The top pharmacy benefit manager (PBM) in the U.S., CVS Caremark, will restore coverage to obesity products from Eli Lilly, allowing a significant number of patients to gain access to the drugs through their existing insurance.
CVS will begin covering Lilly’s GLP-1 pill Foundayo on Monday of next week, June 1, while coverage of Lilly’s injected treatment Zepbound begins on October 1. CVS Caremark, which is the pharmacy chain’s drug benefits unit, is the largest PBM in the country.
CVS previously covered Zepbound until Lilly’s market rival Novo Nordisk struck a formulary access deal with the retail giant that kicked in on July 1 of last year and made Wegovy CVS’s preferred treatment for obesity. The decision to drop Zepbound from its list of covered drugs triggered a class-action lawsuit from users of Lilly’s product who disputed CVS’s claim that Zepbound and Wegovy were interchangeable.
“While GLP-1s represent a major clinical advancement, the broad demand for a high-priced medicine creates a level of financial strain that is difficult to absorb at scale,” CVS explained in a release. “As a result, many of our customers have made tough trade-offs, limiting coverage in order to maintain sustainable, balanced benefit programs. Ongoing collaboration with pharmaceutical companies is helping to make this in-demand drug class more accessible.”
In a statement, Novo Nordisk's SVP of market access & public affairs and patient support solutions, Tom Scales, pointed out that both versions of Wegovy—pill and injection—will retain “preferred status” across CVS’s formularies and that patients currently on Wegovy can remain on the GLP-1 treatment without interruption.
“As CVS Caremark adds other weight loss medications to their formulary, in addition to Wegovy, Novo Nordisk supports the opportunity for patients seeking care for obesity and the prescribers who treat them to have flexibility in choosing an option that makes the most sense for them,” Scales added.
The adjustment is a key win for Lilly as it continues to put distance between itself and Novo, despite the Danish company’s first-to-market edge. The FDA approved Wegovy in 2021 and signed off on its oral version in December of last year. Zepbound reached the market in late 2023, followed by Foundayo last month.
‘For too long, effective obesity treatment has been out of reach for the people who need it,’ Ilya Yuffa, president of Lilly USA and global customer capabilities, said in a release. “Not all medicines work the same way for patients. Broader coverage puts real choice in the hands of millions of Americans and their doctors.”
For eligible patients with commercial coverage, Zepbound and Foundayo will be available for $25 a month. Additionally, those on Medicare Part D may also be eligible to pay $50 per month for any of Lilly or Novo’s obesity medicines through the Medicare GLP-1 Bridge program. The initiative, which was announced earlier this month, begins on July 1 and runs through the end of 2027.
“The addition of Foundayo to CVC Caremark’s commercial template coverage is expected to further bolster its early launch momentum,” analysts from Citi wrote in a note to clients. “With a more streamlined process coming soon for commercial insurance patients, more extensive coverage lowers hurdles and further adds to the volume inflection that is expected from broad Medicare Part D access.”
Citi also pointed out that “payer coverage continues to be the primary barrier to GLP-1 access and is the leading cause of discontinuations.”
Lilly said that its obesity drugs are now covered by the top three PBMs, which also include Express Scripts and OptumRx.
“We’re creating access and options that would not have existed without our leadership in the market,” Ed DeVaney, the President of CVS Caremark, said in its release. “We acted boldly through active engagement and negotiation with our drug manufacturer partners to tackle affordability and access for our customers and their members.”