CVS Caremark Zepbound Coverage Lawsuit: A "Profits Over Patients" Scheme?

Case Overview: A class action lawsuit claims CVS Caremark put profits over patients by cutting off coverage for Zepbound, Eli Lilly’s weight-loss drug, in favor of rival Wegovy, leaving patients without access to a medically necessary treatment.

Consumers Affected: The decision affected as many as 200,000 people who were prescribed Zepbound through their employer-sponsored health plans.

Court: Not specified in the article, but a federal court in New York is mentioned in related search results. The article provided doesn't explicitly state the court for the primary lawsuit.

Pharmacy benefit manager CVS Caremark is putting profits over patients by cutting off coverage for Zepbound, Eli Lilly’s blockbuster weight-loss drug, a new lawsuit claims.

The class action lawsuit argues that Caremark’s move to drop Zepbound in favor of rival Wegovy left patients without access to the treatment their doctors deemed most effective, violating federal protections around medically necessary care, Fox reports.

CVS Caremark's Decision Affects Thousands of Patients

The lawsuit was filed on behalf of two individuals, but claims the decision affected as many as 200,000 people. Both plaintiffs had been prescribed Zepbound through their employer-sponsored health plans, only to be told that coverage had ended and they would need to switch to Wegovy. 

One patient who made the switch reported painful side effects, including gastrointestinal issues and weight regain, underscoring the lawsuit’s argument that the drugs are not interchangeable for every patient.

Lawsuit Argues Zepbound and Wegovy Are Not Interchangeable

GLP-1 receptor agonists, which include Wegovy, Ozempic, Mounjaro, and Zepbound, have rapidly transformed the conversation around obesity treatment. Originally developed for diabetes, these medications mimic gut hormones that regulate insulin and appetite, leading to significant weight loss. 

Zepbound, approved to treat both obesity and sleep apnea, targets two hormones instead of one—GLP-1 and GIP—and has been shown in studies to deliver nearly 50 percent more weight loss than Wegovy.

While both drugs have drawn intense demand, they carry hefty price tags: around $1,100 to $1,350 per month before discounts. Even with manufacturer coupons, patients often pay hundreds of dollars out of pocket, and many insurance plans still refuse to cover them.

The lawsuit argues that Caremark cannot call Zepbound “not medically necessary” while covering Wegovy for the same condition, particularly since Zepbound has shown greater effectiveness in clinical trials and comes at a slightly lower list price. For patients, the case highlights the growing battle over access, cost, and control in the booming market for obesity drugs.

The GLP-1 Drug Boom and Legal Battles

CVS Caremark’s lawsuit is just one of many playing out in courtrooms across the country. Eli Lilly, the maker of Zepbound and Mounjaro, was sued by Texas Attorney General Ken Paxton last month for allegedly bribing providers with perks like “free nurses” to push its high-demand GLP-1 medications. The complaint claims these practices improperly steered prescriptions toward Lilly’s products, costing Medicaid millions.

At the same time, families have filed lawsuits over severe side effects from drugs like Mounjaro, including stomach paralysis, while lawsuits tied to Ozempic are piling up. Federal judges consolidated dozens of Ozempic cases in Pennsylvania, where patients allege that the companies behind the drugs failed to adequately warn about risks ranging from pancreatitis to kidney issues.

If you’ve used any of the weight loss drugs before, let us know your experience in the comments section below!