CVS Caremark, the nation’s top pharmacy benefit manager (PBM), will reinstate coverage for Eli Lilly’s obesity products, making the drug available to a significant number of patients through their existing insurance.
CVS will begin covering Lilly’s GLP-1 pill Foundayo next Monday, June 1st, and will begin covering Lilly’s injectable treatment Zepbound on October 1st. CVS Caremark, the drug benefits arm of the pharmacy chain, is the nation’s largest PBM.
CVS previously featured Zepbound until Lilly’s market rival Novo Nordisk struck an official access deal with the retail giant, starting July 1 of last year, making Wegovy CVS a priority in obesity treatment. The decision to remove Zepbound from the drug list prompted a class action lawsuit from users of Lilly products who challenged CVS’ claims that Zepbound and Wegovy were interchangeable.
“GLP-1 represents a major clinical advance, but widespread demand for expensive drugs has created a level of financial burden that is difficult to absorb at scale,” CVS explained in a release. “As a result, many of our customers are making tough trade-offs in limiting coverage to maintain sustainable and balanced benefit programs. Through our continued collaboration with pharmaceutical companies, we are able to make this high-demand drug class more accessible.”
Tom Scales, Novo Nordisk’s SVP of Market Access, Public Affairs and Patient Support Solutions, noted in a statement that both the tablet and injectable versions of Wegovy maintain “preferred status” across CVS’ formulations, allowing patients currently taking Wegovy to continue their GLP-1 treatment without interruption.
“As CVS Caremark adds other weight loss drugs to its prescriptions in addition to Wegovy, Novo Nordisk supports the opportunity for patients seeking treatment for obesity and the prescribers who treat them to have the flexibility to choose the option that makes the most sense for them,” Scales added.
The adjustment is a significant victory for Lilly, which continues to distance itself from Novo despite the Danish company’s first-to-market advantage. The FDA approved Wegovy in 2021 and approved the oral version last December. Zepbound will hit the market at the end of 2023, followed by Foundayo last month.
“For too long, effective obesity treatments have been out of reach for the people who need them,” Ilya Yuffa, president of Lilly USA and global customer relations, said in a release. “Not all drugs work the same for patients, and expanding coverage puts real choice in the hands of millions of Americans and their doctors.”
For eligible patients with commercial insurance, Zepbound and Foundayo are available for $25 per month. In addition, Medicare Part D enrollees may also be eligible to pay $50 per month for Lilly or Novo obesity drugs through the Medicare GLP-1 Bridge Program. The initiative, announced earlier this month, will begin on July 1 and run until the end of 2027.
“We expect the addition of Foundayo to CVC Caremark’s commercial templates to further increase initial launch momentum,” Citi analysts wrote in a client note. “With a more streamlined process coming soon for commercially insured patients, broader coverage will lower the hurdle and further increase the expected volume changes from broader Medicare Part D access.”
Citi also noted that “payer coverage continues to be a major barrier to GLP-1 access and a major cause of discontinuation.”
Lilly said its obesity drugs are currently being targeted by three top PBMs, including Express Scripts and OptumRx.
“We are creating access and options that would not exist without our leadership in the market,” Ed Devaney, president of CVS Caremark, said in a release. “We took bold action through active engagement and negotiation with our drug manufacturer partners to address affordability and access for our customers and our members.”
