CVS Health will return Eli Lilly’s weight-loss injection Zepbound to certain drug lists, the company said, restoring the medicine as an additional preferred option for insurance coverage. The reinstatement applies to CVS Caremark’s commercial formularies and is scheduled to take effect on October 1.
Caremark, the pharmacy benefit management unit of CVS, had removed Zepbound from its coverage lists on July 1 of last year. At the time it continued to reimburse for Novo Nordisk’s competing GLP-1 product Wegovy after negotiating a more favorable price for that drug with the Danish manufacturer.
In a separate change, Caremark will lift a new-to-market coverage block on Eli Lilly’s recently launched oral GLP-1 pill Foundayo, effective June 1, in instances where health plans have authorized coverage. The company described the new-to-market block as a policy that insurers and pharmacy benefit managers use to restrict coverage for newly FDA-approved medicines.
CVS framed the two decisions as measures intended to broaden access to GLP-1 weight-loss therapies while addressing cost concerns for employers and health plans. The company said the reinstatement of Zepbound and the removal of the block on Foundayo are aimed at offering employers and payers more options for GLP-1 treatments at a more affordable price point.
The popularity of GLP-1 medications for weight-loss and their elevated prices have prompted some employers and health plans to limit or discontinue coverage for these treatments. CVS has previously noted that many of its clients had been dropping coverage of GLP-1 drugs for obesity, a trend that has influenced payer formulary decisions.
Pharmacy benefit managers negotiate rebates and administrative fees with drug manufacturers, assemble lists of covered medicines known as formularies, and reimburse pharmacies when patients fill prescriptions under those plans. Caremark said it engaged with drug manufacturers to address affordability and access.
"We acted boldly through active engagement and negotiation with our drug manufacturer partners to tackle affordability and access for our customers and their members," said Ed DeVaney, president, CVS Caremark.
The timing and scope of the changes reflect CVS Caremark’s stated objective to provide employers and health plans with additional coverage options for GLP-1 weight-loss therapies while attempting to manage costs. Zepbound will resume a position on commercial formularies on October 1, and the Foundayo new-to-market block will be removed on June 1 where plans have approved coverage.
Context and next steps
Employers and health plans affected by formulary adjustments will see Zepbound listed again as an additional preferred option starting October 1. Where applicable, pharmacies will be able to dispense Foundayo under plan coverage after the new-to-market block is removed on June 1, assuming the health plan has already authorized coverage for that oral pill.