CVS Caremark drops Zepbound from standard formularies, making Wegovy preferred for weight loss

CVS Caremark will stop covering tirzepatide (Zepbound) for weight loss on its standard formularies and make semaglutide (Wegovy) the preferred GLP-1 for obesity treatment. The change took effect July 1, 2025 ^[1][3].

CVS Caremark, which manages prescription drug benefits for more than 25 million to 30 million Americans, announced the decision on May 1, 2025 ^[3]. The move applies to the obesity indication only. Tirzepatide remains available as Mounjaro for people with type 2 diabetes, and members already taking Mounjaro were told they would see no disruption ^[1][3].

CVS said the change would save employer clients 10% to 15% year over year compared with the previous year ^[2]. "The egregiously high list prices set by drug manufacturers of GLP-1s for weight loss are the single biggest barrier to patient access," CVS Health said in a statement. "Our formulary strategy maintains clinically appropriate coverage while using competition to drive lower costs" ^[2]. In a letter to members, CVS wrote: "This change is happening because there's another covered medication that's safe and effective for your condition and may cost less" ^[2]. Novo Nordisk said at the time that it did not ask CVS Caremark to block its competitor ^[2].

People already taking Zepbound could ask for a formulary exception. Under the Massachusetts Group Insurance Commission, whose non-Medicare plans use the CVS Caremark formulary, prescribers could start submitting exception requests on June 16, 2025, ahead of the July 1 effective date ^[1]. Existing prior authorizations for Zepbound, including those approved for obstructive sleep apnea, were set to transfer to Wegovy, and members would have to try and fail Wegovy before tirzepatide could be covered ^[1]. Members who do not get an exception can still fill a Zepbound prescription but pay the full cost ^[2]. Eli Lilly's LillyDirect program lists a single-dose Zepbound price of $499 a month, and list prices for the drugs can exceed $1,000 a month ^[2].

The two drugs are not identical. CVS said controlled trials may show Zepbound to be more effective for weight loss, but that real-world evidence suggests the two are comparable ^[1]. Two studies — one funded by Zepbound's manufacturer and one that was not — found Zepbound produced more weight loss than Wegovy ^[2]. Wegovy is the only drug in the class with FDA approval to reduce the risk of major cardiovascular events, such as heart attack, stroke and cardiovascular death, in adults with established heart disease; cardiovascular outcomes for tirzepatide were still under investigation at the time of the change ^[1].

Shares of Eli Lilly closed down nearly 12% after the announcement ^[4]. Lilly reported first-quarter revenue up 45%, with Zepbound sales quadrupling to $2.31 billion and Mounjaro more than doubling to $3.84 billion, but did not raise its full-year revenue forecast ^[4]. Lilly chief executive David Ricks said he was "not surprised" and that the company was "not interested at all in one of one deals ... reducing access and choice for doctors and patients" ^[4].

Prescribing data from Truveta, covering 1,647,238 patients and 6,059,445 GLP-1 prescriptions from January 2024 through July 2025, show how quickly the shift moved. Tirzepatide prescribing for obesity had been growing by an average of 0.06 percentage points a month; from June to July 2025 it grew 0.03 points. Semaglutide for obesity rose 0.1 points in that month — its largest one-month gain in the study period, against an average of 0.02 points a month before ^[3]. First-time semaglutide prescriptions rose 4.9%, while first-time tirzepatide prescriptions fell slightly for the first time in nearly a year ^[3]. Truveta said the timing coincided with the formulary change but that the analysis did not evaluate causality ^[3].

Why it matters for patients

Which GLP-1 a person can get at a covered price now depends heavily on which pharmacy benefit manager and employer plan they are under. For people on CVS Caremark plans, staying on Zepbound means switching to Wegovy, requesting a formulary exception with documentation from a prescriber, or paying out of pocket ^[1][2]. Switching is not a simple one-for-one swap. Both drugs require titration, starting low and increasing as tolerated, and the starting Wegovy dose varies by individual; clinical data on direct transitions is limited, according to CVS guidance ^[1].

The change also covers Zepbound's approval for obstructive sleep apnea, even though Wegovy had not been FDA-approved for that use at the time ^[1]. It is one of several coverage shifts: Blue Cross Blue Shield of Massachusetts was reported to be planning to remove all GLP-1s for weight loss and cover them only for type 2 diabetes ^[2]. Some employers have stopped covering GLP-1s for weight loss entirely, while the Massachusetts plan continued to cover them ^[1][2].

What happens next

• June 16, 2025: Prescribers can begin submitting formulary exception requests for tirzepatide ^[1].
• July 1, 2025: Zepbound is removed from CVS Caremark's standard formulary for obesity, and Wegovy becomes the preferred option ^[1][3].
• Novo Nordisk's first-quarter financial results were scheduled for May 7, 2025 ^[4].
• The date for Blue Cross Blue Shield of Massachusetts to drop GLP-1 coverage for weight loss has not been reported ^[2].