CVS formulary decisions again shape the oral GLP-1 race

Pharmacy benefit managers, not just clinical trial results, are shaping which GLP-1 medicines patients can get covered in 2026. Analysts point to CVS Caremark's formulary choices as a repeat of the pattern seen in 2025, when the company excluded Zepbound (tirzepatide) from its most widely used plans in favor of Wegovy (semaglutide) ^[1][2].

That 2025 decision took effect July 1 and removed Zepbound from CVS Caremark's Standard, Advanced Control, and Value formularies — the plans used by most employers ^[2]. CVS Caremark has confirmed there were no new GLP-1 formulary changes in January 2026, meaning the Zepbound exclusion has continued into this year ^[2]. According to research cited by the website Honest Care, more than 100 million Americans lack commercial insurance coverage for Zepbound as of 2026, a sharp rise from prior years ^[2].

The original exclusion had a measurable financial effect. Eli Lilly disclosed during its second-quarter 2025 earnings call that the CVS decision was already hurting Zepbound prescriptions in July of that year, and the company expected it to weigh on third-quarter sales growth even though Zepbound revenue had jumped 172% year-over-year to $3.381 billion in the same quarter ^[1]. Lilly management said at the time that Zepbound still led the U.S. branded obesity drug market, with two-thirds of patients using it, but the formulary exclusion was flagged as a headwind ^[1].

The dispute has also produced litigation. In September 2025, two class-action lawsuits — Larkin v. CVS Caremark in the Southern District of New York and Hamburger v. CVS Caremark in Washington, D.C. — accused CVS of prioritizing its own rebate profits over patient outcomes, alleging Novo Nordisk pays larger rebates for Wegovy than Lilly does for Zepbound ^[2]. The complaints estimate roughly 200,000 patients were affected and note CVS Caremark controls 27% of all U.S. pharmacy claims ^[2]. CVS Caremark has said the lawsuits are without merit ^[2].

Meanwhile, the oral GLP-1 race has its own complications separate from formulary status. Lilly's oral drug orforglipron produced an average weight loss of 12.4% (27.3 pounds) over 72 weeks at its highest dose in Phase 3 testing, with 59.6% of participants losing at least 10% of body weight ^[1]. That trailed Novo Nordisk's oral semaglutide, which showed 15.1% average weight loss over 68 weeks in its OASIS 1 trial, with about 85% of patients losing at least 5% of body weight ^[1]. Novo Nordisk has submitted a new drug application to the FDA for a 25 mg oral version of Wegovy for obesity, with a decision that was expected by the end of 2025 ^[1].

Why it matters for patients

For people relying on employer or commercial insurance managed by CVS Caremark, coverage can depend more on which drugmaker's rebate deal a PBM accepts than on how a drug performed in trials. Patients currently on an excluded drug may be required to try the preferred alternative first, request a formulary exception with documentation from a doctor, or pay out of pocket ^[2]. Some CVS Caremark plans have introduced a $200-a-month copay option for GLP-1 weight-loss drugs where no coverage existed before, which is one alternative to full self-pay pricing ^[2]. Whether a similar exclusion applies specifically to an oral competitor in 2026, and which drug is affected, is not detailed in the available sources.

What happens next

CVS Caremark has said it made no new GLP-1 formulary changes as of January 2026 ^[2]. The FDA decision on Novo Nordisk's oral semaglutide application for obesity, originally expected by the end of 2025, was pending as of the most recent reporting available ^[1]. Beyond that, the sources reviewed do not specify further dated milestones for 2026 formulary reviews.