CVS Health has announced it will reinstate insurance coverage for Eli Lilly's popular weight-loss injection Zepbound and add its new oral weight-loss medication to its standard drug plan. This move helps Eli Lilly continue to compete with Novo-Nordisk A/S in the lucrative weight-loss drug market, placing the two pharmaceutical giants back on equal footing within a major insurance formulary. A year ago, CVS had partnered with Novo-Nordisk A/S, designating the latter's Wegovy as the preferred weight-loss drug for its standard plan and removing coverage for Zepbound.
CVS Health stated on Thursday that it will resume coverage for Eli Lilly's blockbuster weight-loss injection Zepbound and include its new oral weight-loss drug in its standard formulary. This is positive news for the drugmaker and for patients, who will gain more treatment options.
Coverage for Zepbound will be reinstated on October 1, while coverage for Eli Lilly's newly approved oral weight-loss drug, Mounjaro, will begin on June 1. This action will support Eli Lilly in its ongoing competition with Novo-Nordisk A/S in the hotly contested weight-loss medication sector, re-establishing parity between the two companies in a mainstream insurance formulary.
Last year, CVS entered into an agreement with Novo-Nordisk A/S, designating the latter's Wegovy as the preferred weight-loss drug for its standard insurance plan and simultaneously ending coverage for Zepbound. At that time, this meant insured patients who wanted to use Eli Lilly's drug would either have to pay significantly more out-of-pocket or navigate additional, cumbersome procedures.
Now, Eli Lilly and Novo-Nordisk A/S's glucagon-like peptide-1 (GLP-1) drugs will soon both be listed as preferred medications on CVS Caremark's standard commercial drug list. This list is available for selection by insurance companies and employers, covering approximately 25 to 30 million Americans. Caremark is one of the largest pharmacy benefit managers in the United States.
Partners who adopt this standard drug list can still choose not to provide coverage for GLP-1 drugs prescribed for weight loss, meaning not all patients will have access to coverage for both medications.
Despite this, CVS anticipates that this adjustment will further reduce the overall cost of weight management medications by an additional 10% to 15%.
CVS stated that last year's agreement with Novo-Nordisk A/S represented the first time a major pharmacy benefit manager had taken steps to foster competition in the GLP-1 market and lower overall drug costs. The company reported that both Eli Lilly and Novo-Nordisk A/S subsequently engaged proactively, with ongoing price negotiations effectively lowering the cost barrier for weight-loss GLP-1 drugs.
Eli Lilly said in a statement, "With expanded coverage, millions of Americans will have access to Zepbound and Mounjaro, providing patients and doctors with real choice in obesity treatment. We will continue our efforts to make these treatments accessible to more people."
Eli Lilly added that its oral weight-loss drug has now gained coverage approval from the three largest pharmacy benefit managers in the nation, including Caremark.
Novo-Nordisk A/S responded that its Wegovy injection and its new oral counterpart will retain their preferred status on the CVS formulary. The company stated that patients insured through CVS Caremark can continue their medications without interruption in service.
Pharmacy benefit managers are contracted by employers, government agencies, unions, and other health plan sponsors to negotiate prices for drugs on their formularies.
Ed Devaney, President of CVS Caremark, said in the announcement, "It is through our proactive role in the industry that people gain more choices for their medications. We actively engage and negotiate with drug manufacturers, boldly advancing initiatives to address the issues of high drug costs and access challenges."
CVS has committed that Caremark will ensure a smooth transition for its clients, consulting partners, healthcare providers, and plan members to access coverage for the relevant drugs.
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