Less for Less: CVS drops Zepbound for Wegovy
CVS Health drops coverage of the more effective Tirzepatide (Zepbound) for Semaglutide (Ozempic, Wegovy) and Liraglutide (Saxenda).
CVS Health is the closest pharmacy for many people in the US, and they have been one of the main points by which GLP1 Receptor Agonists can be accessed – a trusted name in the retail pharmaceutical business.
Check out our quick explainer
Disappointingly, CVS Health has dropped the more effective Zepbound (Tirzepatide) for less effective Wegovy (Semaglutide) and Saxenda (Liraglutide).
TOM MURPHY
The Associated Press article puts it charitably (a "coverage challenge"), but this seems like an absolute step away from the simple goal of effective patient care.
To be fair, they made this decision before the results of the SURMOUNT-5 trial which was a direct head to head comparison between Tirzepatide and Semaglutide:
GLP1.Guide Staff
Louis J Aronne
Tirzepatide was proven to be more effective than Semaglutide by that study, and is in line with what everyone already knew anecdotally. Ozempic and Wegovy work very well, but Zepbound and Mounjaro work even better.
Despite the reduced efficacy of Semaglutide in comparison to Tirzepatide, CVS Health is removing coverage of Zepbound (Tirzepatide).
CVS's press release
Here's the announcement in the words of CVS Health:
While this move could indeed be regarded as "improving access", it's certainly a step down for those who already had access to Zepbound.
CVS Caremark had this to say in a letter to consumers (as reported by CNN):
“This change is happening because there’s another covered medication that’s safe and effective for your condition and may cost less,” CVS Caremark said in a letter sent in May to its patients using Zepbound. “Please keep in mind, if you refill your current medication on or after 7/1/2025, you’ll need to pay the full cost.”
So, it's possible to get Zepbound, but only at "full" cost.
CVS Health is planning to sell Wegovy at a "discounted" price of $500 monthly:
CVS Health also said Thursday that it will start selling Wegovy at a discounted price of about $500 monthly at thousands of drugstores for people without coverage.
LillyDirect may be the better choice for most
CVS Health's new price for an inferior product makes dramatically less sense now that LillyDirect exists:
4 2.5mg single-dose vial is $349 according to Lilly Direct:
So at this point, why bother with CVS Health?
Why did CVS Health drop Zepbound?
So why would CVS switch from a more effective drug to a less effective substitute? Well you might have guessed it – Cost.
With Tirzepatide coming out of shortage, and companies clamping down on compounding of GLP1 drugs across the board, the price of Tirzepatide is seemingly just too high for CVS Health.
In the past CVS Health was able to supply Zepbound in-house – to put it simply they were a compounder at massive scale. This made it easy to offer Zepbound cheaper than they could have otherwise bought it (it certainly didn't cost them $1000 a dose) and make profits.
They launched a weight management program that seems to have been doing very well (at the very least results wise):
When the rubber hits the road though, the recent announcements by Novo Nordisk to offer Wegovy at a reduced price were incredibly compelling.
It's disappointing, but considering a potential world where CVS switched to only Saxenda, the inclusion of Wegovy is at least an improvement.
A ray of hope: Formulary Exceptions
One important thing to note is that there's still an avenue to stay on Zepbound, formulary exemptions for sufficient weight loss or intolerable side effects:
If you have previously tried Wegovy and either experienced severe or intolerable side effects or did not achieve sufficient weight loss, you may request a formulary exception to be covered for a different weight loss drug through CVS Caremark. 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 review will consider clinical history/response to prior treatment and will require supportive documentation from your provider. We want patients to be taking medications that are safe and effective.
It's worded incredibly carefully but this may be a place where a little pushing/elbow grease might go a long way. Read lightly, even the case of insufficient weight loss may be enough to get a formulary exception.
Of course, in practice, this "review" is likely to be heavily influenced by corporate incentives – CVS Health's incentive (along with medical providers) is to avoid Zepbound (even though it's more effective) in favor of cheaper options.
Is the loss of effectiveness grounds for legal trouble?
With the gap between Wegovy and Zepbound, it's surprising that companies like CVS Health can switch from one to the other and treat them as substitutes. At this point it's all but proven that Wegovy is an inferior good to Zepbound (though both are still excellent solutions for type 2 diabetes management and weight loss).
So how could CVS Health get away with dropping one option for a less effective one?
While most weight management situations are not immediately life or death, type 2 diabetes is a much more serious disease, but we only have data on Tirzepatide being better for weight loss. Hba1c was not measured by the SURMOUNT-5 trial.
CVS also hasn't had the "cleanest shirt" when it comes to malpractice:
- CVS was ordered to pay 95 Million in a whistleblower lawsuit
- CVS sued by a state AG for overcharging medicaid members
- CVS was sued (along with Aetna) over prepaid cards
Despite the swap for a less effective substitute, there doesn't seem to be grounds for a large class action lawsuit against CVS Health in this matter, but it's something worth looking out for. The ability to get an exemption largely plays a huge role – those who have a "need" for Tirzepatide may still be able to get it.
