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      Enabling wider access to effective weight management treatment

       

      Our bold approach to improving affordability and access

      We recently announced our decision to remove the weight management drug Zepbound from our Standard Control, Advanced Control and Value formularies, effective July 1, 2025. We’ll continue to prefer similar medications, including Wegovy. Weight management drugs have the potential to vastly improve the health of people living with obesity or other weight-related health issues. But drug manufacturers have priced them out of reach for many people – and for the payors who sponsor their benefit plans.

      Our clients count on us to help make medications more affordable so they can offer coverage of effective treatments toward our shared goal of helping their members improve their health. One way we do this is through our formulary strategy, which we use to negotiate discounts and prefer products for which we can deliver low net cost.

      Clinical comparison

      Wegovy (semaglutide) and Zepbound (tirzepatide) are part of a blockbuster class of drugs commonly referred to as “GLP-1s.” This class includes glucagon-like peptide-1 receptor agonists (GLP-1s) such as semaglutide. It also includes GIP/GLP-1s such as tirzepatide, which also target a second receptor – the glucose-dependent insulinotropic polypeptide receptor.

      Both semaglutide and tirzepatide have been shown to help people lose weight when paired with lifestyle changes. While some studies have suggested tirzepatide to be a more effective weight loss agent, real-world evidence suggests the two are comparable.1 By preferring one over the other, we can drive competition in the market to help bring prices down. This is critically needed because obesity affects more than 40 percent of U.S. adults.2

      This decision can help make weight management treatment more accessible, while preserving clinical integrity.

       

      Frequently asked questions

       

      Research on the long-term clinical efficacy of GLP-1s is ongoing. In one study, weight loss from semaglutide ranged from 13.2–22 pounds, compared with 15.4–28.6 pounds for tirzepatide.3 These results show that both medications are effective for weight management. It is important to remember that the health benefits of these medications are not tied to losing the largest amount of weight possible, but helping members achieve a healthy weight and helping them maintain that weight loss over time.

      These medications are intended to be used in conjunction with lifestyle changes. For best results, we recommend supporting members using these drugs with a structured program such as CVS Weight Management™. Members who have struggled to lose weight on medication alone have lost 13 times as much weight after enrolling in the program.4

      Semaglutide is the only drug in this class that’s been approved to help reduce the risk for CV events in patients with established heart disease. These events include heart attack, stroke and heart-related death. Research shows this CV risk reduction benefit exceeds what might be expected through weight loss alone. And benefits occur before target dosing or weight loss is achieved.5 CV outcomes for tirzepatide (Zepbound) are still being studied.

      Yes, however, the way it works to treat OSA has been attributed to weight loss. This suggests semaglutide should be similarly effective.6

      Study results on tolerability are inconclusive. Gastrointestinal (GI) side effects, such as nausea, vomiting and diarrhea, are common with both drugs. These effects may lessen over time or with dosing adjustments.7

       

      Taking all of this into account, we are comfortable preferring Wegovy, the most studied drug in this class.
      Of course, we’ll continue to evolve our strategy based on market dynamics, new clinical information and the GLP-1 pipeline.

       

      About one-third of our clients have elected not to cover weight management GLP-1s as part of their benefits. As costs continue to rise, clients are faced with a difficult decision as to whether they can continue to afford to offer coverage for these medications.

       

      Using formulary design to drive cost savings

      We’ve long used formulary strategy to drive competition and cost savings.  

      • Taking action for insulin affordability

        In 2012, we recognized a need to act on escalating insulin prices. We used formulary strategy to bring insulin prices back to affordable levels for our members. Other PBMs followed our lead.
      • Moving the needle on biosimilar adoption
        In 2024, we were the first PBM to remove Humira, preferring instead the biosimilar Hyrimoz at a $0 copay for many members. A proactive plan eased the transition for members and prescribers. This move yielded $1.5 billion in gross savings for our clients.8

      Based on positive past results, we’re confident our decision to exclude Zepbound will enable wider, more affordable coverage for weight management drugs. 

      Clients who use our template formularies could save an estimated 10-15 percent year-over-year in the anti-obesity medication (AOM) space, as a result of this change.9

       

       

      We aim to help improve the health and lives of the people who depend on us. If you have questions, contact your account team.

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