An Eli Lilly & Co. Zepbound injection pen arranged in the Brooklyn borough of New York, US, on Thursday, March 28, 2024.
Shelby Knowles | Bloomberg | Getty Images
CVS Health on Thursday said it will restore coverage of Eli Lilly‘s blockbuster weight loss injection Zepbound and start covering its new obesity pill on its standard drug plans – a win for the drugmaker and certain patients who will be able to access more treatment options.
CVS will add Zepbound coverage on Oct. 1, and start covering Lilly’s newly approved Foundayo pill on June 1. The move will boost Lilly’s efforts to maintain its dominance over Novo Nordisk in the blockbuster weight loss market, as it puts the two companies on equal footing on major drug plans.
It comes a year after CVS struck a deal with Novo Nordisk to make its drug Wegovy the preferred obesity treatment on its standard plans, while dropping coverage of Zepbound. That meant patients on those plans would have had to pay more out of pocket or go through extra hurdles to get Lilly’s drug.
But GLP-1 medications from both Lilly and Novo will soon be co-preferred options on CVS Caremark’s standard commercial formulary template – a list of covered drugs that insurers and employers can choose to adopt – which represents 25 million to 30 million Americans. Caremark is one of the nation’s largest pharmacy benefit managers.
Plan sponsors that adopt Caremark’s standard formulary can still opt out of covering GLP-1s for weight loss, so coverage of Lilly’s and Novo’s treatments isn’t guaranteed for all patients.
Still, CVS expects the move to drive 10% to 15% additional savings across the weight management category.
CVS on Thursday touted last year’s agreement with Novo Nordisk as the first move by a major pharmacy benefit manager to spur competition in the GLP-1 market and “bend the cost curve.” CVS said both Lilly and Novo responded by partnering with the healthcare giant to make GLP-1s for weight loss more affordable, pointing to “successful continued pricing negotiations” with both drugmakers.
“With this expanded coverage, millions of Americans will have access to Zepbound and Foundayo, giving patients and their doctors a real choice in how obesity is treated,” Lilly said in a statement. “We’ll keep working to make that true for everyone.”
Lilly added that its pill will be covered by all three of the nation’s largest pharmacy benefit managers, including Caremark.
In a statement, Novo said both its Wegovy injection and newly launched pill with the same name will retain their preferred status on CVS’ formularies. CVS Caremark patients can remain on those drugs “without interruption,” Novo added.
As a PBM, Caremark is hired by employers, government entities, unions and other health plans to negotiate the cost of medications included on formularies chosen by plan sponsors.
“We’re creating access and options that would not have existed without our leadership in the market,” said Ed DeVaney, CVS Caremark president, in a release. “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 said Caremark will ensure a “smooth transition” to covered therapies for customers, consultants, providers and members.
