Eli Lilly & Co.’s Zepbound injection pen placed on Thursday, March 28, 2024 in the Brooklyn borough of New York City, USA.
Shelby Knowles | Bloomberg | Getty Images
CVS Health On Thursday, it announced it would restore coverage. Eli Lillylaunches blockbuster weight loss injectable Zepbound and begins incorporating its new obesity drug into standard drug plans. This is a win for drug companies and some patients who now have access to more treatment options.
CVS added coverage for Zepbound on October 1st and plans to begin coverage for Lilly’s newly approved Foundayo pill on June 1st. The move will strengthen Lilly’s efforts to maintain its dominance. novo nordisk This will give both companies an edge in the blockbuster weight loss market as they will be on equal footing with major drug plans.
This comes a year after CVS signed a deal with Novo Nordisk to make its drug Wegovy the preferred obesity treatment in the company’s standard plan, while removing coverage for Zepbound. That means patients in those plans would have had to pay more out-of-pocket or jump through additional hurdles to obtain Lilly’s drug.
But Lilly and Novo’s GLP-1 drugs will soon become co-preferred options on CVS Caremark’s Standard Over-the-Counter Prescription Template (a list of eligible drugs that insurance companies and employers can choose to include), which represents 25 million to 30 million Americans. Caremark is one of the nation’s largest pharmacy benefit management companies.
Plan sponsors with Caremark’s standard formulary can opt out of GLP-1 coverage for weight loss, so coverage of Lilly and Novo treatments is not guaranteed for all patients.
Still, CVS expects the move to drive additional savings of 10% to 15% across weight management categories.
CVS on Thursday touted last year’s agreement with Novo Nordisk as the first move by a major pharmacy benefits manager to increase competition in the GLP-1 market and “bend the cost curve.” CVS noted that both Lilly and Novo have responded by partnering with health care giants to make GLP-1 for weight loss more affordable, and that it has had “ongoing successful price negotiations” with both drug companies.
“This expanded coverage will give millions of Americans access to Zepbound and Foundayo, giving patients and physicians real choice in how to treat obesity,” Lilly said in a statement. “We continue to strive to make that true for everyone.”
Lilly added that the company’s pills will be covered by all three of the nation’s largest pharmacy benefit management companies, including Caremark.
Novo said in a statement that both its WeGoBe injection and the newly launched tablet of the same name will maintain CVS’s formulation priorities. CVS Caremark patients can continue taking these medications “without interruption,” Novo added.
As a PBM, Caremark is hired by employers, government agencies, unions, and other health plans to negotiate the cost of drugs included in formularies selected by plan sponsors.
Ed DeVaney, president of CVS Caremark, said in the release: “We took bold action through active engagement and negotiation with our pharmaceutical partners to address affordability and access for our customers and their members.”
CVS said Caremark guarantees customers, consultants, providers and members a “smooth transition” to covered treatments.
