Some patients taking GLP-1 medications for weight loss, and those who are forced to switch to another medication due to changes in insurance coverage, they are not satisfied with it.
As of July 1, CVS Caremark (one of the largest pharmacy profit managers in the US) dropped Zepbound (Tirzepatide) from its preferred drug list and replaced it with Wegovy (Semaglutide).
Zepbound is made by Eli Lilly, along with its corresponding diabetes medication, Mounjaro, while Wegovy is produced by Novo Nordisk, which makes Ozempic.
CVS Caremark drops coverage of common weight loss medications
CVS Caremark has condemned the rising costs of change. In a June 27 statement on its website, the company said, “drug manufacturers are responsible for setting drug prices on their own, and they price these drugs at high cost, making it difficult for many people to access them.”
CVS Caremark said it will partner with Novo Nordisk to “lower the prices of out-of-pocket drugs” to “significantly increase member access to Wegovy at a more affordable price.”
“On July 1, 2025, we will prefer Wegovy and take prescription actions to remove Zepbound,” the statement continued. “We are confident that our decision to prefer Wegovy in the commercial template formula will allow for a wider and more affordable coverage of weight control medications while maintaining clinical integrity.”
Dr. Tro Kalayjian, a board-certified physician based in New York and practicing obesity medicine, noted that a lack of patient selection always has a negative effect on patients.
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“Some people don’t tolerate certain drugs, and being forced to change to new drugs presents clear measures to stall progress,” he told Fox News Digital. “Forcing switching disrupts the continuity of care.”
“Drug switching is not always seamless. In many cases, administration needs to be reinduced and side effects can reappear.”
Many patients who received letters from Caremark about the Switch have expressed concerns on social media.
“I just approved Zepbound two months ago. I only lasted for two months and it’s already down 25.8 pounds,” wrote one user on Reddit. “I’ve now increased my two doses since my third month. There were few side effects. It’s working really well for me. I’m really nervous about having to switch medications.”
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Another user wrote, “I sent a letter saying that CVS is no longer covered and I can move to Wegovy. But I tried Wegovy before Zepbound. There should be an exception to this rule.
CVS Caremark has previously tested Wegovy with patients
Experienced “severe or unbearable side effects” or “failure to achieve sufficient weight loss” can be requested for a “exception to the formula” covered by another weight loss medication.
“You or your provider may initiate an exception request, which allows a case-by-case medical essentials review to determine whether compensation for alternative therapy is appropriate based on your clinical situation,” the company said.
Patients can choose to purchase Zepbound directly from Eli Lily, Kalayjian noted, but the drug is expensive and costs around $300 to $500 a month.
“Unfortunately, people are very desperate. They are buying research-grade medicines from Tiktok and social media,” he warned.
Kalayjian pointed out that Zepbound is “slightly effective” than Wegovy because it has an additional mechanism, but both drugs are “very similar” in weight loss results.
“I’m feeling a little less nauseous and vomiting from Zepbound,” he added.
In a recent 72-week clinical trial published in The New England Journal of Medicine, researchers compared the safety and efficacy of tilzepatide (Zepbound) and Semaglutide (Wegovy).
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This study found that tilzepatide was achieved Greater weight lossparticipants will drain approximately 50 pounds (20.2% of their body weight).
According to a press release summarizing the results of the study, the group taking semaglutide lost an average of 33 pounds or 13.7% of baseline body weight.
Overall, 32% of people taking tilzepatide lost at least 25% of their body weight. Semaglutide users lost about 16%.
Tilzepatide users also reported a “significant reduction in waist perimeter” than semaglutide users.
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The reported side effects are very similar for the two drugs, with 44% experiencing nausea and 25% experiencing abdominal pain.
Fox News Digital reached out to Eli Lilly and Novo Nordisk for comment.
