CVS Caremark to Cover Eli Lilly Weight Loss Drugs

CVS Health announced it will restore coverage for Eli Lilly’s injectable weight loss medication, Zepbound, and begin covering the company’s new oral obesity pill, Foundayo, on its standard drug plans [1]. The decision, which places Eli Lilly’s treatments on equal footing with competitor Novo Nordisk, affects a formulary template that serves between 25 million and 30 million Americans [1].

Key takeaways

• CVS Caremark will begin covering the Foundayo pill on June 1 and restore Zepbound coverage on October 1 [1].
• The move makes GLP-1 medications from both Eli Lilly and Novo Nordisk co-preferred options on the pharmacy benefit manager's standard commercial formulary [1].
• CVS expects the expanded coverage to result in 10% to 15% savings across the weight management category [1].
• Plan sponsors, such as employers and unions, retain the ability to opt out of covering GLP-1 medications for weight loss [1].
• Both Foundayo and Zepbound carry warnings regarding potential risks, including thyroid tumors and thyroid cancer [2].

Expanding access to obesity treatments

The shift marks a significant change from the previous year, when CVS dropped coverage of Zepbound in favor of Novo Nordisk’s Wegovy [1]. Under the new arrangement, CVS Caremark patients will have access to both Lilly and Novo Nordisk treatments as co-preferred options [1]. Eli Lilly stated that its new oral medication, Foundayo, will be covered by all three of the nation’s largest pharmacy benefit managers [1].

Foundayo is a once-daily oral GLP-1 receptor agonist that does not require food or water restrictions, while Zepbound is an injectable medication that acts as a dual GIP and GLP-1 receptor agonist [2]. Clinical trials for Foundayo, known as the ATTAIN program, involved over 4,500 participants and demonstrated weight loss results in adults with obesity or overweight conditions [2]. Zepbound is also FDA-approved for treating moderate-to-severe obstructive sleep apnea in addition to weight management [2].

Why it matters

CVS Caremark, a major pharmacy benefit manager, described the move as a result of "successful continued pricing negotiations" with both Eli Lilly and Novo Nordisk [1]. By creating a competitive environment between the two drugmakers, CVS aims to "bend the cost curve" for weight loss treatments [1]. While the company expects this to drive significant savings, coverage is not guaranteed for all members, as individual plan sponsors—such as employers and unions—must choose to adopt the standard formulary [1]. CVS has committed to ensuring a "smooth transition" for members and providers as the new coverage policies take effect [1].