Understanding the CVS Caremark Formulary Change
Before rushing to your local CVS, it is critical to understand the distinction between CVS Pharmacy (the retail store) and CVS Caremark (the pharmacy benefit manager, or PBM). CVS Caremark is the entity that manages prescription drug benefits for many insurance plans, not the retail store where you pick up your medication.
Effective July 1, 2025, CVS Caremark made a significant formulary change, opting to remove Zepbound (tirzepatide) from its preferred drug list in favor of Wegovy (semaglutide). This was a financial decision based on contract negotiations and rebates with the drug manufacturers. For patients whose insurance plan is managed by CVS Caremark, this means their Zepbound may no longer be covered, or coverage may require a much more stringent prior authorization process. This change impacts insurance coverage, not the physical inventory of the retail pharmacy.
Separating Insurance Coverage from Pharmacy Availability
Many patients mistakenly believe that because CVS Caremark no longer covers Zepbound, their local CVS Pharmacy will not stock it. This is not the case. A CVS retail pharmacy operates independently of the PBM's formulary decisions when it comes to filling prescriptions, provided you have a valid prescription and a method of payment.
- Pharmacy Stock: A CVS retail store can and will fill a Zepbound prescription if it is in stock. You can still transfer or drop off your prescription there.
- Insurance Coverage: The problem lies with your insurance. If your plan is managed by CVS Caremark and was affected by the formulary change, it will likely deny coverage for Zepbound unless you successfully appeal the decision.
- Cost: Without insurance coverage, you would be responsible for the full, high cash price of the medication.
What are your options if your coverage is affected?
If you received a letter from CVS Caremark about the formulary change and your coverage is impacted, you have several paths to continue your treatment.
Alternative paths for Zepbound patients
| Option | Description | Pros | Cons |
|---|---|---|---|
| File an appeal | Your healthcare provider can submit an appeal for a formulary exception, often with a letter of medical necessity explaining why Zepbound is a better choice for you than Wegovy. | You may be able to stay on Zepbound with continued insurance coverage. The process is legally required to be expedited in some cases. | The process can be time-consuming and there is no guarantee of success. Your doctor may need to provide specific clinical evidence. |
| Use the Zepbound Savings Card | Eligible commercially insured patients without coverage may be able to pay a lower monthly price for Zepbound through Eli Lilly's savings program. | Substantially reduces the out-of-pocket cost. Can be used at retail pharmacies. | Still more expensive than a covered co-pay. Requires commercial insurance, but not government plans like Medicare. |
| Purchase via LillyDirect | Eli Lilly's direct-to-consumer pharmacy offers Zepbound vials for self-pay without needing to go through insurance. | Can potentially offer a lower self-pay price. Avoids insurance bureaucracy. | Requires a valid prescription and is cash-pay only. The single-dose vials are only available this way. |
| Explore alternative medications | Discuss switching to the now-preferred drug, Wegovy, or other weight-loss options with your doctor. | Ensures continued insurance coverage under many CVS Caremark plans. Your doctor may find a suitable alternative. | Wegovy and Zepbound are not identical and may produce different results. Requires a new prescription. |
How to check Zepbound stock and fill your prescription
Even if your insurance covers Zepbound or you plan to pay out-of-pocket, confirming stock is a wise step. While an FDA shortage was resolved in October 2024, local pharmacy availability can fluctuate due to high demand.
- Call your local CVS Pharmacy: It is best to call the specific CVS location where you intend to fill the prescription. Ask if they have your specific dosage strength in stock.
- Check other pharmacies: If your CVS is out of stock, consider calling other local pharmacies, including Walgreens, independent pharmacies, or those located within supermarkets.
- Consider online fulfillment: Online pharmacies like Amazon Pharmacy or Eli Lilly's LillyDirect can also be options for filling your prescription and potentially shipping it to you.
- Use online tools: Some online tools and community trackers can provide real-time updates on local stock, but these should be verified by calling the pharmacy directly.
Conclusion
In summary, the answer to "Can I still fill my Zepbound prescription at CVS?" is a qualified "yes." You can still take your prescription to a CVS retail pharmacy. However, the more crucial question for many is "Will my insurance still cover Zepbound at CVS?" The answer to that, for many CVS Caremark customers, is "no," as of July 1, 2025, due to a formulary change. If you are affected, your options range from appealing the decision to exploring alternative payment methods or switching medications. It is essential to communicate with your healthcare provider and verify both your insurance coverage and the specific pharmacy's stock before attempting to fill your prescription.
