Eli Lilly & Co. injection pen. Zepbound held in the Brooklyn area of New York, US, on Thursday, March 28, 2024.
Shelby Knowles | Bloomberg | Getty Images
CVS Health on Thursday he said he would restore the coverage of Eli Lilly‘s blockbuster weight loss injection Zepbound has also begun covering its new obesity pill in its generic drug plans — a win for the drugmaker and for some patients who will have access to more treatment options.
CVS will add Zepbound coverage on Oct. 1, and began covering Lilly’s newly approved pill Foundayo 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 two companies on equal footing in major drug programs.
It comes a year after CVS struck a deal with Novo Nordisk to make its drug Wegovy the obesity treatment of choice in its regular plans, while dropping coverage of Zepbound. That meant patients in those plans would have to pay more or go through other hurdles to get Lilly’s drug.
But GLP-1 drugs from both Lilly and Novo will soon be co-opted into CVS Caremark’s standard formulary — a list of covered drugs that insurers and employers can choose to use — representing 25 to 30 million Americans. Caremark is one of the largest pharmacy benefit managers in the country.
Plan sponsors who use Caremark’s regular formulary may opt out of GLP-1 coverage to reduce, so coverage of Lilly and Novo treatments is not guaranteed for all patients.
Still, CVS expects the move to drive an additional 10% to 15% savings in the weight management category.
CVS on Thursday touted last year’s deal with Novo Nordisk as the first step by the pharmacy benefit giant to promote competition in the GLP-1 market and “bend the cost curve.” CVS said both Lilly and Novo responded by partnering with the health care giant to make GLP-1 weight loss supplement worse, pointing to “ongoing pricing discussions” with both drugmakers.
“With this expanded merger, millions of Americans will have access to Zepbound and Foundayo, giving patients and their doctors a choice in how obesity is treated,” Lilly said in a statement. “We will continue to work to make that a reality for everyone.”
Lilly added that its pill will be covered by all three major pharmacy benefit managers in the country, including Caremark.
In a statement, Novo said it is “exciting” that the Wegovy injection and the newly introduced pill of the same name will retain their preferred status in CVS formulas. CVS Caremark patients can stay on those medications “without interruption,” Novo added.
As a PBM, Caremark is hired by employers, federal agencies, unions and other health plans to negotiate the cost of drugs included in formularies chosen by plan sponsors.
“We are creating access and options that would not exist without our leadership in the market,” said Ed DeVaney, president of CVS Caremark, in the release. “We’ve been bold in engaging and engaging with our drugmaker partners to address affordability and access to our customers and members.”
CVS said Caremark will ensure a “smooth transition” of covered treatments for customers, advisors, providers and members.
