CVS Caremark to cover Foundayo from June 1, completing PBM coverage
CVS Caremark's decision means Foundayo joins the formularies of all three major pharmacy benefit managers, though individual employers still decide what their plans cover.
Eli Lilly said on May 28, 2026 that CVS Caremark will begin covering Foundayo (orforglipron) on its commercial template on June 1, 2026, and will add Zepbound (tirzepatide) back to those templates by October 1, 2026. With that step, Lilly said all three of the nation's largest pharmacy benefit managers will cover its full obesity medicine portfolio [1][2].
CVS Caremark described the changes in its own announcement the same day. It said it will remove the "new-to-market block" on Foundayo effective June 1, 2026, "where approved for coverage by plans," and will add Zepbound back to commercial formularies as an additional preferred option on October 1, 2026 [2].
One limit applies to both dates: plan sponsors that adopt CVS Caremark's template formularies "retain discretion to customize coverage for their members" [2]. Coverage under a template does not guarantee that a given employer's or health plan's benefit includes the drug.
Lilly said eligible patients with commercial coverage can pay as little as $25 a month for either medicine [1]. Medicare Part D beneficiaries may also be eligible to pay $50 per month for their obesity medicines beginning July 1 through the Medicare GLP-1 Bridge program [1]. Neither announcement spells out what makes a patient eligible for the $25 or $50 figures, and those criteria have not been disclosed in these releases [1][2].
For people already taking Zepbound, Lilly said coverage continues uninterrupted and access will broaden across template plans by October 1 [1].
"For too long, effective obesity treatment has been out of reach for the people who need it," said Ilya Yuffa, executive vice president and president of Lilly USA and global customer capabilities. "Not all medicines work the same way for patients. Broader coverage puts real choice in the hands of millions of Americans and their doctors" [1].
Ed DeVaney, president of CVS Caremark, said, "We're creating access and options that would not have existed without our leadership in the market" [2]. CVS Health reported approximately 88 million plan members in its pharmacy benefits manager as of March 31, 2026 [2].
Foundayo is described by Lilly as the only once-daily GLP-1 pill for weight management that can be taken any time of day without food or water restrictions. Zepbound is described as the most-prescribed injectable weight management medicine in the United States [1]. In the ATTAIN-1 trial, people taking the highest dose of Foundayo who stayed on treatment lost an average of 27.3 pounds (12.4%), compared with 2.2 pounds (0.9%) for placebo [1]. In the 72-week SURMOUNT-1 study of adults without diabetes, average weight loss was 15.0% (34 pounds) at 5 mg of Zepbound, 19.5% (44 pounds) at 10 mg, 20.9% (48 pounds) at 15 mg, and 3.1% (7 pounds) for placebo [1].
Why it matters for patients
Pharmacy benefit managers negotiate which prescription medicines a health plan pays for. When a drug sits on a formulary, members generally pay a share of the cost instead of the full retail price. Foundayo and Zepbound are not the same medicine and are not interchangeable; the ATTAIN and SURMOUNT results above come from separate trials with different designs and populations [1].
Because employers can customize these templates, two people with commercial insurance through different companies may see different answers at the pharmacy counter even after June 1 and October 1 [2]. Lilly directs people to coverage-check tools at Foundayo.com and Zepbound.com and notes that coverage information is updated regularly [1].
The $25 monthly figure applies to patients Lilly describes as eligible and does not apply to everyone with commercial coverage [1]. What insurers require before approving coverage — such as prior authorization or a body mass index threshold — is not described in either announcement [1][2]. The Medicare Part D arrangement beginning July 1 is also described only in general terms, and the full program rules have not been reported in these releases [1].
What happens next
- June 1, 2026: CVS Caremark commercial templates begin covering Foundayo, and the new-to-market block is removed where plans approve coverage [1][2].
- July 1, 2026: Medicare Part D beneficiaries may be eligible for $50 a month through the Medicare GLP-1 Bridge program [1].
- October 1, 2026: Zepbound returns to CVS Caremark commercial templates as an additional preferred option, broadening access for current patients [1][2].
Sources
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