As a medicine company, we believe healthcare providers and patients
should have the ability to choose the medicine that suits the health needs of the
individual, rather than being forced into a single option based on formulary decisions.
Text "Rx" to 85099 to receive updates if you were impacted by the CVS Caremark decision. We will continue to update this site as we learn more.
Important Updates on Zepbound® Coverage with CVS Caremark®
What to know
On May 1, 2025, CVS Health announced that CVS Caremark, the pharmacy benefits manager division of CVS Health,
will stop covering Zepbound as a preferred obesity management medication on select formularies, effective July 1, 2025.
Not every formulary is impacted. Only some CVS Caremark formularies will no longer cover Zepbound as a preferred medication.
Call CVS Caremark to find out which specific formulary you have and if you are impacted.
For those who are impacted, CVS Caremark has stated that you can keep getting your Zepbound prescription until July 1, 2025.
The announcement from CVS Caremark relates to insurance coverage only, and is not for CVS, the
retail pharmacy. This does not impact your ability to fill your Zepbound prescription at CVS retail pharmacy.
How to prepare
Action: Call CVS Caremark to check if your specific formulary is impacted and why.
Ask what specific information may be needed to approve coverage.
The phone number is usually on the back of your insurance card.
When: Now.
Confirming if your specific coverage is impacted as early as possible before July 1, 2025 can help you explore any options that may be available.
Action: Talk with your healthcare provider about whether updating your prescription to a 90-day supply before July 1, 2025 is appropriate based on your treatment plan.
This may or may not be an option based on timing of when refills occur, and terms of insurance coverage.
When: Now. Talk to your healthcare provider to understand if this option is appropriate for you.
If it is, your prescription will need to be updated to a 90- day supply before July 1, 2025, when this change takes effect.
Action: If you and your healthcare provider decide Zepbound is right for you and you want to stay on Zepbound after July 1, 2025, speak with them to determine options to submit an appeal or submit a letter of medical necessity request to approve coverage.
When: It is important to wait to submit an appeal or a letter of medical necessity request until on or after July 1, 2025, when this coverage decision takes effect.
Click here
to learn about
self pay options available through LillyDirect® Self Pay Pharmacy Solutions
Make your voice heard
Ask your employer's Human Resources (HR) department now about choosing an insurance plan that covers obesity management medications like Zepbound,
and that allows patients and providers to choose the most appropriate medication for them.
You could also consider sharing your concerns on social media, reaching out to your federal,
state or local representatives, or contacting your state department of insurance.
If you want help, some people use an AI tool like Claude.ai or ChatGPT to help organize their thoughts and concerns.
Frequently Asked Questions
A formulary is a list of medicines that are covered by participating health insurance plans.
CVS Caremark has stated this change will take effect July 1, 2025.
This change does not impact all CVS Caremark formularies. To understand the type of specific plan you have, call CVS Caremark.
On certain CVS Caremark formularies, Zepbound will remain covered at equal status to Wegovy® (semaglutide).
For other formularies, coverage of Zepbound will change as of July 1, 2025.
On plans impacted by this change, Wegovy will become the preferred obesity management medication.
Contact your employer's Human Resources (HR) department about choosing an insurance plan that covers obesity management
medications like Zepbound,
and that allows patients and providers to choose the most appropriate medication for them.
CVS Caremark stated that it began notifying affected customers at the end of April.
If you have questions about whether you are impacted, please call CVS Caremark for more information.
You should not experience any interruptions before July 1, 2025.
If you are impacted, CVS Caremark has stated that existing prior authorizations for Zepbound will be cancelled on June 30, 2025.
After June 30, 2025, you and your healthcare provider may be able to submit a new prior authorization for continued Zepbound coverage.
If you choose to submit a new prior authorization, it can be helpful for you or your healthcare provider to contact CVS Caremark in advance to understand what specific information is required for approval.
You can talk to your healthcare provider about the right options for you.
A letter of medical necessity should not be submitted before July 1st.
Submitting it before this date will cause confusion, as the change does not take effect until July 1st,
and the system will not recognize that Zepbound is not covered.
If you have a prescription, you can purchase Zepbound without insurance.
The Zepbound single-dose pen can be filled through LillyDirect or any other pharmacy.
The Zepbound single-dose vial can be filled through LillyDirect Self Pay Pharmacy Solutions.
Your cost will likely change significantly if your plan was impacted. Call CVS Caremark
directly for information on your specific situation.
Anyone who is on Zepbound and has one of the CVS Caremark formularies will be impacted,
including those who were prescribed for moderate to severe OSA with obesity.
Lilly is committed to advancing health access and ensuring all people living with obesity have access to
innovative, effective care.
SAFETY SUMMARY WITH WARNINGS
Warning:
Warnings - Zepbound may cause
tumors in the thyroid, including thyroid cancer. Watch for possible symptoms, such as a lump or swelling in the
neck, hoarseness, trouble swallowing, or shortness of breath. If you have any of these symptoms, tell your
healthcare provider.
Do not use Zepbound if you or any of your family have ever had a type of thyroid cancer called medullary
thyroid
carcinoma (MTC).
Do not use Zepbound if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
Do not use Zepbound if you have had a serious allergic reaction to tirzepatide or any of the ingredients in
Zepbound.
Zepbound may cause serious side effects, including:
Severe stomach problems. Stomach problems, sometimes severe, have been reported in people who
use
Zepbound. Tell your healthcare provider if you have stomach problems that are severe or will not go away.
Kidney problems (kidney failure). Diarrhea, nausea, and vomiting may cause a loss of fluids
(dehydration), which may cause kidney problems. It is important for you to drink fluids to help reduce your
chance
of dehydration.
Gallbladder problems. Gallbladder
problems have happened in some
people who use Zepbound. Tell
your healthcare provider right away
if you get symptoms of gallbladder
problems, which may include pain
in your upper stomach (abdomen),
fever, yellowing of skin or eyes
(jaundice), or clay-colored stools.
Inflammation of the pancreas (pancreatitis). Stop using
Zepbound and call your healthcare
provider right away if you have
severe pain in your stomach area
(abdomen) that will not go away,
with or without vomiting. You may
feel the pain from your abdomen to
your back.
Serious allergic reactions. Stop
using Zepbound and get medical
help right away if you have any
symptoms of a serious allergic
reaction, including swelling of your
face, lips, tongue or throat,
problems breathing or swallowing,
severe rash or itching, fainting or
feeling dizzy, or very rapid
heartbeat.
Low blood sugar (hypoglycemia). Your risk for getting low blood
sugar may be higher if you use
Zepbound with medicines that can
cause low blood sugar, such as a
sulfonylurea or insulin. Signs and
symptoms of low blood sugar may
include dizziness or light-headedness,
sweating, confusion
or drowsiness, headache, blurred
vision, slurred speech, shakiness,
fast heartbeat, anxiety, irritability,
mood changes, hunger, weakness
or feeling jittery.
Changes in vision in patients with type 2 diabetes. Tell your healthcare provider if you have
changes in vision during treatment with Zepbound.
Depression or thoughts of suicide. You should pay attention to changes in your mood, behaviors,
feelings or thoughts. Call your healthcare provider right away if you have any mental changes that are new,
worse,
or worry you.
Food or liquid getting into the lungs during surgery or other procedures that use anesthesia or deep sleepiness (deep sedation).
Zepbound may increase the chance of food getting into your lungs during surgery or other procedures. Tell all your healthcare providers that you are taking Zepbound before you are scheduled to have surgery or other procedures.
Common side effects
The most common side effects of Zepbound include nausea, diarrhea, vomiting, constipation, stomach (abdominal)
pain,
indigestion, injection site reactions, feeling tired, allergic reactions, belching, hair loss, and heartburn.
These
are not all the possible side effects of Zepbound. Talk to your healthcare provider about any side effect that
bothers you or doesn’t go away.
Your healthcare provider should show you how to use Zepbound before you use it for the first
time.
Tell your healthcare provider if you are taking medicines to treat diabetes including an insulin or
sulfonylurea which could increase your risk of low blood sugar. Talk to your healthcare provider about low
blood sugar levels and how to manage them.
If you take birth control pills by mouth, talk to your healthcare provider before you use Zepbound.
Birth
control pills may not work as well while using Zepbound. Your healthcare provider may recommend
another
type of birth control for 4 weeks after you start Zepbound and for 4 weeks after each increase in your dose of
Zepbound.
Review these questions with your healthcare provider:
❑ Do you have other medical conditions, including problems with your pancreas or kidneys, or severe problems
with
your stomach, such as slowed emptying of your stomach (gastroparesis) or problems digesting food?
❑ Do you take diabetes medicines, such as insulin or sulfonylureas?
❑ Do you have a history of diabetic retinopathy?
❑ Are you scheduled to have surgery or other procedures that use anesthesia or deep sleepiness (deep sedation)?
❑ Do you take any other prescription medicines or over-the-counter drugs, vitamins, or herbal supplements?
❑ Are you pregnant, plan to become pregnant, breastfeeding, or plan to breastfeed? Zepbound may harm your unborn baby. Tell your healthcare provider if you become pregnant while using Zepbound. It is not known if Zepbound passes into your breast milk. You should talk with your healthcare provider about the best way to feed your baby while using Zepbound.
Pregnancy Exposure Registry: There will be a pregnancy exposure registry for women who have taken Zepbound during pregnancy. The purpose of this registry is to collect information about the health of you and your baby. Talk to your healthcare provider about how you can take part in this registry, or you may contact Lilly at 1-800-LillyRx (1-800-545-5979).
How to take
Read the Instructions for Use that come with Zepbound.
Use Zepbound exactly as your healthcare provider says.
Use Zepbound with a reduced-calorie diet and increased physical activity.
Zepbound is injected under the skin (subcutaneously) of your stomach (abdomen), thigh, or upper arm.
Use Zepbound 1 time each week, at any time of the day.
Change (rotate) your injection site with each weekly injection. Do not use the same site for
each
injection.
If you take too much Zepbound, call your healthcare provider, seek medical advice promptly, or contact a Poison Center expert right away at 1-800-222-1222.
Zepbound injection is approved as a 2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, or 15 mg per 0.5 mL in single-dose pen or single-dose vial.
Learn more
Zepbound is a prescription medicine. For more information, call 1-800-LillyRx
(1-800-545-5979).
This summary provides basic information about Zepbound but does not include all information known about this medicine. Read the information that comes with your prescription each time your prescription is filled. This information does not take the place of talking with your healthcare provider. Be sure to talk to your healthcare provider about Zepbound and how to take it. Your healthcare provider is the best person to help you decide if Zepbound is right for you.
ZP CON BS 20DEC2024
Zepbound® and its delivery device base are registered trademarks owned or licensed by Eli Lilly
and
Company, its subsidiaries, or affiliates.
INDICATIONS
Zepbound® (ZEHP-bownd) is an
injectable prescription medicine
that may help adults with:
obesity, or some adults with
overweight who also have weight-related
medical problems to lose
excess body weight and keep the
weight off.
moderate-to-severe obstructive
sleep apnea (OSA) and obesity to
improve their OSA.
It should be used with a reduced-calorie diet and increased physical activity.
Zepbound contains tirzepatide and should not be used with other tirzepatide-containing products or any GLP-1 receptor agonist medicines. It is not known if Zepbound is safe and effective for use in children.