The pharmacy benefit manager dropped Zepbound a year ago in favor of rival Wegovy — now both Lilly and Novo Nordisk drugs will be co-preferred options
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CVS Health $CVS's pharmacy benefit management unit, CVS Caremark, announced Thursday that it will restore coverage of Eli Lilly $LLY's weight loss injection Zepbound and add the company's new oral weight loss pill Foundayo to its standard commercial formularies.
Oct. 1 is the target date for Zepbound's return to covered status, the company said. For Foundayo, which the FDA cleared in April, formulary inclusion begins June 1 for plans that have elected to cover it.
Roughly 25 million to 30 million people fall under the standard formulary template, NBC News reported. Because employers and health plans make their own final decisions about drug coverage, a spot on the standard template does not translate into a guarantee that either medication will be available to every member.
Thursday's news walks back last year's formulary shake-up, when CVS Caremark struck a pricing arrangement with Novo Nordisk that elevated Wegovy to preferred status and pushed Zepbound off the covered list altogether. Patients who said they fared better on Zepbound than on Wegovy pushed back hard against that change, and a class-action suit filed over the decision is still pending, NBC News reported. Mounjaro, Lilly's diabetes treatment that shares Zepbound's active ingredient, was carved out of the original exclusion and remained covered throughout.
Under the new arrangement, CNBC reported, the two manufacturers' obesity treatments will share co-preferred standing on the Caremark standard commercial formulary. In its own statement, Novo Nordisk said the Wegovy injection and its oral counterpart would keep their preferred position, and that existing patients face no disruption to access.
The restructured formulary is projected by CVS to reduce spending on weight management drugs by an additional 10% to 15%. At its sticker price, Zepbound runs patients $1,086 per month, and Lilly does offer reduced pricing for those paying out of pocket; the company noted that certain privately insured patients could see their costs drop to a $25 copay, NBC News reported.
"We acted boldly through active engagement and negotiation with our drug manufacturer partners to tackle affordability and access for our customers and their members," CVS Caremark president Ed DeVaney said in a statement.
The two pills from Lilly and Novo differ in key ways. Foundayo carries no food or timing restrictions, while the Wegovy pill requires patients to take it first thing each morning with a small sip of water and fast for at least half an hour afterward. Novo has published a cross-trial comparison claiming its Wegovy pill produced greater weight loss than Foundayo, though the study was not a direct head-to-head clinical trial. The two companies have set the lowest doses of their respective pills at $149 a month for uninsured patients.
Zepbound has already been available through the other two major pharmacy benefit managers operating in the U.S. — Express Scripts and Optum Rx.
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