Status check: the Zepbound formulary class action against CVS Caremark remains live as restoration nears
CVS Caremark brings Zepbound back to its main commercial formularies on October 1, 2026, but the class action over last year's removal is still active — and employers still choose whether to cover weight-loss drugs at all.
Two weeks before CVS Caremark restores Zepbound (tirzepatide) to its most common commercial formularies, the class-action lawsuit challenging the removal of the drug last year is still going. NBC News reported that the suit was filed in September and "remains active" [2]. The provided sources do not describe the case's current procedural posture — including any ruling on a motion to dismiss — so the details of where the litigation stands are not established here.
The backdrop is a reversal CVS Health announced on May 28, 2026. Caremark said it will add Zepbound back to its commercial formularies "as an additional preferred option October 1, 2026," framing the move as an effort to increase access to GLP-1s "at a more affordable price for plan sponsors who elect to provide coverage of those medications for their members" [1]. A Caremark spokesperson told NBC News the change applies to its standard formulary, affecting about 25 million to 30 million people [2].
What changed and what didn't
Caremark is one of the country's largest pharmacy benefit managers, deciding which medications millions of Americans can get through insurance and what they pay out of pocket [2]. CVS says its PBM had roughly 88 million plan members as of March 31, 2026 [1].
When Caremark dropped Zepbound last year, the decision drew backlash from patients who said they were pushed to switch to Novo Nordisk's Wegovy (semaglutide) despite getting better results on Zepbound [2]. The removal did not affect people taking Mounjaro, Eli Lilly's diabetes drug that contains the same active ingredient [2].
Caremark is also changing course on Lilly's oral GLP-1. The company said that effective June 1, 2026, it removed the new-to-market block on Foundayo (orforglipron) "where approved for coverage by plans" [1]. NBC News reported the pill would be added to the list starting that Monday [2].
On price, Zepbound carries a monthly list price of $1,086, and even with Lilly's cash-pay discounts people can end up paying hundreds of dollars a month [2]. Lilly said some patients with private insurance could pay as little as a $25 copay once Zepbound returns to the Caremark formulary by October 1 [2].
"We acted boldly through active engagement and negotiation with our drug manufacturer partners to tackle affordability and access for our customers and their members," said Ed DeVaney, president of CVS Caremark [1].
Why it matters for patients
Formulary placement is not the same as coverage. CVS states plainly that plan sponsors adopting its template formularies "retain discretion to customize coverage for their members" [1]. NBC News made the same point: being added to the formulary does not guarantee every insurance plan will cover the drug, because employers often make the final call on whether to pay for weight-management medications — though being on the list can make coverage more widely available [2].
That means an individual's situation on October 1 depends on the specific employer or plan, not just on Caremark's template. Someone who switched from Zepbound to Wegovy last year may or may not find Zepbound covered again, and the sources do not describe how prior authorization, step therapy or transition rules will be applied. Caremark says it will provide advance communication and support to customers, consultants, providers and members, including proactive outreach and clinical support programs [1].
The lawsuit matters separately from the restoration. A formulary change going forward does not automatically resolve claims about how the earlier switch was handled, and the outcome of the case is not known from these sources.
What happens next
- June 1, 2026: Caremark's new-to-market block on Foundayo (orforglipron) lifted, where plans approve coverage [1].
- October 1, 2026: Zepbound returns to Caremark's commercial formularies as an additional preferred option [1], with Lilly saying it will be back by that date [2].
- Ongoing: The class action remains active [2]. Any schedule for hearings or rulings is not stated in the available sources.
For context, the other two major PBMs, Express Scripts and Optum Rx, already cover Zepbound [2].
Sources
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