Zepbound is available at CVS Pharmacy, but there's a critical distinction
Yes, Zepbound is available at CVS retail pharmacies, and patients can fill their prescriptions there just as they would any other medication. However, confusion and concern have arisen due to a recent, significant change involving the insurance arm of CVS Health, CVS Caremark. For patients, understanding the difference between the physical pharmacy location and the pharmacy benefit manager (PBM) is crucial for managing costs and ensuring continued access to their treatment.
The CVS Caremark formulary decision
In May 2025, CVS Health announced that its PBM division, CVS Caremark, would drop Zepbound from its standard national preferred formulary effective July 1, 2025. Instead, the formulary would prioritize coverage for Wegovy, a competing GLP-1 medication. This means that for some insurance plans managed by CVS Caremark, Zepbound is no longer the preferred drug for obesity management.
This decision is part of a broader trend where PBMs negotiate with pharmaceutical manufacturers to control costs, often by favoring one drug over another in the same therapeutic class. For a patient, this change can have a direct and significant impact on their out-of-pocket expenses.
What the coverage change means for patients
For patients with a prescription for Zepbound, the change in CVS Caremark's formulary does not mean they are immediately cut off from their medication. The actual effect depends on the specifics of their individual insurance plan.
- Existing Prior Authorizations: For impacted plans, existing prior authorizations for Zepbound were reportedly canceled on June 30, 2025. Patients and their providers may need to submit a new prior authorization for continued coverage, which may now require a step-therapy process (trying Wegovy first).
- Variable Coverage: Not all CVS Caremark-managed plans are affected equally. Some formularies may continue to cover Zepbound, though often at a higher cost-sharing tier. Patients should contact their insurance provider to confirm their specific plan's coverage details.
- Higher Costs: Without preferred formulary status, patients will likely face higher co-pays, or the medication may not be covered at all, leaving them to pay the full cash price, which can exceed $1,000 per month.
Alternative ways to access and save on Zepbound
Given the insurance complexities, patients have several options to consider for obtaining Zepbound.
- Manufacturer Savings Programs: Eli Lilly offers a savings card program for commercially insured patients. Those with coverage for Zepbound may pay as little as $25 for a prescription, while those without coverage may be eligible for a discounted rate.
- LillyDirect Self-Pay Pharmacy: Eli Lilly also operates a direct-to-consumer online pharmacy. Patients with a valid prescription can purchase Zepbound vials at a lower, self-pay price without needing insurance. This option bypasses the PBM altogether.
- Telehealth Services: Many online weight-loss programs and telehealth platforms can help patients get a valid Zepbound prescription from a licensed healthcare provider. They can often provide support for navigating insurance paperwork, including prior authorizations.
- GoodRx and Discount Coupons: Websites like GoodRx track retail prices and offer coupons that can lower the cash price of Zepbound at various pharmacies, including CVS.
Comparing CVS retail and CVS Caremark access
| Aspect | CVS Retail Pharmacy | CVS Caremark (as PBM) |
|---|---|---|
| Physical Stock | Can fill a prescription for Zepbound. Inventory depends on stock levels and dose availability. | Manages the list of covered drugs (formulary) for many insurance plans, not the physical store inventory. |
| Availability | Dependent on having a valid prescription. | Not applicable. This refers to insurance coverage, not physical access. |
| Cost | Final cost determined by insurance coverage and eligibility for manufacturer savings programs. | Manages insurance coverage rules, which directly affect out-of-pocket costs for members. |
| Coverage Status | Accepts prescriptions regardless of insurance status. | Determines if Zepbound is a preferred drug and how much it costs for members. |
| Current Stance | Has Zepbound available for filling, similar to other retail pharmacies. | As of July 1, 2025, removed Zepbound from certain preferred formularies, favoring Wegovy. |
How to proceed with your Zepbound prescription
If you have a prescription for Zepbound, your first step should be to investigate your specific insurance plan's details, particularly if your coverage is managed by CVS Caremark. Contact the number on the back of your insurance card or use their online portal to check your formulary and any prior authorization requirements.
For those affected by the formulary change, discuss your options with your doctor. They can help navigate the prior authorization process or explore alternative treatments, such as switching to Wegovy or other medications. Meanwhile, exploring manufacturer savings programs and direct-to-consumer purchasing through LillyDirect can provide more affordable alternatives.
Conclusion
In summary, while Zepbound can be purchased at a physical CVS Pharmacy with a valid prescription, the crucial factor for many patients is insurance coverage. CVS Caremark's decision to shift formulary preference to Wegovy means that patients with affected plans will likely face higher costs or greater administrative hurdles for continued Zepbound access. Patients must be proactive, confirm their insurance details, and leverage alternative resources like manufacturer savings and telehealth to ensure uninterrupted and affordable access to their medication.
