Full Breakdown
CVS Caremark Restores Coverage of Eli Lilly’s Zepbound and Adds Foundayo
5/28/2026, 11:04:31 PM
Background & Context
In July 2025 CVS Caremark dropped Zepbound after striking a pricing deal with Novo Nordisk that made Wegovy a preferred GLP-1. The decision prompted patient backlash, a September 2025 class-action suit, and criticism that patients were forced to switch to a less-effective therapy for conditions such as sleep apnea. Lilly subsequently reduced its price to the PBM, prompting the reversal.
Timeline
- Jul 1 2025 – Zepbound removed from CVS Caremark’s standard formulary.
- Sep 2025 – Class-action lawsuit filed alleging loss of access to Zepbound.
- Jun 1 2026 – Foundayo (Lilly’s oral GLP-1) added to CVS Caremark’s standard formulary.
- Oct 1 2026 – Zepbound reinstated as a preferred option on the same formulary.
Key Figures & Groups
- CVS Health / CVS Caremark – Pharmacy-benefit manager implementing the coverage change.
- Eli Lilly & Co. – Manufacturer of Zepbound, Foundayo, and diabetes drug Mounjaro.
- Novo Nordisk A/S – Maker of Wegovy, the competing GLP-1.
- Ed DeVaney – President, CVS Caremark.
- Ilya Yuffa – EVP & President, Lilly USA.
- Evan Seigerman – BMO Capital Markets analyst.
- David Risinger – Leerink Partners analyst.
Data & Statistics
- CVS Caremark’s standard formulary covers an estimated 25 – 30 million commercially insured Americans; Reuters cites ?90 million CVS patients overall.
- CVS expects 10 %-15 % cost reductions across the GLP-1 class.
- Eligible members could pay as little as $25 per month for Zepbound or Foundayo, versus a list price of $1,086 for Zepbound.
- Approximately 10 million patients are projected to regain access to Zepbound.
- In 2025, about 70 % of standard-formulary users were forced to switch to Wegovy.
Why It Matters
Restoring Zepbound expands therapeutic choice for obesity and related comorbidities, potentially improving clinical outcomes for patients who respond better to tirzepatide. The dual coverage also intensifies competition between Lilly and Novo, influencing pricing dynamics for GLP-1 drugs that have become a major driver of pharmacy-spending growth.
Official Statements & Responses
CVS described the change as delivering “equal access” and “the same co-pays” for Novo and Lilly products, and projected additional savings for health plans. Ed DeVaney emphasized that CVS is “creating access and choice that would not exist without our leadership in the marketplace.” Lilly’s Ilya Yuffa noted that “broader coverage puts real choice in the hands of millions of Americans and their doctors.” Novo Nordisk affirmed that Wegovy will retain preferred status and highlighted its commitment to patient flexibility.
Criticism & Opposition
Patient groups argued that the 2025 removal forced abrupt therapy changes, especially for individuals using Zepbound to manage sleep-apnea-related weight issues. The class-action suit contends that the PBM’s formulary decision limited effective treatment options and increased out-of-pocket costs.
On-the-Ground Reports
Patients reported having to switch to Wegovy or discontinue therapy after the 2025 formulary change, prompting public complaints and the lawsuit. Industry observers noted that the backlash accelerated negotiations leading to the 2026 reinstatement.
Conflicting Reports & Gaps
Sources differ on the total number of individuals affected: CVS statements cite 25-30 million covered by the standard formulary, while Reuters mentions ?90 million CVS patients overall. The exact discount negotiated with Lilly for Zepbound has not been disclosed, and final Medicare coverage decisions for Zepbound remain pending.
Verbatim Quotes
- “What this change means is that, for those clients that do (choose to provide coverage), they will have equal access to both the Novo and Lilly products, and consumers will have the same co-pays for each,” — CVS spokesperson
- “We are creating access and choice that would not exist without our leadership in the marketplace,” — Ed DeVaney, president, CVS Caremark
- “Broader coverage puts real choice in the hands of millions of Americans and their doctors,” — Ilya Yuffa, EVP & President, Lilly USA
- “giving patients and their doctors a real choice in how obesity is treated.” — Lilly spokesperson
- “Resumed Caremark coverage for Zepbound may limit a prior competitive edge for Novo, which leveraged preferred placement on the template,” — Evan Seigerman, BMO Capital Markets analyst
- “The change means Foundayo is now covered by all three major pharmacy benefit managers, “a meaningful positive development for Lilly’s obesity medicine coverage,” said Leerink Partners analyst David Risinger.” — David Risinger, Leerink Partners analyst
What’s Next
Lilly plans to seek FDA approval for its next-generation tirzepatide candidate retatrutide later in 2026. Medicare’s GLP-1 pricing framework is under review, and both manufacturers continue to negotiate rebates that could further alter formulary positioning.
