CVS Health announced Thursday it will restore coverage of Eli Lilly’s Zepbound and add Lilly’s newly approved obesity pill, Foundayo, to its standard drug plans. The changes take effect Oct. 1 for Zepbound and June 1 for Foundayo, expanding access to treatments for millions of Americans. The move follows a year-long shift in coverage that previously favored Novo Nordisk’s Wegovy over Lilly’s drug.
CVS Expands Access to GLP-1 Medications
Both Lilly and Novo Nordisk’s GLP-1 drugs will now be co-preferred options on CVS Caremark’s standard commercial formulary. The formulary, used by 25 million to 30 million Americans, lists covered drugs that insurers and employers can adopt. Plan sponsors can still exclude GLP-1s for weight loss, but the update reflects broader industry efforts to increase competition and affordability.
Related: CNBC and Addepar launch Family Office Tracker
Last year, CVS struck a deal with Novo Nordisk to make Wegovy the preferred obesity treatment on its plans, leaving Lilly’s Zepbound with higher out-of-pocket costs for patients. This new arrangement aims to balance access by allowing both companies’ drugs to compete on equal footing.
CVS claims the changes will drive 10% to 15% additional savings in the weight management category. The company credits “successful continued pricing negotiations” with both Lilly and Novo Nordisk for lowering costs. Lilly called the expanded coverage a win for patients, emphasizing it gives doctors and patients “a real choice” in treating obesity.
Related: American Tests Positive for Ebola in Africa
Novo Nordisk Maintains Preferred Status
Novo Nordisk stated its Wegovy injection and newly launched pill will retain preferred status on CVS’ formularies. Patients currently on Wegovy can remain on the drug without interruption, according to the company. Lilly’s Foundayo, however, will now be covered by all three major pharmacy benefit managers, including Caremark.
As a pharmacy benefit manager, Caremark negotiates medication costs for employers, government entities, and health plans. Ed DeVaney, Caremark president, said the company acted “boldly” to improve access, calling its leadership a key factor in expanding treatment options.
Related: Walmart outlook suffers from high gas prices
The formulary update doesn’t guarantee coverage for all patients. Employers or insurers adopting the standard plan can still opt out of covering GLP-1s for weight loss. CVS said it will ensure a “smooth transition” for customers, providers, and members switching to newly covered therapies.
CVS’ decision highlights ongoing industry efforts to address rising drug costs. Both Lilly and Novo Nordisk have partnered with Caremark to negotiate pricing, though competition between the two companies remains fierce. The expanded coverage could shift market dynamics, but challenges in ensuring universal access persist.
Leave a Reply