CVS sued after PBM favors Wegovy over Zepbound
Two New York residents have filed a lawsuit against CVS after the company’s pharmacy benefit manager, Caremark, denied coverage for Zepbound in favor of Wegovy.
The plaintiffs — Dennis Larkin of Mahopac, N.Y., and Danielle Gosline of Auburn, N.Y. — said the coverage denials were “arbitrary and capricious” and that Zepbound was medically necessary,” according to the lawsuit filed Sept. 3. The lawsuit alleges CVS Caremark violated ERISA, the Employee Retirement Income Security Act.
In July, CVS Caremark chose Wegovy as the preferred GLP-1 medication for its largest commercial template formularies after the PBM secured a lower net price for the Novo Nordisk drug compared to Zepbound.
Mr. Larkin was prescribed Zepbound for weight management and severe obstructive sleep apnea, and Ms. Gosline was prescribed Zepbound for weight management, according to the lawsuit.
Eli Lilly’s Zepbound is a GIP/GLP-1 drug approved for chronic weight management and obstructive sleep apnea, while Novo Nordisk’s Wegovy is a GLP-1 for chronic weight management, cardiovascular disease and liver disease.
The lawsuit seeks to be classified as a class action, declare Zepbound as medically necessary for weight management and obstructive sleep apnea, and order CVS to cover Zepbound.
CVS told Becker’s the lawsuit lacks merit and the company intends to “defend ourselves vigorously against those claims.”
“Wegovy and Zepbound are two clinically similar products, and by forcing the drug manufacturers to compete with one another on price, CVS Caremark has unlocked significant cost savings for the employers and unions who hire us to manage their pharmacy benefits,” CVS said in a statement. “In addition to increasing affordability and access to this therapy class immediately, we anticipate that our formulary decision will encourage both Eli Lilly and Novo Nordisk to more aggressively compete with one another in the future and lower the U.S. prices for their products.”
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