Executive Summary

Managing pharmacy costs in the diabetes category has become increasingly complex. While certain drug classes—particularly GLP-1 receptor agonists—have captured headlines, the broader category spans multiple high-cost therapeutic classes that contribute to overall cost trends.

Scripius takes a comprehensive approach to managing this category, focusing on achieving the lowest net drug cost across all diabetes therapies. For a commercial population, this approach has delivered measurable results. Per member per month (PMPM) spend increased from $6.28 in 2023 to $6.77 in 2024, representing a 7.8% year-over-year trend increase. In 2025, PMPM reached $7.09, with the trend slowing to 4.7%—a nearly 40% reduction in year-over-year trend growth1.

This performance compares favorably to national benchmarks, where diabetes-related drug spending is projected to grow at approximately 9 to 13% annually. These results underscore Scripius’ ability to manage complex drug categories through a coordinated, data-driven approach.

The challenge of high-cost diabetes therapies

The diabetes drug category includes multiple, high-cost therapeutic classes, including insulin, glucagon-like peptide-1 receptor agonists (GLP-1s), sodium-glucose cotransporter-2 (SGLT2) inhibitors, and dipeptidyl peptidase-4 (DPP-4) inhibitors. 

Market growth continues to accelerate, driven by rising disease prevalence, increased utilization, and newer therapies entering the market. While GLP-1 medications have received significant attention due to rapid utilization growth, focusing on a single class does not address the broader cost challenge.

Effective cost management requires a comprehensive strategy that evaluates the full diabetes portfolio and identifies opportunities across all drug categories.

Case study: SGLT2 strategy and the removal of Jardiance

One of the most significant cost-saving opportunities in the diabetes category is in the SGLT2 inhibitor class. In the third quarter of 2024, Scripius removed Jardiance from its commercial formulary and replaced it with lower-cost alternatives, including Brenzavvy, while maintaining Farxiga as a preferred option. Brenzavvy is a clinically comparable SGLT2 therapy available at a significantly lower cost.

To support this transition, Scripius secured reliable access to Brenzavvy through partnerships with Mark Cuban Cost Plus Drug Company and Intermountain Home Delivery Pharmacy, ensuring that members could access the therapy without disruption.

This change produced measurable results. Comparing 2024 to 2025, PMPM spend in the SGLT2 class declined from $2.48 to $2.23, representing a 10.2% reduction. 

“When we removed Jardiance as a preferred agent and replaced it with Brenzavvy, the anticipated savings were $1.6 million annually. But we have realized more than $3.4 million in savings with this commercial population.”

— Matt Mitchell, PharmD, FAMCP, MBA
Chief Pharmacy Officer, Scripius

Beyond SGLT2s: Managing costs across the diabetes category

Scripius applied similar strategies across multiple diabetes drug classes, contributing to measurable improvements in overall diabetes cost trends (see box).

Key actions included:

• DPP-4 optimization: Removed high-cost branded products from formularies and replaced them with lower-cost generic alternatives.
• Insulin access improvements: Expanded access to lower-cost insulin options, aligning with broader market changes that have made insulin more affordable.
• GLP-1 utilization management: Implemented strategies such as preauthorization requirements to confirm appropriate use.

Scripius actively manages these and other cost drivers to improve overall diabetes cost performance.

The lowest net cost approach

Scripius applies a lowest net cost framework across the diabetes category, evaluating therapies based on clinical effectiveness, total cost after rebates, and long-term value.

Rebates remain part of the strategy but do not drive formulary decisions. Instead, Scripius prioritizes solutions that deliver measurable savings, supported by transparent pricing and clinical oversight. This approach enables rapid adoption of lower-cost, clinically appropriate alternatives.

“This change was part of a broader review of the diabetes category to identify cost-saving opportunities. We wanted to guide members toward clinically effective, lower-cost options while ensuring they had reliable access to those therapies.”

— Matt Mitchell

What this means for employers and health plans

For employers and health plans, the diabetes category highlights the importance of a comprehensive, data-driven approach to pharmacy benefit management.

By focusing on lowest net cost and addressing multiple therapeutic classes, Scripius demonstrates that a coordinated, class-wide approach can meaningfully reduce trend growth while sustaining appropriate access to care. These results translate into more predictable pharmacy spending and improved affordability for both plans and members.

Ready to learn more about Scripius? Talk to your pharmacy benefits consultant or contact us.

Email: MakeTheSwitch@Scripius.Org

Call: 801-442-3117

1. TII Diabetes and GLP1s for Commercial FI, December 2025, Corey Reinig, ASA, MAAA and Jeff Klein, FSA, MAAA