By Sriparna Roy
May 28 (Reuters) – CVS Health will restore Eli Lilly’s weight-loss injection Zepbound to its list of covered drugs and add the drugmaker’s newly approved obesity pill, Foundayo, it said on Thursday.
CVS Caremark, one of the largest U.S. pharmacy benefit managers, had dropped Zepbound on July 1, while it continued to reimburse for rival Novo Nordisk’s Wegovy after negotiating a better price from the Danish drugmaker.
Zepbound will return to CVS Caremark’s commercial formularies, or lists of covered medications, as an additional preferred option on October 1. The move is aimed at giving employers and health plans more affordable access to GLP-1 weight-loss treatments. Lilly’s shares rose 4% in afternoon trading.
“What this change means is that, for those clients that do (choose to provide coverage), they will have equal access to both the Novo and Lilly products, and consumers will have the same co-pays for each,” a CVS spokesperson said.
CVS anticipates that its clients will save an additional 10% to 15% across the therapy class due to its negotiations with both Novo and Lilly, the spokesperson said.
For those employers who choose to cover GLP-1s for weight loss, the member co-pays will be lower than the manufacturers’ direct-to-consumer prices, the spokesperson said.
The change will not eliminate reliance on the direct-to-consumer market, according to Robert Popovian, founder of healthcare consultancy Conquest Advisors.
“The key question for consumers is whether this competition actually lowers their out-of-pocket costs, or whether the savings stay mostly with plans, PBMs and employers,” Popovian said.
Eligible patients with commercial coverage can get Lilly’s Zepbound and Foundayo for as little as $25 a month, about the same for Novo’s weight-loss drugs.
EXPANDED ACCESS FOR LILLY’S WEIGHT-LOSS DRUGS
CVS also said its standard commercial formulary template will include Foundayo as a co-preferred weight-loss drug starting Monday, after the removal of a new-to-market block.
For newly approved drugs, CVS said there is typically a brief lag as it evaluates whether they should be added to its formularies and negotiates discounts with manufacturers.
Pharmacy benefit managers negotiate rebates and fees with drugmakers, create formularies and reimburse pharmacies for patients’ prescriptions.
All three of the nation’s largest pharmacy benefit managers now cover Lilly’s full obesity medicine portfolio.
BMO Capital Markets analyst Evan Seigerman said Lilly’s products could benefit from more affordable access for CVS’s roughly 90 million patients, which could drive Foundayo sales in the second half of the year.
(Reporting by Sriparna Roy in Bengaluru; Editing by Sahal Muhammed and Will Dunham)
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