CVS Caremark, one of America’s most powerful pharmacy benefit managers, will begin covering more GLP-1 medications again later this year, potentially expanding access to the blockbuster weight-loss drug for millions of Americans.
CVS announced Thursday that it would restore Eli Lilly’s weight-loss injection Zepbound to its list of covered drugs on Caremark’s standard commercial formulary template, which represents roughly 25 million to 30 million Americans, CVS spokesman Philip Blando told the Globe. Caremark will also add the drugmaker’s newly approved oral obesity pill, Foundayo.
Pharmacy benefit managers play a key role negotiating drug prices, processing pharmacy claims, handling prescription authorizations, and managing drug benefits for health insurers and employers.
In addition to owning approximately 9,000 retail pharmacy locations across the US, Rhode Island-based CVS Health owns Aetna, a health insurer, and Caremark, a PBM.
The decision marks a reversal for Caremark, which last summer became the only major pharmacy benefit manager to exclude Zepbound while continuing to cover rival Novo Nordisk’s Wegovy. The move underscored the growing tug-of-war between PBMs and drugmakers as the demand for GLP-1 medications has exploded.
Zepbound will return to CVS Caremark’s lists of covered medications on Oct. 1. Foundayo, the new oral GLP-1, will be covered starting June 1. The move is designed to give employers and health plans more affordable access to GLP-1s.
“We estimate we’ve generated between 10 to 15 percent of additional savings across the class for our clients, based on our successful negotiations with both manufacturers,” said Blando, who said that both Wegovy and Zepbound will have the same copay.
For eligible patients with commercial coverage, both Zepbound and Foundayo are available for as little as $25 a month, Eli Lilly said. (The specific copay amount is set individually by employers or unions.)
When asked whether Caremark made a mistake in stopping its coverage of Zepbound, Blando suggested that Caremark dropping Zepbound coverage ultimately helped bring down costs.
“We were the only major pharmacy benefit manager a year ago that took action to drive meaningful competition in this class, and both manufacturers have responded by partnering with us to now make this class more affordable and more accessible,” said Blando.
In September, just two months after Caremark stopped covering Zepbound, patients filed a class-action lawsuit against CVS over the decision, arguing that while the Woonsocket company was willing to cover Wegovy, the two drugs were not medically interchangeable. Some patients who reportedly lost weight on Zepbound then gained some of it back while on Wegovy, the lawsuit said.
Wegovy and Zepbound are both considered effective at treating obesity, and were approved by the US Food and Drug Administration to do so. Yet, research shows there are differences between the two.
Some studies have found that people who have used Zepbound, tirzepatide injection, lost more weight compared to those using semaglutide medications such as Wegovy.
Caremark’s coverage adjustment is also a victory for Eli Lilly.
“For too long, effective obesity treatment has been out of reach for the people who need it,” said Ilya Yuffa, executive vice president and president of Lilly USA and global customer capabilities in a statement. “Not all medicines work the same way for patients. Broader coverage puts real choice in the hands of millions of Americans and their doctors.”
Alexa Gagosz can be reached at alexa.gagosz@globe.com. Follow her @alexagagosz and on Instagram @AlexaGagosz.