CVS Caremark says Zepbound will return to its standard formulary

CVS Health announced on May 28, 2026 that its pharmacy benefit manager, CVS Caremark, will add Zepbound (tirzepatide) back to its commercial formularies as an additional preferred option effective October 1, 2026, and that it removed the new-to-market block on Foundayo (orforglipron), Eli Lilly's oral GLP-1 for weight management, effective June 1, 2026 ^[1]. The two dates matter: the announcement and the Zepbound effective date are more than four months apart ^[1][5].

The reversal undoes a decision from a year earlier. On May 1, 2025, CVS Caremark said it would remove Zepbound from its standard preferred formulary effective July 1, 2025, and make Novo Nordisk's Wegovy (semaglutide) the preferred obesity treatment ^[2][6]. Novo Nordisk said both the Wegovy injection and its newly launched oral version keep preferred status on CVS formularies, and that patients on those drugs can continue "without interruption" ^[5]. Caremark's preferred obesity coverage will now include both companies' products as co-preferred options ^[1][5].

The numbers

The change applies to Caremark's standard commercial formulary template, which CVS says covers about 25 million to 30 million Americans ^[3][5]. Zepbound carries a monthly list price of $1,086 ^[3]. Under the new arrangement, CVS said it negotiated lower costs with Lilly, and eligible patients with commercial coverage may pay as little as $25 a month for either Zepbound or Foundayo ^[1][4]. Medicare Part D beneficiaries may be eligible to pay $50 per month for obesity medicines starting July 1, 2026 through the Medicare GLP-1 Bridge program, a CMS demonstration running from July 1, 2026 through December 31, 2027 ^[1]. CVS expects the deal to produce 10% to 15% in additional savings across the weight management category ^[5].

The 2025 exclusion produced measurable churn. A Truveta analysis of 700,907 patients, presented at the AMCP Annual Meeting in April 2026, found monthly switching away from tirzepatide ran at about 0.6% before May 2025 and rose to 10.2% in June and July — a roughly 17-fold increase — before prescribing trends leveled off ^[1].

Legal fallout from the 2025 switch is still unresolved. A proposed ERISA class action, Larkin v. Caremark RX, LLC, was filed in the Southern District of New York on September 3, 2025 and remains active as of mid-2026, with no publicly reported ruling on dismissal, class certification or settlement ^[2][3]. A separate, narrower case focused on sleep apnea coverage was dismissed on June 10, 2026 ^[2].

Why it matters for patients

Formulary placement is not the same as coverage. Plan sponsors — employers, unions and government entities — that adopt Caremark's standard formulary can still opt out of covering GLP-1s for weight loss entirely, so the change does not guarantee coverage for everyone whose plan uses Caremark ^[5]. Being on the list can make coverage more widely available, but employers often make the final call ^[3].

The timing gap is the practical issue. Foundayo's block came off June 1, 2026 ^[1][5], while Zepbound's return does not take effect until October 1, 2026 ^[1][5][6]. Lilly said coverage continues uninterrupted for current Zepbound patients and that access "will broaden across template plans by October 1" ^[4]. Caremark also said there are continuity protections for members currently maintained on semaglutide ^[1]. The $25 and $50 figures are described as eligibility-linked, and the sources do not spell out the eligibility rules ^[1][4].

One wrinkle in the sources: one account describes CVS as having dropped Zepbound "in May 2025" ^[1], while others date the removal to the July 1, 2025 effective date ^[2][6]. The announcement came May 1, 2025; the change took effect July 1, 2025 ^[2].

What happens next

June 1, 2026: Foundayo coverage begins on the CVS Caremark commercial template ^[4][5]. July 1, 2026: the Medicare GLP-1 Bridge pilot opens, running through December 31, 2027 ^[1]. October 1, 2026: Zepbound returns as an additional preferred option ^[1][5][6]. The other two large PBMs, Express Scripts and Optum Rx, already cover Zepbound ^[3], and Lilly says all three now cover its full obesity portfolio ^[4]. How individual employers respond is not yet known.