CVS Caremark will reinstate coverage for the weight loss drug Zepbound this year, following its removal from the list of covered medications last year, according to the manufacturer Eli Lilly. This decision is significant as CVS Caremark is one of the largest pharmacy benefit managers in the United States, influencing which drugs millions can obtain through insurance and the costs they must pay.
The previous removal of Zepbound from CVS Caremark’s formulary led to complaints from patients. Many said they had to switch to Wegovy, a competitor’s drug from Novo Nordisk, even though they had seen better results with Zepbound. Importantly, patients using Lilly’s diabetes drug Mounjaro, which has the same active ingredient as Zepbound, were not affected.
A class-action lawsuit against the removal of Zepbound was filed in September and remains ongoing. The drug has a monthly list price of $1,086, though Lilly provides discounts for cash payments. Still, patients can pay hundreds monthly for the medication.
Eli Lilly announced that Zepbound will return to CVS Caremark’s formulary by October 1, with some privately insured patients potentially paying a $25 copay. Additionally, Foundayo, Lilly’s new weight loss pill approved in April, will also be listed starting Monday.
A spokesperson for CVS Caremark indicated that this change impacts around 25 to 30 million people. However, being included in the formulary does not ensure coverage by every insurance plan, as employers ultimately decide on medication payments. Notably, rival pharmacy benefit managers Express Scripts and Optum Rx already provide coverage for Zepbound.
Test Your Understanding
How much do you know?
