CVS Caremark, the pharmacy benefit management arm of CVS Health, has announced that it will remove Eli Lilly’s weight-loss drug Zepbound from its standard formulary effective July 1, 2025. This decision means that Zepbound will no longer be covered for many patients whose insurance plans utilize CVS Caremark’s standard drug list. The move comes after CVS secured more favorable pricing terms with Novo Nordisk for its competing drug, Wegovy .
The primary reason appears to be cost. CVS Caremark negotiated better pricing with Novo Nordisk for Wegovy, leading to its preference over Zepbound on the formulary. This shift is part of a broader trend where pharmacy benefit managers are leveraging competitive pricing to manage escalating drug costs .
Despite Zepbound’s strong sales performance—reporting $2.31 billion in the first quarter of 2025—Eli Lilly’s stock experienced a decline following the announcement, reflecting investor concerns over the potential impact on future revenues .
If you’re currently prescribed Zepbound and your insurance is through CVS Caremark, consider the following steps:
Before the formulary change takes effect, ask your healthcare provider to prescribe a 90-day supply of Zepbound. This approach can help you maintain continuity in your treatment while exploring alternative options or awaiting potential formulary updates .
Eli Lilly is reportedly seeking to renegotiate terms with CVS Caremark, which may lead to Zepbound’s reinstatement on the formulary under stricter conditions. These could include mandatory participation in lifestyle modification programs as a prerequisite for approval .
To proactively address this, consider using tools like the Semaglutide App, which can help track diet, exercise, and other health metrics. Such documentation may be valuable in meeting future prior authorization criteria.
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The removal of Zepbound from CVS Caremark’s formulary underscores the dynamic nature of drug coverage decisions, often influenced by pricing negotiations and cost-management strategies. Patients affected by this change should engage with their healthcare providers promptly to discuss alternative treatments and strategies to ensure uninterrupted care.
Staying informed and proactive is key to navigating these changes effectively.