The Weekly Dose: 5/13/25

Let’s talk about what just happened.

CVS Caremark decided to pull Zepbound from its preferred formulary.That means if your insurance is through CVS, you could lose access on July 1.

No conversation. No explanation. Just gone.

They replaced it with Wegovy. Even though we now have the strongest data ever published showing Zepbound blows Wegovy out of the water.

At the exact same time, Trump signed an Executive Order that could reshape how drugs are priced, sold, and accessed in this country.

And sitting in the middle of all that chaos is you.

Trying to hang on to the medication that finally worked.

Trying to stay insured.

Trying to stay informed.

Trying to stay on the pen.

CVS made a deal.

They got a better rebate offer from Novo Nordisk, so they’re kicking Zepbound off the list and giving Wegovy exclusivity.

This wasn’t about patient care.It wasn’t about clinical outcomes.It was about money.

And the day after they did it, Eli Lilly published the SURMOUNT 5 trial results.Zepbound vs Wegovy. Head to head.

Here’s what the data showed:

Zepbound patients lost 20.2 percent of their body weight
Wegovy patients lost 13.7 percent
That’s 47 percent more weight loss
Zepbound outperformed Wegovy on every benchmark
And for anyone already on 10 or 15 milligrams of Zepbound, there’s no Wegovy equivalent

Let me say that again.

There is no Wegovy dose that replaces Zepbound 7.5mg-15mg.

This is not a lateral switch.

It’s a downgrade.

But the CVS decision still stands.

Joe is a physician assistant.

He treats obesity every day.

And when he saw the CVS decision, he started a Change.org petition.We chatted all about it on the podcast today.

He talked about what this means for real people, people who’ve worked hard, found something that helps, and are about to lose access to it.

He said something that stuck with me:

“We cannot let cost saving measures be the reason people regain weight, lose progress, or feel abandoned.”

Trump’s Executive Order says we’re done letting other countries pay less for the same drugs.

It pushes for Most Favored Nation pricing and directs HHS to explore direct to consumer sales at global prices.

If you’re already getting meds through LillyDirect or NovoCare, this could scale those programs.

If you’re paying out of pocket, this could eventually lower that burden.

But here’s the thing:

None of that matters if your insurer decides to cut you off now.

This decision goes live July 1.

You’ve still got time.

But don’t wait.

Ask your doctor for a letter of medical necessity
- Make sure it documents your current dose, treatment response, and that Wegovy is not a comparable option
Get a 3 month fill of Zepbound prior to July 1
- Having a good few months of Zepbound on hand gives you an edge
Bring the SURMOUNT 5 study to your next appointment
- Print it. Highlight your dose. Hand it over
Talk to HR or your benefits manager
- Ask if your plan follows the CVS formulary
Sign Joe’s petition

File an appeal immediately
- Reference SURMOUNT 5 and note that there is no substitute for your dose
Request a formulary exception
- These can still be granted case by case
If you have OSA, use it
- Zepbound is the only GLP-1 approved for obesity with obstructive sleep apnea
- If your provider can code it that way, it may still be covered
- You can get them online with a google search for around $200
Consider manufacturer programs or compounding
- Look at LillyDirect or vetted compounders if coverage drops
Keep everything
- Every denial, every bill, every receipt. Save it all.