An Eli Lilly & Co. Zepbound injector pen displayed in the Brooklyn neighborhood of New York, United States, on Thursday, March 28, 2024.
Shelby Knowles | Bloomberg | Getty Images
CVS Health announced Thursday that it would restore coverage of Elie LillyZepbound, ‘s blockbuster weight-loss shot, and begin covering its new obesity pill in its standard drug plans — a win for the drugmaker and some patients who will be able to access more treatment options.
CVS will add Zepbound coverage on October 1 and will begin coverage of Lilly’s newly approved Foundayo pill on June 1. The move will boost Lilly’s efforts to maintain its dominance in Novo Nordisk in the blockbuster weight loss market because it puts both companies on equal footing when it comes to major drug plans.
This comes a year after CVS struck a deal with Novo Nordisk to make its drug Wegovy the preferred obesity treatment in its standard plans, while dropping coverage for Zepbound. That meant patients on those plans would have had to pay more out of pocket or jump through additional hoops to get Lilly’s drug.
But Lilly and Novo’s GLP-1 drugs will soon be co-preferred options on CVS Caremark’s standard commercial formulary model — a list of covered drugs that insurers and employers can choose to adopt — which represents 25 to 30 million Americans. Caremark is one of the nation’s largest pharmacy benefit managers.
Plan sponsors who adopt Caremark’s standard formulary can still choose not to cover GLP-1 for weight loss, so coverage for Lilly and Novo’s treatments is not guaranteed for all patients.
Still, CVS expects the move to generate 10% to 15% additional savings in the weight management category.
CVS on Thursday touted last year’s deal with Novo Nordisk as the first step by a major pharmaceutical benefits manager to spur competition in the GLP-1 market and “bend the cost curve.” CVS said Lilly and Novo responded by partnering with the healthcare giant to make GLP-1 for weight loss more affordable, noting “continued successful pricing negotiations” with the two 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 will continue to work to make this true for everyone.”
Lilly added that its pill will be covered by the country’s three largest pharmacy benefit managers, including Caremark.
In a statement, Novo said its Wegovy injection and new pill of the same name will retain their preferred status on CVS formularies. CVS Caremark patients can continue taking these medications “without interruption,” Novo added.
As a PBM, Caremark is hired by employers, government entities, unions and other health plans to negotiate the cost of drugs included on formularies chosen by plan sponsors.
“We are creating access and options that would not have existed without our market leadership,” Ed DeVaney, president of CVS Caremark, said in a statement. “We have acted boldly through active engagement and negotiations with our drug manufacturing partners to address 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.