Lilly moved its employee pharmacy benefits to Rightway after Caremark dropped Zepbound

Eli Lilly moved the pharmacy benefit manager for employees in its medical plan from CVS Caremark to Rightway, effective January 1, 2026 ^[1]. The change came several months after Caremark removed Lilly's obesity drug Zepbound from its standard commercial formulary and kept Novo Nordisk's Wegovy as the preferred product ^[1]. Lilly has not said the formulary decision prompted the switch ^[1].

PBMs negotiate with drugmakers, manage covered-drug lists and pharmacy networks, and run utilization management such as prior authorization ^[1]. Rightway describes its model as 100% pass-through and is considerably smaller than CVS Caremark ^[1]. In a pass-through arrangement, rebates and other negotiated savings are returned to the health plan, and the PBM does not keep the difference between what the plan is charged for a prescription and what the pharmacy is paid ^[1]. Applied Policy, a health policy firm, described the arrangement in an analysis of employer oversight of pharmacy benefits ^[1].

In May 2026, Caremark announced that Zepbound would return to its commercial formularies as an additional preferred option beginning October 1, 2026, for plan sponsors that elect to cover weight-management medications ^[1]. A September pricing guide also lists the October 1 return ^[2]. Lilly has not publicly indicated whether Caremark's revised formulary will affect its PBM arrangement with Rightway ^[1].

The episode sits against a backdrop of tight employer coverage for weight-loss drugs. In 2025, 19% of large employers offering health benefits reported covering GLP-1 drugs prescribed primarily for weight loss, while 57% did not, according to KFF ^[1]. Business Group on Health has reported that employers use a range of measures to manage GLP-1 coverage, including verifying clinical eligibility, requiring participation in weight-management programs, limiting which providers may prescribe the drugs, and excluding certain medications from formularies ^[1].

Employers that sponsor self-funded plans generally act as fiduciaries under ERISA and are required to act in the interests of plan participants when overseeing benefits, even when a PBM administers them ^[1]. The Department of Labor proposed a rule in January 2026 that would require PBMs serving employer-sponsored self-insured plans to disclose more about rebates, fees, spread-pricing revenue and pharmacy payments; it has not been finalized ^[1].

Why it matters for patients

Which GLP-1 a person can fill, and what it costs, is often set by the employer's PBM contract rather than by the prescribing clinician ^[1]. Caremark's decision to drop Zepbound affected people in plans using Caremark's standard commercial formulary; the October 1, 2026 change applies only to plan sponsors that elect to cover weight-management medications ^[1]. Whether any specific employer adds Zepbound on that date has not been reported.

Lilly's switch covers only Lilly's own employees ^[1]. It does not change coverage for customers of Caremark or of any other PBM, and it does not change the list price of Zepbound, Wegovy or any other drug. Formularies can also change at the start of a plan year, so coverage that applies now may not apply later.

Activity around PBM compensation may eventually make more information public, but the proposed DOL disclosure rule is not final ^[1]. The Federal Trade Commission has reported that access to lower-cost drugs may be restricted as part of rebate negotiations between PBMs and manufacturers, and has alleged in a separate insulin case that PBMs excluded lower-list-price products while favoring higher-list-price products carrying substantial rebates ^[1].

What happens next

• October 1, 2026: Zepbound returns to CVS Caremark's commercial formularies as an additional preferred option for plan sponsors that elect to cover weight-management medications ^[1][2].
• Lilly has not said whether it will revisit its Rightway arrangement ^[1].
• The DOL's proposed PBM fee disclosure rule, issued in January 2026, has not been finalized ^[1].

It has not been disclosed how many employers plan to add Zepbound to their formularies on October 1, or how many people were affected by the original formulary removal.