CVS Caremark begins covering Foundayo

CVS Caremark removed its "new-to-market block" on Foundayo (orforglipron) effective June 1, 2026, clearing the way for the drug to be covered under the pharmacy benefit manager's commercial template formularies where plans have approved coverage ^[3][4]. The change, announced May 28, made CVS the last of the three largest PBMs to open the door to Lilly's once-daily obesity pill ^[2][3].

A new-to-market block is a temporary hold PBMs place on newly approved drugs while they review them and negotiate prices. Until it was lifted, Foundayo was effectively unavailable through CVS Caremark's standard commercial formularies, even for patients whose plans covered weight-loss drugs.

CVS paired the Foundayo news with a second change: Zepbound (tirzepatide) returns to its commercial formularies as an additional preferred option on October 1, 2026 ^[3][4]. Caremark had dropped Zepbound in May 2025 in favor of Novo Nordisk's Wegovy (semaglutide), and both the Wegovy injection and the Wegovy pill keep preferred status ^[4]. CVS said plan sponsors that adopt its template formularies still retain discretion to customize coverage for their members ^[3]. CVS Health reported roughly 88 million PBM plan members as of March 31, 2026 ^[3].

The cost numbers

Lilly said eligible patients with commercial coverage may pay as little as $25 a month for either Foundayo or Zepbound ^[1][4]. Medicare Part D beneficiaries may be eligible to pay $50 a month starting July 1, 2026, through the Medicare GLP-1 Bridge program, a CMS demonstration that runs from July 1, 2026 through December 31, 2027 ^[1][4]. Both figures depend on eligibility rules that the sources do not spell out in detail.

Why the block mattered

Jefferies analysts pointed to the missing CVS coverage as a main reason Foundayo's launch trailed Novo Nordisk's Wegovy pill, which had full coverage in its first week on the market ^[2]. The gap was stark. In week 13 of Foundayo's launch, IQVIA counted 19,550 weekly prescriptions, down for a third straight week after peaking at 21,648 in week 10 ^[2]. Wegovy pill in its own week 13 was above 105,000 ^[2]. Jefferies called Foundayo's launch "muted," with weekly scripts roughly flat for five weeks ^[2].

The picture changed after coverage broadened. Lilly CEO David Ricks said the company began broad direct-to-consumer marketing after securing commercial access across the three major PBMs in June ^[2]. Foundayo scripts climbed from about 24,303 in mid-July to 34,219 in early August, 40,862 by late August, and 47.5K by the week reported September 11 ^[2]. Wegovy pill also hit a record of about 183,000 in that same period ^[2]. Citi analysts caution that IQVIA data may still miss some Foundayo prescriptions filled through telehealth channels ^[2].

Lilly's second-quarter Foundayo sales were $98 million globally, including $67 million in the U.S., which the Fierce Pharma tracker described as disappointing to many analysts against a Wall Street consensus of about $130 million for the quarter ^[2].

Why it matters for patients

For people whose employer or health plan uses a CVS Caremark commercial template formulary, the June 1 change means Foundayo can now be covered, though only if the plan itself covers weight-management drugs at all. Coverage of a drug class remains a plan-by-plan decision ^[3][4].

The October 1 Zepbound change matters differently. When Caremark dropped Zepbound in May 2025, a Truveta analysis of 700,907 patients found monthly switching away from tirzepatide jumped from about 0.6% before the change to 10.2% in June and July 2025 — roughly a 17-fold increase — before prescribing trends leveled off ^[4]. Lilly says current Zepbound patients will see coverage continue uninterrupted, with access broadening across template plans by October 1 ^[1].

What is not yet known from these sources: which specific plans will opt in, what prior authorization or step-therapy rules will apply, or what patients will pay if they do not qualify for the $25 or $50 programs.

What happens next

• July 1, 2026 – Dec. 31, 2027: Medicare GLP-1 Bridge demonstration runs, with a possible $50 monthly copay for eligible Part D beneficiaries ^[4].
• Oct. 1, 2026: Zepbound returns as an additional preferred option on CVS Caremark commercial formularies ^[3][4].

CVS says it will provide advance communication and support to customers, providers and members during the transitions ^[3].