newsio aggregates and links to original sources. We do not own the original images or content. If you believe content infringes on intellectual property rights, contact us — it will be removed at first notice.
biotech/news//Spokane Spokesman-Review
More than 10 million US patients will regain easy access to Zepbound through insurance.
CVS Health will restore insurance access to Zepbound for over 10 million US patients after price cuts.
KEY POINTS
Starting October 1, both Zepbound and Wegovy will have equal co-pay status on Caremark's standard formulary.
Lilly's new weight-loss pill Foundayo will join certain formularies on June 1, now covered by all major PBMs.
The policy change is projected to reduce health plan obesity drug costs by 10% to 15%.
Lilly stopped using Caremark for its employee benefits after last year's restrictive move, switching to Riteway.
More than 10 million US patients will regain easy access to Eli Lilly & Co.’s obesity shot Zepbound through insurance after CVS Health Corp. reversed a controversial decision to restrict it for certain drug plans.
The reversal comes after Lilly agreed to cut the price it charges many health plans for Zepbound, a spokesperson for CVS said. In July, CVS’ Caremark drug benefit unit, which negotiates medicine prices for insurance plans, began restricting access to Zepbound because of a deal with rival Novo Nordisk A/S that secured a better price for Wegovy.
The agreement pushed more patients to Novo’s drug Wegovy, which is part of the same class of medications, but is less effective than Zepbound and treats some different diseases.
Starting October 1 of this year, Zepbound and Wegovy will be on equal footing, CVS said. Both will be available for the same co-pay in health plans that use Caremark’s standard formulary and cover obesity drugs.
Lilly’s new weight-loss pill Foundayo will also be available for certain plans starting June 1.
The change means Foundayo is now covered by all three major pharmacy benefit managers, “a meaningful positive development for Lilly’s obesity medicine coverage,” said Leerink Partners analyst David Risinger.
CVS declined to share the lower price it negotiated for Zepbound. The drug’s US list price is more than $1,000 a month, though health plans generally pay less, and Lilly offers steep discounts to patients who pay in cash as well as to certain employers through a program called Employer Connect that launched earlier this year.
The change is expected to save health plans 10% to 15% on their obesity drug costs, a CVS spokesperson said.
Lilly shares climbed as much as 2.8% in New York. The stock had risen 16% this month through Wednesday’s close, sending the company’s market capitalization back above $1 trillion. CVS shares rose as much as 1.4%, while Novo shares fell as much as 2.4% in Copenhagen. The Danish drugmaker had gained 6.6% through Wednesday’s close.
Novo “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,” the company said in a statement.
A spokesperson for Lilly said effective treatment has been out of reach for too many people for too long, with the expanded coverage “giving patients and their doctors a real choice in how obesity is treated.”
Lilly and Novo have fiercely competed to dominate the weight-loss market with expensive, brand-name injections over the past few years, but that’s expected to slow down as patients turn to pills and generic shots become available in the US in the 2030s. Generic injections have already launched in other countries.
The deal between CVS and Novo last year favoring Wegovy over Zepbound was supposed to help the Danish drugmaker regain its lead in the obesity market that Lilly currently dominates. Lilly owns about 60% of the diabetes and obesity market, and most new patients today are asking for Zepbound - a slightly newer drug - over Novo’s Wegovy shot. That’s created challenges for Novo, which is hoping a new pill will help revive sales.
Pharmacy benefit managers like Caremark exert significant influence on which medications are available to patients. The industry says it uses that power to negotiate lower prices from pharmaceutical companies. But it also can interfere with patient care by making it more difficult for patients to get the drugs that healthcare providers prescribe.
The decision to restrict Zepbound on certain plans had significant consequences for some patients who found switching to another medication disruptive. It was challenging for patients who had been using Zepbound to treat conditions for which Wegovy is not approved, like sleep apnea. Some of those patients were able to get Mounjaro instead, which is also made by Lilly and has the same pharmaceutical ingredients as Zepbound, but is approved for diabetes and not weight loss or sleep apnea.
“Resumed Caremark coverage for Zepbound may limit a prior competitive edge for Novo, which leveraged preferred placement on the template,” said BMO Capital Markets analyst Evan Seigerman.
Lilly said that last year’s move took a bite out of Zepbound prescriptions in the month of July, but overall, it had little impact on the drug’s momentum. Sales surged to $13.5 billion in 2025 and are on track to surpass that this year.
It did, however, dent CVS’ business. Lilly had been using Caremark to manage drug benefits for its own 50,000 employees, but switched to a privately-held pharmacy benefits manager called Riteway in November.