CVS Health announced it will expand coverage of obesity medications across its pharmacy benefit management plans starting this fall and early summer. The insurer will restore coverage of Novo Nordisk's Zepbound on October 1, reversing a previous delisting. CVS will also begin covering Eli Lilly's newly approved Foundayo beginning June 1, 2025.
Both drugs treat chronic weight management in adults with obesity or overweight conditions accompanied by weight-related health issues. Zepbound contains semaglutide, the same active ingredient in diabetes drug Ozempic. Foundayo uses tirzepatide, which Eli Lilly also markets as Mounjaro for diabetes treatment. These medications have gained massive popularity for weight loss, though supply constraints and insurance coverage gaps have limited access for many patients.
The move matters significantly for CVS members. More people can now access these expensive medications through their health plans instead of paying out-of-pocket costs, which typically range from $900 to $1,500 monthly without insurance. CVS's decision follows similar moves by competitors UnitedHealth and Humana, which expanded GLP-1 receptor agonist coverage in recent months.
CVS initially removed Zepbound from some formularies to manage costs, but reinstated it in response to member demand and competitive pressure. The addition of Foundayo gives CVS members a second option in the growing class of weight-loss medications, potentially offering lower out-of-pocket costs depending on the plan's tier structure.
Patients should check their specific CVS Health plan documents to understand coverage details, including prior authorization requirements, quantity limits, and cost-sharing amounts. Coverage policies vary by plan type and employer. Those currently paying out-of-pocket for these medications should contact CVS to discuss switching to covered options once the new dates take effect.
This expansion reflects