The Major Shift: CVS Caremark Removes Zepbound from Standard Formularies
Effective July 1, 2025, CVS Caremark—one of the nation's largest Pharmacy Benefit Managers (PBMs)—made a significant change to its standard drug lists. The weight management drug Zepbound (tirzepatide) was removed from its Standard Control, Advanced Control, and Value formularies [1.2.3, 1.3.3]. This decision means that for many members under these common plans, Zepbound is no longer a covered medication. Instead, CVS Caremark has designated Wegovy (semaglutide) as the preferred GLP-1 medication for obesity treatment [1.2.2, 1.3.7].
This formulary action applies even to patients who were previously using Zepbound with success; existing prior authorizations for Zepbound under affected plans were canceled as of June 30, 2025 [1.2.1]. The change has been impactful, with one study noting a 16-fold increase in patients switching from tirzepatide to another drug in July 2025 [1.3.4]. The move even prompted a class-action lawsuit filed against the PBM [1.2.8].
Understanding Zepbound (Tirzepatide)
Zepbound, manufactured by Eli Lilly, is an injectable prescription medicine approved by the FDA for chronic weight management [1.4.1]. It is indicated for adults with obesity (BMI ≥ 30) or those who are overweight (BMI ≥ 27) with at least one weight-related health condition [1.4.1].
What sets Zepbound apart is its unique mechanism. It is the first and only approved obesity treatment that activates two different hormone receptors: GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 (glucagon-like peptide-1) [1.4.1, 1.4.6]. This dual-action approach helps reduce appetite and food intake, leading to significant weight loss [1.4.3]. In clinical trials, patients taking Zepbound lost an average of up to 20.9% of their body weight over 72 weeks [1.5.3]. In 2025, Zepbound also received FDA approval to treat moderate-to-severe obstructive sleep apnea (OSA) in adults with obesity [1.4.2, 1.4.5].
The 'Why' Behind the Formulary Decision
CVS Caremark has stated that the decision to remove Zepbound and prefer Wegovy was driven by a need to balance access and affordability amid the rising costs of GLP-1 medications [1.2.2]. PBMs negotiate rebates and discounts with drug manufacturers to achieve a lower net cost [1.2.3]. The company announced it had partnered with Novo Nordisk, the maker of Wegovy, to increase access to that medication at a more affordable price for plan sponsors [1.2.4, 1.3.1]. Critics argue that such decisions are about money and rebates rather than clinical superiority, as patients are forced to switch from a medication that may be working well for them [1.3.6].
How to Determine Your Specific Zepbound Coverage
Crucially, the CVS Caremark standard formulary is not the final word for every patient. Individual employers and health plans can customize their formularies [1.2.1]. A plan sponsor can choose to override the standard list and continue covering Zepbound. Therefore, you must verify your own plan's details. Here’s how:
- Log into Your Member Portal: The most reliable source is your personal account on the CVS Caremark website or app.
- Use the "Check Drug Cost" Tool: This feature allows you to search for specific medications like Zepbound and see its coverage status, tier, and estimated cost under your plan.
- Review Your Plan's Formulary Document: This detailed PDF lists all covered drugs. Look for the 2025 version.
- Contact Member Services: Call the number on your insurance card to speak directly with a representative about Zepbound coverage.
- Talk to Your HR Department: Your employer's benefits administrator can provide information on why specific coverage decisions were made for your company's plan.
Zepbound vs. Wegovy: A Head-to-Head Comparison
While both are weekly injectables for weight loss, Zepbound and Wegovy have key differences in their mechanism and clinical trial results [1.5.3, 1.5.4].
| Feature | Zepbound (Tirzepatide) | Wegovy (Semaglutide) |
|---|---|---|
| Mechanism of Action | Dual GIP and GLP-1 receptor agonist [1.4.6] | Single GLP-1 receptor agonist [1.5.3] |
| Manufacturer | Eli Lilly [1.4.1] | Novo Nordisk [1.3.7] |
| FDA-Approved For | Chronic weight management in adults; Obstructive Sleep Apnea in adults with obesity [1.4.1, 1.4.5] | Chronic weight management in adults and children 12+; Reducing cardiovascular risk in adults with heart disease [1.5.4, 1.5.7] |
| Average Efficacy | Up to ~21% body weight loss in trials [1.5.6] | Up to ~15% body weight loss in trials [1.5.6] |
| CVS Caremark 2025 Status | Removed from standard formularies [1.2.3] | Preferred drug on standard formularies [1.3.7] |
What Are Your Options If Zepbound Is No Longer Covered?
If you find your plan has dropped Zepbound, you still have several potential paths forward.
1. Appealing for a Formulary Exception
You and your doctor can file an appeal or request a formulary exception based on medical necessity [1.2.7, 1.3.9]. This is a viable option if you've already been successful on Zepbound, or if you've tried and failed on the preferred alternative (Wegovy). The appeal would argue that Zepbound is uniquely effective for your condition [1.3.6].
2. Utilizing the Eli Lilly Savings Program
Eli Lilly offers a Zepbound Savings Card that remains active through 2025 [1.6.1].
- If you have commercial insurance that covers Zepbound: You may be able to pay as little as $25 for a 1- or 3-month prescription [1.6.3].
- If you have commercial insurance that does not cover Zepbound: You may still use the card to get a 1-month supply for a reduced price, with savings of up to $569 [1.6.1]. This can bring the monthly cost down significantly from the list price [1.6.3].
3. Switching to a Preferred Alternative
The most direct path is to talk to your doctor about switching to a covered alternative like Wegovy [1.2.2]. As the preferred formulary option, it will likely have the lowest out-of-pocket cost for most members. Other covered alternatives might include Saxenda, Qsymia, or orlistat, depending on the formulary [1.3.2].
Conclusion: Navigating Weight-Loss Medication Coverage in 2025
The answer to "Will CVS Caremark cover Zepbound in 2025?" is a nuanced "no" for its standard plans, but a possible "yes" depending on your specific employer plan [1.2.1, 1.2.3]. The PBM has shifted its preference to Wegovy as a cost-control measure [1.3.1]. Patients currently taking or considering Zepbound must take proactive steps to check their individual plan's formulary, explore appeal options for medical necessity, and investigate manufacturer savings programs to manage costs.
Disclaimer: This article provides information based on publicly available data as of September 2025 and is not medical or financial advice. Consult with your healthcare provider and insurance plan administrator for personal guidance.
Explore official formulary documents on the CVS Caremark website.
