CVS halts Zepbound coverage, cites high costs for weight loss medication

CVS Caremark, one of the three -pharmaceutical advantages managers (PBM) in the United States, has stopped covering the famous ELI Lilly weight loss, and blame medications like it to increase the cost of the total plan.

GLP-1 products, originally developed to treat type 2 diabetes, but are now accredited by the food and Drug Administration (FDA) specifically for obesity under commercial names such as Wegovy and Zepbound, “contribute greatly to the total plan costs”. The removal of the drug coverage will lead to estimated savings from the customer from 10 % to 15 % year on an annual basis in the space of anti -population drugs for its customers who choose to cover these drugs for weight loss, according to Blado.

Zepbound, the brand name of Eli Lilly’s Tirzepatide, was approved by the FDA in 2023 to manage chronic weight in adults with obesity or weight gain with weight -related medical problems. Tirzepatide has already been approved to treat type 2 diabetes and was sold under the Mounjaro brand name.

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Zepbound was widely seen as a changing games in anti-obesity, after participating in a late stage studying up to a quarter of body weight-which made it more effective than Wegovy.

“The highly high list prices” for the GLP-1 products determined by the drug manufacturers are “the biggest obstacle to reaching the patient.”

He said: “Many warm, including Medicare and many state entitlements, have rejected the GLP-1 weight loss due to the high prices set by Brand Pharma.”

However, there are still exceptions if the drug is considered a “medical necessity”. This exemption will be reviewed “on the basis of each case separately,” according to Blado.

CVS CAREMARK is a subsidiary of CVS Health Corp, which also owns the CVS pharmacy. As director for pharmacy, CVS Caremark works mainly as a negotiator between pharmacies, insurance companies and drug manufacturers in the prescribed drug supply chain. PBMS negotiates with drug and pharmacy manufacturers to determine the amount of medicines, which medicines can obtain and any pharmacies can part of their network.

The pedestrians walk through the CVs Caremark Corp. In New York, the United States, on Tuesday, April 30, 2013. CVs Careark Corp. Profit data on May 1. Photographer: Victor J. Blue/Bloomberg via Getty Images

He criticized PBMS giants, saying that their role needs to be changed. ELI Lilly told Fox Business that the only way to reduce prices for consumers is if “brokers takes less for themselves.”

Dr. Christopher McGuwan, a digestive medicine specialist and a specialist at the Fox Business company, told the CVS Careark decision to drop the coverage of the drug “very troubled for already stable patients and flourish in the drug.”

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“We now see that the insurance policy goes beyond the medical judgment-which forces patients to turn into an alternative, although it is still effective, it has been presented in experiments directly to produce less extinction of weight from Zepbound.”

McGuan highlighted that the GLP-1 drugs “are not switched into practice, even if they are like paper.” He said that switching medications “could reflect the mid -progress.”

“For many, this is not just a simple replacement. It is a high -risk change that can affect long -term results, or lead to weight restoration, or the introduction of new side effects,” McGuan said.

This goes beyond CVS Caremark, according to McGoan, who is concerned that its decision with Zepbound “emphasizes a disturbing direction” where “financial contracts between benefits and drug manufacturers are increasingly formed clinical decisions.”

ELI Lilly & Co. (Shelby Nols / Bloomberg via Getti Imachurs / Tire)

This means that patients who have lower choices are not because of the best for their health, but because of the scenes deduction, continued.

“In the care of obesity, it is concerned with continuity. Once the patient finds a drug that works, while maintaining that success should be the priority,” he said. “Instead, we are witnessing the disruption of progress and forced patients to navigate the treatment changes who have never been requested.”

ELI Lilly Fox Business told the company committed to ensuring that patients reach the treatment they need.

“Although all CVS Caremark plans are affected, we have made strong efforts to communicate in a proactive way with many patients who may be affected and have made clear and subsequent steps through our support programs,” Lily said in a statement, adding that the company encourages patients to speak with health care providers about medical necessity or alternative coverage paths. It has also added resources on its website.

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If customers lose coverage, Eli Lily said that it has expanded through the Self -Pushing Pharmacy solutions for Lillydirect, the company’s self -payment program, which removes some of the third -party supply chain entities, and is provided to patients without covering medications with a discount.

The drug giant said that the patient who described Zepbound and needs to be accessed without going through his health insurance can get one dose bottles for about $ 500.