CVS Caremark has removed coverage of Zepbound, a GLP-1 weight-loss drug, citing pricing concerns and shifting payer dynamics that are reshaping how weight-loss treatments are covered under insurance plans, according to a report from AM Best.
In a statement, the pharmacy benefit manager pointed to drug pricing as a central challenge for insurers. “The egregiously high list prices set by drug manufacturers of GLP-1s for weight loss are the single biggest barrier to patient access,” a CVS spokesperson said. “Many payers, including Medicare and numerous state benefit plans, have declined to cover GLP-1s for weight loss because of the unsustainably high prices set by brand pharma.”
CVS said its updated formulary approach is designed to maintain coverage for treatments it deems clinically appropriate, while also using market competition to manage costs. Although Zepbound is being excluded, CVS stated it is continuing to expand access to other weight-loss drugs considered more cost-effective under current insurance models.
The company declined to say whether its new arrangement with Novo Nordisk, maker of Wegovy, influenced the Zepbound decision, according to the report.
Under the deal, CVS became the first retail pharmacy in Novo Nordisk’s pharmacy network, and Wegovy is now available at reduced pricing across 9,000 CVS locations. The agreement could offer a pathway for insurers and plan sponsors to control spending while still offering GLP-1 coverage.
The shift comes as insurers and benefit managers reassess how high-cost, high-demand weight-loss drugs fit into long-term coverage strategies. Medicare, Medicaid, and many employer-sponsored plans continue to exclude coverage of these drugs due to pricing concerns.
CVS Health also announced plans to exit the Affordable Care Act individual exchange business, citing ongoing financial underperformance and limited potential for future profitability in that segment.
As of the first quarter of 2025, CVS Health reported net income of $1.78 billion, up from $1.12 billion a year earlier. The company’s insurance and PBM operations remain backed by Best’s Financial Strength Ratings of A (Excellent).
