CVS Caremark picks Wegovy over Zepbound for its biggest commercial drug lists
From July 1, 2025, many people on CVS Caremark commercial plans will find Wegovy covered and Zepbound off the standard list, a change that affects which obesity drug gets paid for.
Novo Nordisk has locked in the preferred spot for Wegovy on CVS Caremark's largest commercial template formularies, effective July 1, 2025, pushing Eli Lilly's Zepbound off those covered-drug lists [1]. CVS Caremark runs the pharmacy benefits business of CVS Health and is the largest pharmacy benefit manager in the country, as Novo pointed out [1]. A CVS spokesperson told Bloomberg News that Zepbound "will be excluded" from plans that use the standard list of covered drugs [1].
Prem Shah, CVS Health's executive vice president and group president, said on the company's earnings call that the formulary involved reaches "tens of millions of lives" [1]. People already taking Zepbound under affected plans can move to Wegovy, or in some cases seek an exemption for medical need reviewed case by case, the CVS spokesperson said [1].
Wegovy's active ingredient is semaglutide and Zepbound's is tirzepatide, so the two are separate products, not interchangeable versions of one drug [2]. Both are started at a low dose and increased gradually [2].
Under the agreement, Novo is letting CVS sell Wegovy to cash-paying customers for $499 at more than 9,000 U.S. locations [1]. That matches the monthly price Novo set in early March through its NovoCare Pharmacy, which mails the drug to self-paying patients at $499 for all five dosage strengths, against a list price of $1,349 per package [1]. Novo later extended the $499 rate to certain out-of-pocket patients filling prescriptions at regular drugstores [1]. Lilly made a similar move in late February, cutting single-dose Zepbound vials to $349 a month at the 2.5-mg strength and $499 at the 5-mg strength [1].
The same week, Novo announced partnerships with the telehealth companies Hims & Hers, LifeMD and Ro. Hims & Hers is offering a $599 monthly bundle that includes prescriptions for every Wegovy dose along with round-the-clock care, clinical support and nutrition guidance, while Ro and LifeMD will offer Wegovy at $499 a month alongside weight-management programs [1]. Those deals followed a dispute between Novo and Hims & Hers over the latter's sale of compounded semaglutide during a shortage [1].
Lilly CEO David Ricks told analysts on his company's first-quarter earnings call that he was "not surprised this kind of thing was announced" [1]. He said the private pay market matters to Lilly and that he wants the company to grow there while offering more choice to people who pay out of pocket [1]. Novo's executive vice president of U.S. operations, Dave Moore, said in a statement that Novo has a "responsibility" to work with others across the U.S. health care system and connect patients with "authentic, FDA-approved Wegovy" in a convenient and affordable way [1].
One state employee plan shows how the transition can play out. The Massachusetts Group Insurance Commission, whose non-Medicare members get prescriptions through CVS Caremark, said Zepbound leaves its formulary on the same July 1 date, with Wegovy becoming the preferred obesity option; other covered choices in the category include orlistat, Qsymia and Saxenda [2]. Members who already tried Wegovy and either could not tolerate it or lost too little weight may request a formulary exception covering tirzepatide, and prescribers could begin filing those requests on June 16, 2025 [2]. An approved exception means a tier 3 copay for Zepbound, while Mounjaro stays at tier 2 [2].
Why it matters for patients
The covered drug can change on July 1, 2025, including for adults who already hold a prescription and a prior authorization [1][2]. The Massachusetts commission said an active Zepbound prior authorization carries over to Wegovy without a new one, and existing overrides will be transitioned; the Zepbound approval still expires on its original date, and covering Wegovy after that requires a new prior authorization [2]. Coverage for Zepbound's obstructive sleep apnea indication is also ending there, and all members, whatever the reason for treatment, must try and fail Wegovy before tirzepatide can be covered [2]. Members with diabetes taking Mounjaro are not disrupted, and a formulary change is not a qualifying event that allows someone to switch or drop a medical plan, the commission said [2].
The commission told members that controlled trials may show Zepbound produces greater weight loss while real-world evidence suggests the two perform comparably, and it noted that semaglutide is currently the only drug in the class approved by the FDA 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 are still under investigation [2]. Wegovy is not FDA-approved for obstructive sleep apnea [2].
Cost depends on coverage. A cash payer can get Wegovy at $499 a month at CVS stores [1]. Someone who loses Zepbound coverage and is denied an exception would owe the full price of that drug [2]. The commission said direct-transition data is limited, that both drugs require titration, and that the starting Wegovy dose is up to the prescriber [2].
What happens next
Prescribers can begin submitting formulary exception requests for tirzepatide to CVS Caremark on June 16, 2025, according to the Massachusetts commission [2]. The formulary change and the Zepbound exclusion take effect July 1, 2025 [1][2]. Novo has not disclosed how many plans or members sit under the specific template formularies involved beyond CVS Health's statement of "tens of millions of lives" [1], and no count has been reported of how many people currently taking Zepbound will be moved [1][2].
Sources
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