CVS Health Announces It Will Drop Zepbound and Prioritize Coverage of Wegovy

On Thursday, May 1, 2025, CVS Health announced that beginning July 1, 2025, its pharmacy benefit manager (PBM) division will drop tirzepatide (Zepbound; Eli Lilly and Co.) from its preferred formulary list and instead prioritize coverage of semaglutide (Wegovy; Novo Nordisk). According to an article by Forbes, this decision appears to be a move in a broader set of battles that involves competing pharmaceutical companies, PBMs, and pharma and direct-to-consumer telehealth companies. Such conflicts further emphasize the complexity of the US pharmaceutical chain.¹

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About Zepbound

Zepbound is Eli Lilly’s novel approach to weight management, which involves the dual activation of both glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonists, which mimics the actions of native GIP and GLP-1 receptor agonists. GLP-1 is known to regulate appetite and caloric intake, and by adding GIP activation, it provides a synergistic enhancement of appetite control. As of May 2025, Zepbound is approved with indications for long-term weight loss and maintenance in adults with obesity or overweight who have at least 1 weight-related comorbidity.^2,3

Zepbound is one of many GLP-1 receptor agonists to gain popularity due to their significant success helping individuals lose weight. However, coverage of these drugs is “patchy" because of their cost and the wide population of patients who could take them, according to AP News. Additionally, recent shortages have made both access and coverage challenging. For this reason, PBMs are able to pit the products against each other to negotiate lower prices in exchange for inclusion on a formulary.^1,4

AP News reported that David Whitrap, CVS Health spokesman, said that most employers end up using the standard formulary because of the discounts that are negotiated with them. Patients who are currently receiving treatment with Zepbound can switch to Wegovy if the prior drug is excluded from their coverage, he said.⁴

The SURMOUNT-5 Trial: Zepbound vs Wegovy

This announcement came shortly before results from the multicenter, randomized, open-label phase 3b SURMOUNT-5 (NCT05822830)⁵ clinical trial in which Zepbound demonstrated weight loss superiority to Wegovy. The results, published in The New England Journal of Medicine, showed that after 72 weeks, adults with obesity or overweight who did not have diabetes but had at least 1 comorbidity (eg, hypertension, dyslipidemia, obstructive sleep apnea, or cardiovascular disease) on Zepbound had met its primary end point as well as all 5 key secondary end points.³

In this study, a total of 751 patients were randomly assigned to receive a maximum tolerated dose of Zepbound (10 mg or 15 mg) or Wegovy (1.7 mg or 2.4 mg), of which most (89.3% and 92.8%, respectively) received at least one 15-mg dose of Zepbound and at least one 2.4-mg dose of Wegovy. SURMOUNT-5’s primary end point was to demonstrate superiority among individuals treated with Zepbound in percent change from baseline in body weight at study completion compared with Wegovy. Secondary end points included changes from baseline in body mass index, body weight, waist circumference, and percentages (greater than or equal to 10%, 15%, and 20%) of body weight reduction.^3,5

Individuals treated with Zepbound experienced an average weight loss of approximately 20.2%, which was significantly greater than the 13.7% average weight loss seen with Wegovy (47% greater relative weight loss). Participants in the Zepbound and Wegovy groups had lost, on average, about 50.3 and 33.1 lbs, respectively. Approximately 64.6% of individuals treated with Zepbound had achieved nearly 15.0% weight loss compared with 40.1% on Wegovy. In addition, participants in the Zepbound group had also achieved a superior waist circumference reduction (7.2 inches) compared with Wegovy (5.1 inches).^3,5

The study authors also reported that the safety profiles demonstrated in the SURMOUNT-5 trial were similar to those observed in prior SURMOUNT studies. Most adverse events were considered mild to moderate in severity and consisted of gastrointestinal issues.³

"In the SURMOUNT-5 trial, Zepbound demonstrated a significantly higher magnitude of weight reduction compared to Wegovy across all comparisons," Leonard C. Glass, MD, FACE, senior vice president of global medical affairs at Lilly Cardiometabolic Health, said in a news release from Eli Lilly and Co. "These data confirm Zepbound as a leading treatment option for people living with obesity and equip health care providers with critical insights to make well-informed treatment decisions as part of a comprehensive obesity care plan."³

Moving Forward

It is uncertain what CVS’s move will mean for patients going forward. Although Whitrap had said patients may transition to Wegovy, there are uncertainties regarding the efficacy and tolerability after a change of therapy. Additionally, patients may face disruptions in treatment, whereas health care professionals could face administrative burdens as they navigate the resulting effects, prior authorizations, and appeals on behalf of their patients.¹

Eli Lilly has reported working proactively to address patient access to Zepbound through offering copay assistance and patient support programs, as well as a direct-to-consumer pharmacy which allows patients to obtain Zepbound and other Lilly medications directly. Despite their initiatives, patients will likely continue to face the effects while manufacturers, payers, and PBMs jockey for position amidst the rise of GLP-1 receptor agonists.¹

REFERENCES

1. Joseph S. CVS Dropping Zepbound: What It Means For Patients, Payers, And Pharma. Forbes. May 5, 2025. Accessed May 14, 2025. https://www.forbes.com/sites/sethjoseph/2025/05/05/cvs-dropping-zepbound-what-it-means-for-patients-payers-and-pharma/

2. Bradford N. Navigating Weight Loss Medications: Long-Term Use, Discontinuation, and Maintaining Weight Loss. Pharmacy Times. April 22, 2025. Accessed May 14, 2025. https://www.pharmacytimes.com/view/navigating-weight-loss-medications-long-term-use-discontinuation-and-maintaining-weight-loss

3. Ferruggia K. Zepbound Shows Superior Weight Loss Compared to Wegovy in SURMOUNT-5 Trial. Pharmacy Times. May 14, 2025. Accessed May 14, 2025. https://www.pharmacytimes.com/view/zepbound-shows-superior-weight-loss-compared-to-wegovy-in-surmount-5-trial

4. Murphy T. Lilly star weight-loss drug Zepbound faces coverage challenge from CVS Health. AP News. May 1, 2025. Accessed May 14, 2025. https://apnews.com/article/eli-lilly-zepbound-access-cvs-health-formulary-225b85c54115d8ff5b79d40f74e663e9

5. A Study of Tirzepatide (LY3298176) in Participants With Obesity or Overweight With Weight Related Comorbidities (SURMOUNT-5). ClincialTrials.gov identifier: NCT05822830. Updated December 11, 2024. Accessed May 14, 2025. https://clinicaltrials.gov/study/NCT05822830