CVS Caremark Restores Coverage for Lilly’s Zepbound

CVS Caremark will once again cover Zepbound after removing the obesity treatment from its formulary last year, a decision that triggered widespread criticism from patients and a pending class-action lawsuit.

Drugmaker Eli Lilly announced Thursday that Zepbound will return to CVS Caremark’s standard formulary by Oct. 1, potentially restoring insurance access for millions of Americans seeking weight loss treatment.

The pharmacy benefits manager, one of the largest in the United States, determines which medications are covered through insurance plans and how much patients pay out of pocket.

Patients pushed back after Zepbound removal

CVS Caremark’s decision last year to stop covering Zepbound sparked strong backlash from patients who said they were forced to switch to rival obesity drug Wegovy despite reporting better results with Lilly’s treatment.

The controversy led to a class-action lawsuit filed in September that remains ongoing.

Zepbound carries a monthly list price of approximately $1,086 before discounts. Although Lilly offers savings programs for cash-paying customers, many patients still face monthly costs of several hundred dollars.

According to Lilly, some privately insured patients could pay as little as a $25 copay once the drug returns to the CVS Caremark formulary.

Foundayo weight loss pill also added

Lilly also confirmed that Foundayo, its recently approved weight loss pill, will be added to CVS Caremark’s formulary starting next week.

The oral medication received approval in April and represents Lilly’s latest expansion into the fast-growing obesity treatment market.

A CVS Caremark spokesperson said the formulary changes affect its standard coverage list, which reaches an estimated 25 million to 30 million people nationwide.

Coverage still depends on employers

Even with formulary inclusion, coverage is not guaranteed for every patient. Employers that sponsor health insurance plans often make the final decision about whether weight loss medications are included in benefits packages.

Still, appearing on a major pharmacy benefit manager’s formulary significantly increases access and affordability for patients.

The two other major pharmacy benefit managers in the U.S. — Express Scripts and Optum Rx — already provide coverage for Zepbound.

The reversal by CVS Caremark reflects the growing demand for obesity medications as weight loss drugs continue reshaping the pharmaceutical and healthcare industries.