CVS Caremark will resume covering the weight loss drug Zepbound this year after it removed it from its list of covered medications last year, drugmaker Eli Lilly said Thursday.
CVS Caremark is one of the country’s largest pharmacy benefit managers, deciding which medications millions of people in the U.S. can get through insurance and how much they pay out of pocket.
The decision to remove Zepbound from CVS Caremark’s list of covered drugs, or formulary, last year sparked backlash from patients, who said they were forced to switch to rival drug Wegovy, from Novo Nordisk, despite having gotten better results on Zepbound. The move did not affect patients taking Lilly’s diabetes drug Mounjaro, which contains the same active ingredient as Zepbound.
A class-action lawsuit challenging the decision was filed in September and remains active.
Zepbound has a monthly list price of $1,086, although Lilly offers discounts for patients paying in cash. Even then, people can end up paying hundreds of dollars a month for the medication.
Lilly said Thursday that Zepbound will return to CVS Caremark’s formulary by Oct. 1 and that some patients with private insurance could pay as little as a $25 copay.
Foundayo, Lilly’s weight loss pill that was approved in April, will also be added to the list starting Monday.
A CVS Caremark spokesperson said the change applies to its standard formulary, affecting about 25 million to 30 million people.
Being added to the formulary does not guarantee the drugs will be covered by every insurance plan, since employers often make the final decision about whether to pay for the medications. But being on the list can make coverage more widely available.
The country’s two other major PBMs — Express Scripts and Optum Rx — already cover Zepbound.
