seat for their predatory behavior in the United States health system. PBMs have been found to make coverage decisions based on their financial incentives rather than patient access to affordable medication.

What happened to Januvia's cost?

Januvia, approved by the U.S. Food and Drug Administration (FDA) in 2006, became a blockbuster drug for Merck, generating billions in revenue. For years, the out-of-pocket price of Januvia hovered around $600 per month, a cost largely influenced by Merck’s wholesale acquisition costs (WAC). Despite this high list price, insured patients typically paid low copays because their insurer’s PBM happily negotiated rebates with Merck to include the drug on their preferred formularies. 

In January 2025, Merck slashed the wholesale acquisition cost of diabetes drug Januvia by 42% -- a move likely made in anticipation of Medicare-negotiated pricing taking effect in 2026.

Instead of embracing this change (recall their profit motive), one of the largest PBMs, CVS Caremark, responded by removing Januvia from their formulary, effectively blocking insurance coverage for it. 

Why Would PBMs Drop a Lower-Priced Drug?

PBMs claim to make formulary decisions based on clinical effectiveness and cost-effectiveness, but their business model depends on high list prices and rebate-driven profits. Here’s how:

• Rebates & Spread Pricing

PBMs negotiate large rebates from drug manufacturers in exchange for formulary placement. A higher list price means a bigger rebate. When Merck cut Januvia’s price, the rebate revenue disappeared.

• Steering Patients to More Expensive Alternatives

PBMs can push patients toward drugs with higher list prices and larger rebates, even if they offer no added clinical benefit.

• Preserving PBM Revenue Streams

If manufacturers lower list prices across the board, PBMs stand to lose billions in rebate revenue.

Pearl Freier, president of Cambridge BioPartners Inc., suggests that CVS Caremark may have dropped Januvia because another manufacturer offered a larger rebate for a competing drug. She writes that “[patients] can try to switch to another insurance/formulary that covers Januvia but whether they can do that may depend on what their employer wants to do…”

"Some of you saw that Merck lowered the list price on their Type 2 diabetes drug Januvia by 42%. See below for prescription drug insurance/PBM that dropped the drug in Nov from the formulary/insurance coverage & is recommending a lesser known diabetes drug instead cc @A_Ciaccia https://t.co/yF80S3AAFA"

— Pearl Freier (@PearlF) January 25, 2025

Thankfully, Express Scripts and OptumRx – both large PBMs – appear to have kept Januvia on their 2025 preferred formulary.

Patient Backlash and the Impact of PBM Decisions

Patients have taken to social media to voice their frustration. One X user shared: 

“Yesterday my insurance decided I don’t need Januvia for my diabetes anymore. I’ve been on it for years, and now it’s going to be $600 a month.”

A Bluesky user and type 2 diabetic shared that their new insurance company denied coverage for both Mounjaro and Januvia:

"They denied BOTH the Mounjaro and Januvia. [expletive] hate it here."

— Amie (@amiemiller.bsky.social) March 1, 2025 at 1:47 PM

A Threads user wrote that their prior authorization for Januvia was denied last month. 

Another found that their new insurance denied coverage for their antidepressants and then Januvia starting March 31st. 

Commenting on Medicare’s announcement of its selection of the next 15 drugs eligible for Medicare drug price negotiation, one person expressed fears that the selected drugs would undergo huge price increases prior to the implementation of the negotiated price, citing their own experience of an increase to $900 for a three-month supply of Januvia this year. 

This fiasco highlights how PBMs have too much control over drug access and pricing in the U.S. Instead of passing savings directly to patients, PBMs make decisions based on their profit incentives, not public health, a fact that does not absolve pharmaceutical companies and their own scheme of inflated profiteering. 

Another X user wrote that every time he picks up Januvia for a family member, he thinks about the late UnitedHealthcare CEO Brian Thompson's fate “for no apparent reason” – an unsettling reflection of the failures within our healthcare system.

"every time i pick up januvia for a family member, i think about brian thompson's fate for no apparent reason"

— Roger Sheng (@roger_sheng) February 24, 2025

The picture is certainly grim. 

How are patients supposed to afford Januvia now? 

If you are prescribed Januvia and are finding difficult to afford, PharmacyChecker recommends patients in the United States take the following steps:

1. Consider the generic or another therapeutic alternative.

A generic version of Januvia (sitagliptin) was approved by the FDA in 2023. Manufacturers including Teva, Aurobindo, and Viatris (Mylan) have received approval, but due to patent settlements and market exclusivity agreements, availability and pricing remain limited. To save on out-of-pocket costs, compare sitagliptin prices on PharmacyChecker.com.

2. Check eligibility for manufacturer copayment cards and patient assistance programs.

Resources: NeedyMeds, RxAssist, HealthWell Foundation, Patient Access Network Foundation

If you believe you may be eligible for patient assistance programs, we encourage you to explore those alternatives before resorting to cash pay.

3. Compare U.S. discount coupons and international pharmacy cash prices 

PharmacyChecker.com allows users to compare both international mail-order prices and U.S. pharmacy discount coupons, helping patients maximize their savings on both brand-name and generic drugs.

Related: How Patients Can Save on Prescription Drug Costs in 2025

Final Thoughts

Merck’s price cut – although taking place two decades after massively profiting off of Januvia – should have been a win for patients. Instead, PBMs have demonstrated once again how their business model harms consumers and keeps drug costs artificially high. Until meaningful PBM reform happens, patients will continue to struggle with access to the medications they need—regardless of whether drugmakers lower prices.