CVS Caremark names Wegovy its preferred obesity GLP-1, excluding Zepbound
Starting July 1, 2025, Wegovy replaces Zepbound as the preferred obesity drug on CVS Caremark's largest commercial formularies, affecting tens of millions of covered lives [1].
Novo Nordisk said on May 1, 2025, that its weight-loss drug Wegovy (semaglutide) will become the preferred GLP-1 for obesity treatment on CVS Caremark's largest commercial template formularies starting July 1 [1]. Eli Lilly's Zepbound (tirzepatide) will be excluded from health plans that use CVS's standard list of covered drugs, a CVS spokesperson confirmed to Bloomberg News [1].
CVS Caremark is the largest pharmacy benefit manager in the U.S. [1]. Prem Shah, executive vice president and group president of CVS Health, said on the company's earnings call that the formulary involved in the deal covers "tens of millions of lives" [1].
The deal also covers cash-paying customers. Novo is allowing CVS to sell Wegovy for $499 per month to people paying out of pocket at its more than 9,000 U.S. locations [1]. That mirrors the price Novo set in early March when it launched NovoCare Pharmacy, which ships Wegovy directly to cash-paying patients for $499 per month across all five dose strengths — well below the list price of $1,349 per package [1]. Lilly made a similar move in late February, cutting its 2.5-mg single-dose Zepbound vials to $349 per month and its 5-mg vials to $499 [1].
What the switch looks like on the ground
The Massachusetts Group Insurance Commission (GIC), whose non-Medicare drug benefits are administered by CVS Caremark, published a detailed explanation of how the change works for its members [2]. The GIC said CVS Caremark's formulary is updated quarterly, and that the Zepbound removal is "not intended to reduce access to these medications, but rather to reasonably balance access and affordability" [2]. It noted that many employers and insurers have dropped GLP-1 coverage entirely because of rising costs, while the GIC continues to cover it [2].
Under the GIC's description, members with an active prior authorization for Zepbound do not need a new prior authorization to move to Wegovy; existing overrides transition automatically [2]. Zepbound approvals expire on their original end date, after which a new prior authorization for Wegovy is required [2]. Other covered options in the category include orlistat, Qsymia and Saxenda [2].
Patients who already tried Wegovy and had severe or intolerable side effects, or who did not lose enough weight, may request a formulary exception for tirzepatide, with requests accepted starting June 16, 2025 [2]. Only the prescriber can submit the clinical documentation [2]. If an exception is approved, the member pays the tier 3 copay for Zepbound; Mounjaro stays at tier 2, and people with diabetes already taking Mounjaro are not affected [2]. If an exception is denied, a patient can still fill Zepbound but pays the full cost [2].
The GIC also said coverage for Zepbound's obstructive sleep apnea indication is being removed, and that all members, regardless of indication, must have tried and failed Wegovy before accessing tirzepatide [2]. The GIC argued that sleep apnea improvement is driven by weight loss, so weight loss by any effective method should work — while acknowledging Wegovy is not FDA-approved for that use [2].
On effectiveness, the GIC wrote that "while controlled clinical trials may show Zepbound to be more effective for weight loss, real world evidence suggests that they are comparable in actual use" [2]. It also noted that semaglutide (Wegovy) is currently the only drug in the class with FDA approval to reduce the risk of major cardiovascular events in adults with established heart disease, and that cardiovascular outcomes for tirzepatide are still under investigation [2].
Why it matters for patients
If your plan uses CVS Caremark's standard commercial formulary, a drug you are currently taking may no longer be covered after July 1, 2025 [1][2]. CVS said people already on Zepbound can move to Wegovy or seek case-by-case medical-necessity exemptions [1].
Switching molecules is not a simple swap. The GIC said both drugs require titration, the right starting Wegovy dose depends on where a person is in treatment, and "clinical data on direct transitions is limited" — leaving the dosing choice to the prescriber [2]. A formulary change is also not a qualifying event, so GIC members cannot switch medical plans because of it [2].
For people paying cash, the practical change is where they can buy: Wegovy at $499 a month becomes available at more than 9,000 CVS stores rather than only by mail [1].
What happens next
Exception requests can be submitted starting June 16, 2025; the formulary change takes effect July 1, 2025 [2]. Lilly CEO David Ricks said he was "not surprised this kind of thing was announced" and that Lilly is "not interested at all in one-of-one deals of reducing access and choice for doctors and patients" [1]. Whether other pharmacy benefit managers follow CVS is not stated in these sources.
Sources
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