CVS Caremark Expands GLP-1 Formulary Coverage

CVS Caremark has announced that it will add Zepbound (tirzepatide) back to its most common commercial formularies as an additional preferred option, effective Oct. 1, 2026, and will remove the new-to-market block on Foundayo (orforglipron), effective June 1, 2026, for plans that have approved coverage of the drug.¹ According to the company, the move builds on the pharmacy benefit manager’s (PBM’s) ongoing efforts to expand GLP-1 access for members while managing costs across the class.

Why Is CVS Caremark Making these Changes Now?

CVS Caremark framed the decision as the result of sustained engagement with drug manufacturers on pricing and access, an approach it has applied previously in other high-spend drug categories, including diabetes, high cholesterol, psoriasis, and rheumatoid arthritis.¹ The company said that by acting early, it was able to get ahead of a rapidly evolving GLP-1 pipeline and negotiate more affordable costs that now allow for expanded formulary options.

Caremark is one of the largest PBMs in the US, which dictates which prescription drugs millions of patients in the US can obtain through insurance, as well as their out of pocket costs.²

In a press release, Caremark president Ed DeVaney said the company is “creating access and options that would not have existed without our leadership in the market,” and that Caremark “acted boldly through active engagement and negotiation with our drug manufacturer partners to tackle affordability and access for our customers and their members.”¹

The company said it expects the formulary updates to drive increased savings in the weight management category, building on what it describes as a history of delivering double-digit savings for template formulary customers year over year. CVS Caremark added that it will provide advance communication and support to customers, consultants, providers, and members to help facilitate the transition.¹

What Does the Foundayo Inclusion Signal for the GLP-1 Market?

The removal of the new-to-market block on Foundayo is notable in the context of the broader GLP-1 pipeline. Oral GLP-1 agents have been widely anticipated to expand eligible patient populations and drive further utilization among plan sponsors. CVS Caremark’s decision to make Foundayo available — at plan sponsor discretion — could represent an early signal of how PBMs may approach formulary positioning for oral agents as the class matures.

What Are the Implications for Plan Sponsors and the Commercial Market?

The announcement reflects the broader affordability and access considerations between insurers, employers, and patients that have defined the GLP-1 category for plan sponsors during the past two years.

According to the 2025 KFF Employer Health Benefits Survey, only one in five firms with 200 or more workers covered GLP-1 drugs for weight loss in their largest health plan in 2025.³ Among firms with 5,000 or more workers, coverage had increased to 43% — up from 28% the year prior — but many of those employers reported that utilization was higher than expected and that covering the medications had a significant impact on prescription drug spending.³ Several firms that initially offered coverage had since restricted it to employees with specific medical indications, such as type 2 diabetes, with some noting the challenge of removing a benefit that employees had come to rely on.³

The CVS Caremark announcement reinforces that formulary placement in this category remains contingent on negotiated pricing concessions — a dynamic likely to shape commercial contracting strategies across the drug class as additional agents enter the market.

References

1. CVS Health. CVS Caremark delivers affordability and access to GLP-1 weight management medications with expanded coverage options. Published May 28, 2026. Accessed May 28, 2026. https://www.cvshealth.com/news/company-news/cvs-caremark-delivers-affordability-and-access-to-glp-1-weight-management-medications-with-expanded-coverage-options.html
2. Lovelace Jr., B. (2026, May 28). CVS Caremark will cover Lilly’s weight loss drug Zepbound again after patient backlash. NBC News. https://www.nbcnews.com/health/health-news/cvs-caremark-will-cover-lillys-weight-loss-drug-zepbound-rcna347253
3. Cotter L, Rae M, McGough M, et al. Perspectives from employers on the costs and issues associated with covering GLP-1 agonists for weight loss. Peterson-KFF Health System Tracker. Published October 22, 2025. Accessed May 28, 2026. https://www.healthsystemtracker.org/brief/perspectives-from-employers-on-the-costs-and-issues-associated-with-covering-glp-1-agonists-for-weight-loss/