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Some patients taking GLP-1 drugs for weight loss have been forced to switch to a different medication due to a change in insurance coverage — and they’re not happy about it.
As of July 1, CVS Caremark — one of the biggest pharmacy benefit managers in the U.S. — dropped Zepbound (tirzepatide) from its preferred drug list, replacing it with Wegovy (semaglutide).
Zepbound — along with its counterpart diabetes medication, Mounjaro — is made by Eli Lilly, while Wegovy is produced by Novo Nordisk, which also makes Ozempic.
CVS CAREMARK DROPS COVERAGE OF POPULAR WEIGHT LOSS DRUG
CVS Caremark blamed rising costs for the change. In a June 27 statement on its website, the company noted that “drug manufacturers are solely responsible for setting the price of drugs and have priced these medications at a high cost, making it difficult for many people to access them.”
In an effort to “lower out-of-pocket drug prices,” CVS Caremark said it partnered with Novo Nordisk to “significantly increase access to Wegovy for our members at a more affordable price.”
“On July 1, 2025, we will take a formulary action to prefer Wegovy and remove Zepbound,” the statement continued. “We’re confident our decision to prefer Wegovy on our commercial template formularies will enable wider, more affordable coverage for weight management drugs, while preserving clinical integrity.”
Dr. Tro Kalayjian, a board-certified physician practicing internal and obesity medicine based in New York, noted that lack of patient choice always negatively affects patients.
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“Some people do not tolerate certain medications, and being forced to change to a new drug presents a clear avenue to stall progress,” he told Fox News Digital. “Forced switching disrupts continuity of care.”
“Switching drugs is not always seamless; dosing must often be re-titrated, and side effects can re-emerge.”
Many patients who received letters from Caremark about the switch have taken to social media to express their concerns.
“I was just approved for Zepbound two months ago … I’ve only been on it for two months and I’m already down 25.8 lbs,” one user wrote on Reddit. “I’ve increased my dose twice since I’m now in month three, and I’ve had little to no side effects. It’s been working so well for me, I’m really nervous about having to switch medications.”
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Another user wrote, “CVS just sent a letter stating it was no longer covered and I could transition to Wegovy. However, I did try Wegovy prior to Zepbound and it made me profusely ill. There should be exceptions to this rule. Since I’m only using the shot every other week, maybe I will pay for it through their website. It works for me and I don’t want to take the chance of gaining the weight back.”
“It’s been working so well for me, I’m really nervous about having to switch medications.”
CVS Caremark stated in its announcement that patients who previously tried Wegovy and
experienced “severe or intolerable side effects” or “did not achieve sufficient weight loss” can request a “formulary exception” to be covered for a different weight loss drug.
“You or your provider may initiate an exception request, which allows for a case-by-case medical necessity review to determine whether coverage for an alternative therapy is appropriate based on your clinical circumstances,” the company stated.
Patients can opt to purchase Zepbound directly from Eli Lilly, Kalayjian noted, but the medication is expensive, costing roughly $300-$500 per month.
“Unfortunately, people are so desperate they are buying research-grade versions of the medications from TikTok and social media,” he warned.
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Kalayjian noted that Zepbound is “slightly more effective” than Wegovy, as it has an additional mechanism, but both drugs are “very similar” in their weight loss results.
“There is slightly less nausea and vomiting with Zepbound,” he added.
In a recent 72-week clinical trial published in The New England Journal of Medicine, researchers compared the safety and efficacy of tirzepatide (Zepbound) and semaglutide (Wegovy).
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The study found that tirzepatide achieved greater weight loss, with participants shedding about 50 pounds (20.2% of their body weight).
The group taking semaglutide lost an average of 33 pounds or 13.7% of their baseline weight, according to a press release summarizing the study outcome.
Overall, 32% of the people taking tirzepatide lost at least 25% of their body weight; semaglutide users lost around 16%.
Tirzepatide users also reported a “greater reduction in waist circumference” than those on semaglutide.
The reported side effects were very similar for the two drugs, with 44% of people experiencing nausea and 25% having abdominal pain.
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A spokesperson from Eli Lilly provided the following statement to Fox News Digital.
“Lilly is disappointed with CVS Caremark’s decision, as we believe this limits doctors’ choice and patient access. We believe that maintaining the ability for doctors to choose the right medication for patients is crucial to ensure the best patient care. Zepbound showed proven efficacy and acceptable safety in multiple trials and led to superior weight loss compared to Wegovy in a recent head-to-head trial. Lilly remains committed to providing savings options for appropriate Zepbound patients regardless of their coverage status.”
A spokesperson from Novo Nordisk provided the below statement.
“Coupled with the approval to treat adults and pediatric patients aged 12 years and older with obesity, Wegovy® is now the GLP-1 with the broadest label.”
“Adding to the mounting reasons why HCPs choose Wegovy, beyond weight management, the FDA expanded the label in 2024 to include risk reduction of major adverse cardiovascular events (MACE) such as death, heart attack or stroke in adults with known heart disease and with either obesity or overweight.”
“We continue to explore the real-world potential of Wegovy, and we stand by its beneficial health outcomes beyond weight loss alone.”
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