CVS Caremark drops Zepbound coverage and makes Wegovy the preferred GLP-1

As of July 1, 2025, CVS Caremark stopped covering Eli Lilly's Zepbound (tirzepatide) on its most common commercial formulary and made Novo Nordisk's Wegovy (semaglutide) the preferred GLP-1 medication for weight management ^[1][2]. That formulary template covers between 25 million and 30 million people ^[2].

CVS Caremark manages prescription drug benefits for health insurers, large employers and other payers ^[2]. Zepbound has been FDA-approved since November 2023 for chronic weight management in adults with obesity or who are overweight ^[2]. Wegovy remains covered, along with a few other medications that are generally less effective ^[2]. Before the change, the members who took weight-loss drugs chose Wegovy and Zepbound at roughly equivalent levels when both were available, CVS Health said ^[2].

The Massachusetts Group Insurance Commission, whose non-Medicare plans use CVS Caremark, said GLP-1 medications are the fastest-growing segment of its pharmacy spending. It said the decision "is not intended to reduce access to these medications, but rather to reasonably balance access and affordability" ^[1]. CVS Health said its formulary strategy is meant to push manufacturers to compete on price: "The egregiously high list prices set by drug manufacturers of GLP-1s for weight loss are the single biggest barrier to patient access" ^[2].

Members with an active Zepbound prior authorization do not have to repeat that process to move to Wegovy; the approvals were transitioned so people could get Wegovy without starting over ^[1]. Those approvals still expire on their original end date, and members then need a new prior authorization for continued Wegovy coverage ^[1]. People with diabetes who take Mounjaro, which is the same molecule as Zepbound, were not affected ^[1].

Coverage also ended for Zepbound's obstructive sleep apnea indication. All existing prior authorizations, including those approved for moderate-to-severe sleep apnea, transition to Wegovy, and members must try and fail Wegovy before they can access tirzepatide ^[1]. CVS said the mechanism for improving sleep apnea is weight loss, and that weight loss by any effective method is appropriate for treating it. Wegovy has not been FDA-approved for sleep apnea ^[1].

Members who previously tried Wegovy and had severe or intolerable side effects, or did not lose enough weight, can request a formulary exception for tirzepatide. Prescribers could submit those requests starting June 16, 2025, with supporting documentation such as chart notes. If an exception is approved for Zepbound, the member pays a tier 3 copay; Mounjaro stays at tier 2 ^[1]. If an exception is denied, a member can still fill a Zepbound prescription but pays the full cost ^[1].

The two drugs are not identical. CVS said controlled trials may show Zepbound is more effective for weight loss, while real-world evidence suggests they are comparable ^[1]. CNN reported that studies found people using tirzepatide lost more weight and were more likely to reach specific weight-loss targets than those using semaglutide ^[2]. Side effects can vary, sometimes making one drug more tolerable than the other ^[2]. Semaglutide 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, and those benefits appear even before patients reach target doses or lose significant weight; tirzepatide's cardiovascular outcomes are still under investigation ^[1].

The right Wegovy dose when moving from Zepbound depends on where someone is in treatment. Both drugs require titration, a conversion chart exists, and clinical data on direct transitions is limited ^[1].

Why it matters for patients

A formulary change mid-treatment can mean switching drugs, seeking an exception, or paying the full list price. Tara Eacobacci, a patient whose Zepbound coverage ended, told CNN the change left her "completely outraged," and said she gained 10 pounds and saw her A1C glucose levels spike in one month without the medication ^[2].

Dr. Jody Dushay, an endocrinologist at Beth Israel Deaconess Medical Center, told CNN that adapting to a new medication often interrupts a patient's weight-loss trajectory, and that side effects such as severe constipation, nausea or stomach pain can differ between drugs. She said she gets flooded with messages from patients when coverage announcements come out ^[2]. Dr. Tracy Zvenyach of the Obesity Action Coalition told CNN that exclusionary policies and utilization management reflect a mindset that has not caught up with the science of obesity as a long-term chronic disease ^[2]. CNN also reported that appeals take time ^[2].

What happens next

Zepbound prior authorizations expire on their original end dates, at which point members need a new prior authorization for Wegovy ^[1]. The exception process stays available for people who cannot take Wegovy ^[1]. Separately, CNN reported that BCBS Massachusetts will exclude all GLP-1s from coverage for obesity treatment starting in January, reserving coverage for type 2 diabetes ^[2]. How many people ultimately lose access, and how many exception requests are approved, has not been reported.