CVS Caremark drops Zepbound coverage for weight loss, with Wegovy as the preferred option

On July 1, 2025, CVS Caremark stopped covering Eli Lilly's Zepbound (tirzepatide) for weight management on its most common formulary template, a change that affects 25 million to 30 million people ^[1][4]. Novo Nordisk's Wegovy (semaglutide) is now the preferred GLP-1 for obesity treatment on those plans ^[1][2][5].

CVS Caremark, one of the largest pharmacy benefit managers, sent letters in May telling members that refills on or after July 1, 2025 would require paying the full cost ^[1]. The company said the change is designed to push drugmakers to lower prices. "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 ^[1]. CVS also said the decision was "forcing the drug manufacturers to compete with one another" ^[1].

Massachusetts' Group Insurance Commission, whose non-Medicare plans use the CVS Caremark formulary, described the change as a way to balance access and affordability, noting that some employers have dropped GLP-1 coverage for weight loss altogether ^[2]. Under the exception process, members who had already tried Wegovy and either had intolerable side effects or did not lose enough weight could request coverage of tirzepatide, with prescribers able to submit requests starting June 16, 2025 ^[2]. All existing Zepbound prior authorizations, including those approved for moderate-to-severe obstructive sleep apnea, were set to transition to Wegovy, and the commission said all members, regardless of indication, would need to have tried and failed Wegovy before tirzepatide could be covered ^[2]. Approved exceptions carry a tier 3 copay, while Mounjaro, the tirzepatide brand for type 2 diabetes, stays at tier 2 and is not affected ^[2].

Early data suggest prescribing shifted. Truveta Research, which analyzed 1,647,238 patients prescribed a GLP-1 between January 2024 and July 2025, found that prescriptions for obesity-use tirzepatide rose 0.03 percentage points from June to July 2025, compared with an average monthly increase of 0.06 points over the prior 18 months. Semaglutide for obesity rose 0.1 points in the same month, its largest one-month gain in the study period ^[4]. First-time tirzepatide prescriptions fell slightly, the first monthly drop in nearly a year, while first-time semaglutide prescriptions rose 4.9% ^[4]. Truveta said it did not evaluate whether the formulary change caused the shift, and that a prescription does not always mean a patient fills it ^[4].

Why it matters for patients

Zepbound and Wegovy are both FDA-approved for chronic weight management, but they are not interchangeable for every patient. Studies have found that people taking tirzepatide lost more weight and were more likely to reach specific weight-loss targets than those taking semaglutide, and side effects such as nausea, severe constipation or stomach pain can differ between the two ^[1]. The Massachusetts commission said real-world evidence suggests the drugs are comparable, while noting that controlled trials may show Zepbound to be more effective ^[2]. Zepbound is also FDA-approved for obstructive sleep apnea in people with obesity, and Wegovy is not ^[1][2]. Wegovy is the only drug in the class with FDA approval to reduce the risk of major cardiovascular events in adults with established heart disease ^[2].

Doctors say forced switches are disruptive. Dr. Jody Dushay, an endocrinologist at Beth Israel Deaconess Medical Center, said adapting to a new medication often interrupts a patient's weight-loss trajectory, and that she gets flooded with patient messages when coverage announcements come out ^[1]. Dr. Tracy Zvenyach of the Obesity Action Coalition said exclusionary policies and utilization management "set up one barrier after another" for people with obesity, which she described as a long-term chronic disease ^[1].

Cost is the other variable. Wegovy's list price is $1,349, and Novo Nordisk says 90% of patients have a copay of $0 to $25 per month; the company also offers direct-to-patient shipments through NovoCare Pharmacy at $499 per month ^[5]. Under the CVS Caremark letter, members who stayed on Zepbound would pay the full cost themselves ^[1]. Eli Lilly's cash-pay price for Zepbound after the change has not been disclosed. Employer coverage varies widely: a KFF survey found that 18% of companies with 200 or more employees cover GLP-1s for weight loss, and of those, 24% require employees to meet with a dietitian or other professional ^[5].

What happens next

CVS Caremark said on May 28, 2026 that it will add Zepbound back to its commercial formularies as an additional preferred option on October 1, 2026. It also said it would remove the new-to-market block on Foundayo (orforglipron), an oral GLP-1, effective June 1, 2026, where plans approve coverage ^[6]. Plan sponsors that use CVS Caremark template formularies can still customize coverage for their members ^[6].

Blue Cross Blue Shield of Massachusetts has said it will exclude all GLP-1s from coverage for obesity and cover them only for type 2 diabetes ^[1].

Truveta's prescribing data cover only through July 2025, so whether the shift in prescribing lasted has not been reported ^[4].