Will CVS Caremark Cover Zepbound in 2025?

Zepbound is a medication that’s been making waves for its role in weight loss and diabetes management. As 2025 unfolds, many people are wondering about insurance coverage, especially with CVS Caremark, a major pharmacy benefit manager. This article breaks down what we know so far in simple terms.

Coverage decisions can feel confusing, but they matter a lot if you’re hoping to use Zepbound. Let’s explore how CVS Caremark decides what drugs to cover, what Zepbound does, and what might happen in 2025.

What Is Zepbound and Why Does It Matter?

Zepbound is a brand-name drug with the active ingredient tirzepatide. It’s approved by the FDA to help adults lose weight when paired with diet and exercise. It also treats type 2 diabetes under the name Mounjaro.

The drug works by mimicking hormones that control hunger and blood sugar. This dual action makes it popular for people struggling with obesity or diabetes. Its effectiveness has sparked interest in whether insurance plans like CVS Caremark will cover it.

For many, Zepbound’s cost—over $1,000 a month without insurance—makes coverage a big deal. That’s why knowing if CVS Caremark will step in for 2025 is so important.

How CVS Caremark Decides Drug Coverage

CVS Caremark manages prescription benefits for millions of people. They create a formulary, which is a list of covered drugs, updated every year. This list isn’t random—it’s based on a few key factors.

First, they look at a drug’s safety and how well it works. Clinical studies and FDA approval play a big role here. Zepbound checks these boxes, with solid evidence behind it.

Next, cost comes into play. CVS Caremark negotiates with drug makers to get lower prices. If Zepbound’s maker, Eli Lilly, offers a good deal, it could boost its chances of coverage.

Finally, they consider alternatives. Drugs like Wegovy or Ozempic, which are similar to Zepbound, might compete for a spot on the formulary. CVS Caremark weighs which options give the best value.

Zepbound’s Place in the Weight Loss World

Weight loss drugs are hot right now, and Zepbound is a big player. It belongs to a class called GLP-1 receptor agonists, known for helping people shed pounds. Studies show it can lead to significant weight loss—sometimes over 20% of body weight.

This success has made it a go-to for doctors and patients. But its high price tag means insurance coverage is key. Without it, many can’t afford to keep using it long-term.

CVS Caremark already covers some GLP-1 drugs, like Wegovy, for weight loss in certain plans. This trend suggests Zepbound could follow a similar path in 2025, depending on specific plan details.

What We Know About 2025 Coverage So Far

As of April 2025, CVS Caremark hasn’t released its full 2025 formulary yet. They typically announce updates in late fall, so we’re still waiting for the official word. However, some clues point to what might happen.

In 2024, CVS Caremark added Zepbound to some of its national formularies, often in a preferred tier with prior authorization. This means patients needed approval from their doctor to prove it’s medically necessary. If this continues into 2025, it’s a good sign.

The company also focuses on cost-effective drugs. Zepbound’s list price is about $1,060 a month, slightly less than Wegovy’s $1,300. This could give it an edge in negotiations.

Factors That Could Affect Coverage

Several things could sway whether CVS Caremark covers Zepbound in 2025. One is demand. If lots of patients and doctors push for it, CVS Caremark might prioritize it.

Another factor is competition. Wegovy and Saxenda are already on some CVS Caremark plans. If Zepbound proves more effective or cheaper, it could replace or join them.

Employer preferences matter too. Many CVS Caremark clients are companies offering health plans to workers. If employers want obesity coverage, Zepbound’s odds go up.

Lastly, new data could tip the scales. Studies showing Zepbound lowers overall healthcare costs—like fewer hospital visits—might convince CVS Caremark to cover it widely.

How Prior Authorization Works

If CVS Caremark covers Zepbound in 2025, it might require prior authorization. This is a common step for expensive drugs. It means your doctor has to show why you need it.

For example, they might need to prove you’ve tried diet and exercise without success. Or that you have a condition like obesity or diabetes that Zepbound treats. This process can take a few days or weeks.

It’s a hassle, but it’s how CVS Caremark keeps costs down. If you’re hoping for coverage, talk to your doctor early to get the paperwork ready.

Costs With and Without Coverage

Without insurance, Zepbound costs around $1,060 for a 30-day supply. That’s a lot for most people to pay out of pocket. Coverage through CVS Caremark could drop this dramatically.

With coverage, you might pay a copay—say, $25 to $50—depending on your plan. Some plans use coinsurance, where you pay a percentage, like 20% of the drug’s cost. Either way, it’s much more affordable.

Here’s a quick look at possible costs:

These are estimates—your actual cost depends on your specific plan.

What If Zepbound Isn’t Covered?

If CVS Caremark doesn’t cover Zepbound in 2025, you still have options. Eli Lilly offers a savings card that can lower the price to as little as $550 a month for eligible patients. Check their website for details.

You could also ask your doctor about alternatives. Drugs like Wegovy or Ozempic might be covered instead. They work similarly and could be a good fit.

Another route is appealing to your insurance. If Zepbound is medically necessary, your doctor can request an exception. It’s not a sure thing, but it’s worth a try.

How to Check Your Coverage

Want to know if CVS Caremark will cover Zepbound in 2025 for you? Start by logging into your Caremark.com account. Look for the formulary section—it lists covered drugs.

You can also call CVS Caremark’s customer service. Have your plan ID ready, and ask about Zepbound’s status for 2025. They’ll give you the latest info.

Your employer or HR department might have details too. Since they pick the plan, they can tell you what’s included.

Trends in Obesity Drug Coverage

Obesity drugs are getting more attention from insurers. In the past, many plans didn’t cover them, seeing weight loss as cosmetic. But that’s changing as research shows obesity is a chronic condition.

CVS Caremark has responded to this shift. They’ve added programs like CVS Weight Management, pairing drugs with dietitian support. This suggests they’re open to covering drugs like Zepbound.

As more data rolls in—especially on long-term benefits—coverage could expand. For 2025, this trend looks promising for Zepbound users.

Talking to Your Doctor

Your doctor plays a big role in getting Zepbound covered. They can write a prescription and handle prior authorization if needed. Set up a visit to discuss it.

Bring up your health goals—weight loss, diabetes control, whatever applies. They’ll know if Zepbound fits your needs and how to pitch it to CVS Caremark.

Ask about generics or other options too. Even if Zepbound isn’t covered, your doctor can guide you to something that is.

What Patients Are Saying

People using Zepbound often rave about its results. Online forums and X posts highlight stories of losing 30 pounds or more. Many say it’s life-changing.

But cost is a common complaint. Without coverage, some stop taking it. Others fight for insurance approval and share tips on navigating CVS Caremark’s system.

These real experiences show why coverage matters. If CVS Caremark steps up in 2025, it could help thousands stick with the drug.

Looking Ahead to 2025

We won’t know for sure about Zepbound’s coverage until CVS Caremark releases its 2025 formulary. Based on current trends, it’s likely to be included in some plans, possibly with restrictions like prior authorization.

Keep an eye out for updates in late 2025. Check with CVS Caremark or your employer around November or December for the final word.

Until then, plan ahead. Talk to your doctor, explore savings options, and stay informed about your plan’s benefits.

Summary

Zepbound is a powerful drug for weight loss and diabetes, but its high cost makes insurance coverage crucial. CVS Caremark, a key player in prescription benefits, will decide its 2025 coverage based on effectiveness, cost, and demand. While we don’t have the full picture yet, signs point to possible inclusion, likely with prior authorization.

If covered, your out-of-pocket costs could drop to $25–$50 a month. If not, alternatives and savings programs can help. Stay proactive—check your plan and talk to your doctor to prepare for 2025.

FAQ

Will CVS Caremark cover Zepbound in 2025?
It’s not confirmed yet, but Zepbound is on some 2024 formularies with prior authorization. The 2025 decision will come later this year—check with CVS Caremark in late fall.

How much does Zepbound cost without insurance?
Zepbound’s list price is about $1,060 for a 30-day supply. Without coverage, you’d pay this full amount out of pocket.

What if CVS Caremark doesn’t cover Zepbound?
You can use Eli Lilly’s savings card to lower the cost to around $550 a month. Or ask your doctor about covered alternatives like Wegovy.

How do I find out if my plan covers Zepbound?
Log into Caremark.com, check the formulary, or call customer service with your plan ID. Your employer’s HR team might know too.

Why might CVS Caremark require prior authorization?
They use it to ensure Zepbound is medically necessary, keeping costs down. Your doctor would need to submit proof of need.