CVS Caremark will reinstate coverage for the weight loss drug Zepbound, effective October 1, following its removal from the formulary last year. Drug manufacturer Eli Lilly announced the decision on Thursday, which comes after patients expressed dissatisfaction with being forced to switch to the competing drug Wegovy. The reinstatement of Zepbound may allow some patients with private insurance to pay as little as a $25 copay, despite a monthly list price of $1,086. Lilly also revealed that Foundayo, a new weight loss medication approved in April, will be included in CVS Caremark’s formulary starting Monday. While this change affects approximately 25 to 30 million individuals, coverage is not guaranteed for all insurance plans, as employers ultimately decide on medication coverage.
Why It Matters
The coverage of Zepbound by CVS Caremark is significant as it impacts millions of patients who rely on pharmacy benefit managers (PBMs) for medication access and affordability. Last year, CVS’s decision to remove Zepbound led to a class-action lawsuit, highlighting the potential consequences of formulary changes on patient care. Zepbound’s reinstatement comes at a time when weight loss medications are in higher demand, and the decision aligns CVS with other major PBMs, such as Express Scripts and Optum Rx, which already cover the drug. The outcome of these changes may influence the future landscape of weight loss treatment options and insurance coverage in the U.S.
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