From 1 October 2026, Zepbound (tirzepatide) is a preferred option again on CVS Caremark's most common commercial formularies, sitting alongside Novo Nordisk's Wegovy (semaglutide). CVS Caremark, one of the largest pharmacy benefit managers in the US, announced the change on 28 May 2026 and it took effect this month. The same weeks brought the opposite news from employers: in a Business Group on Health survey, the share covering GLP-1s for weight fell from 72% in 2025 to 60% in 2026.
What happened
In 2025 CVS Caremark made Wegovy its preferred weight-loss GLP-1 and left Zepbound out of its main template formularies. In May 2026 it reversed course in two steps.
| Date | Change at CVS Caremark |
|---|---|
| 1 June 2026 | New-to-market block removed for Foundayo (orforglipron), where plans approve |
| 1 October 2026 | Zepbound reintroduced as a preferred option on the most common commercial formularies |
BioPharma Dive reported that the deal means Foundayo and Zepbound are covered by all three of the largest US pharmacy benefit managers. CVS Caremark said it worked with the manufacturers to secure a more affordable cost, without giving figures. Its release is clear that plan sponsors that adopt its template formularies "retain discretion to customize coverage".
The other half of the story: employers
A formulary only matters if your employer covers weight-loss medicines at all. Fewer do.
- Coverage is falling. The Business Group on Health surveyed 127 large employers covering 8.7 million people, published in late August 2026. Coverage of GLP-1s for obesity fell from 72% to 60% in a year, and 14% have dropped or plan to drop it by 2027.
- Named employers are moving. Starbucks said in August that from October 2026 its health plans would stop covering GLP-1s prescribed for weight loss, for staff working 20 or more hours a week. Coverage may continue when the same drugs treat other conditions, such as type 2 diabetes.
- Costs are the reason given. Employers in the survey expect a median 9.2% rise in healthcare costs for 2027 before plan changes.
What it does not tell us
- What you will pay. Copays depend on your plan, not on the formulary template.
- Whether prior authorisation rules changed. The CVS release does not say.
- How many employers will switch the change on. CVS gives no count of plans adopting it.
What it means for you
If you are on Wegovy and doing well, nothing here asks you to change. If Zepbound was what your prescriber wanted and CVS Caremark was the barrier, the barrier may now be gone. Look up your plan's 2027 drug list during open enrolment, and ask HR whether weight-loss coverage continues next year.
If you are thinking about a switch, our comparisons of Mounjaro and Wegovy and tirzepatide and semaglutide set out the trial numbers. The decision belongs with your prescriber, who will choose the starting dose.
If you are losing coverage, a gap in treatment is the risk to plan for. Weight tends to return after stopping, as we covered in what happens after a GLP-1 stops. Talk to your prescriber early about the options, including Medicare's GLP-1 Bridge if you are on Part D.
What to do with this
Whichever drug your plan covers, the eating side is the same: enough protein to protect muscle while appetite is low, and enough fibre and fluid to keep digestion moving.