• CVS Health's PBM, Caremark, will prioritize Wegovy (Novo Nordisk) over Zepbound (Eli Lilly) on its standard formularies starting July 1, 2025, potentially limiting patient access to Zepbound.
• The decision is likely driven by price negotiations and formulary rebates between CVS and the drug manufacturers, reflecting the complex incentives in the pharmaceutical supply chain.
• Eli Lilly is responding by expanding its direct-to-consumer channels, like LillyDirect, and partnering with telehealth platforms to bypass traditional PBM gatekeepers and ensure patient access to Zepbound.

CVS Health announced that its pharmacy benefit manager (PBM), Caremark, will prioritize Novo Nordisk's Wegovy over Eli Lilly's Zepbound on its standard drug formularies beginning July 1, 2025. This means that Wegovy will become the preferred GLP-1 drug for obesity for Caremark's standard plans, while Zepbound will be excluded. This decision could impact millions of patients who rely on Caremark for their prescription drug coverage, potentially increasing their out-of-pocket costs for Zepbound or requiring them to switch medications. The change reflects ongoing negotiations between PBMs and drug manufacturers regarding pricing and rebates for popular weight-loss drugs.

• What: CVS Health's Caremark will prioritize Wegovy over Zepbound on its standard formularies starting July 1, 2025. This will affect the drug coverage for millions of patients.
• Who: Key players include CVS Health, Caremark, Novo Nordisk (Wegovy manufacturer), Eli Lilly (Zepbound manufacturer), employers, insurers, and patients.
• When: The formulary change takes effect on July 1, 2025.
• Where: This decision impacts patients covered by CVS Caremark across the United States.

CVS Health's decision to favor Wegovy over Zepbound highlights the intense competition in the weight-loss drug market and the significant influence of PBMs. This move likely reflects CVS's efforts to negotiate lower drug prices and secure favorable terms with manufacturers. While CVS emphasizes potential cost savings for clients and members, the change could limit patient choice and disrupt treatment plans for those currently benefiting from Zepbound. Eli Lilly's response, including direct-to-consumer sales and telehealth partnerships, indicates a growing trend of pharmaceutical companies seeking alternative distribution channels to bypass PBMs and ensure patient access to their medications. The long-term impact of these developments remains to be seen, but they underscore the complex interplay of market forces, patient needs, and healthcare costs in the pharmaceutical industry.

"Zepbound is the U.S. branded anti-obesity market leader in both total prescription[s] and new prescription[s]."

"It is our responsibility to continue to work with others across the US healthcare system to find innovative opportunities to meet the needs of these patients and connect them with authentic, FDA-approved Wegovy … in a convenient and affordable way."

"individually determine how much of that savings on Wegovy gets shared with its members either via lower premiums or lower copays at the pharmacy counter,"

CVS Health's decision to prioritize Wegovy over Zepbound represents a significant shift in the weight-loss drug market, potentially impacting access and costs for millions of patients. While CVS cites negotiated discounts as a key driver, the move highlights the ongoing power struggles between PBMs and pharmaceutical companies. Eli Lilly's strategic response, including direct-to-consumer initiatives, suggests a potential reshaping of traditional drug distribution models. The ultimate beneficiaries of these changes, and whether they lead to more affordable and accessible weight-loss treatments, remain to be seen.