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Patients using GLP-1 drugs for weight loss are being required to switch to a different medication due to changes in insurance coverage, leading to dissatisfaction among them.
Starting July 1, CVS Caremark, a major pharmacy benefit manager in the U.S., removed Zepbound (tirzepatide) from its preferred drug list and replaced it with Wegovy (semaglutide).
Zepbound, along with its companion diabetes medication Mounjaro, is manufactured by Eli Lilly, while Wegovy is produced by Novo Nordisk, the maker of Ozempic.
CVS Caremark attributed the change to rising costs. In a statement on June 27, the company mentioned that high drug prices set by manufacturers have made it challenging for many people to access these medications.
In an effort to reduce out-of-pocket expenses for drugs, CVS Caremark announced a partnership with Novo Nordisk to enhance access to Wegovy at a more affordable price for its members.
Some patients taking GLP-1 drugs for weight loss have been forced to switch to a different medication due to a change in insurance coverage. (iStock)
“On July 1, 2025, we will take a formulary action to prefer Wegovy and remove Zepbound,” the statement continued. “We’re confident our decision to prefer Wegovy on our commercial template formularies will enable wider, more affordable coverage for weight management drugs, while preserving clinical integrity.”
Dr. Tro Kalayjian, a board-certified physician specializing in internal and obesity medicine in New York, emphasized that lack of patient choice always has negative consequences for patients.
Many patients who received notifications from Caremark about the switch have expressed their concerns on social media.
Another user wrote, “CVS just sent a letter stating it was no longer covered and I could transition to Wegovy. However, I did try Wegovy prior to Zepbound and it made me profusely ill. There should be exceptions to this rule. Since I’m only using the shot every other week, maybe I will pay for it through their website. It works for me and I don’t want to take the chance of gaining the weight back.”
“It’s been working so well for me, I’m really nervous about having to switch medications.”
CVS Caremark mentioned in its announcement that patients who previously tried Wegovy and experienced “severe or intolerable side effects” or “did not achieve sufficient weight loss” can request a “formulary exception” for coverage of a different weight loss drug.
Patients have the option to purchase Zepbound directly from Eli Lilly, but it comes with a high cost of approximately $300-$500 per month.
Kalayjian cautioned that people are resorting to purchasing research-grade versions of the medications from platforms like TikTok and social media due to desperation.
Kalayjian noted that Zepbound is slightly more effective than Wegovy, as it has an additional mechanism, but both drugs yield similar results in terms of weight loss.
“There is slightly less nausea and vomiting with Zepbound,” he added.
A recent study found that tirzepatide achieved greater weight loss than semaglutide, with participants shedding about 50 pounds (20.2% of their body weight). (iStock)
In a recent 72-week clinical trial published in The New England Journal of Medicine, researchers compared the safety and efficacy of tirzepatide (Zepbound) and semaglutide (Wegovy).
The study revealed that tirzepatide led to greater weight loss, with participants losing about 50 pounds (20.2% of their body weight).
Overall, 32% of individuals taking tirzepatide lost at least 25% of their body weight, while semaglutide users lost around 16%.
Tirzepatide users also reported a greater reduction in waist circumference compared to those on semaglutide.
The reported side effects were very similar for both drugs, with 44% of individuals experiencing nausea and 25% reporting abdominal pain.
Fox News Digital reached out to Eli Lilly and Novo Nordisk for comments.
