Does CVS Caremark cover Wegovy and Zepbound?

What is CVS Caremark, and does its list decide your coverage?

CVS Caremark is a pharmacy benefit manager: it runs drug lists for employers and health plans, but each plan decides what it covers.³

A formulary is the list of medicines your plan covers.⁶ Caremark publishes ready-made “template” formularies that plans can adopt or customize.³ Plans that adopt them “retain discretion to customize coverage for their members.”³

Caremark’s own drug list warns that your plan “may not cover certain medications, products or categories.”¹ Caremark updates its lists on the first day of January, April, July and October.⁶

Where do Wegovy and Zepbound sit on CVS Caremark’s list?

On Caremark’s October 2026 Standard Control list, Wegovy, Wegovy HD, Zepbound and Foundayo are all preferred brands in the weight-loss group.¹

The list calls this group “antiobesity” medicines. It also holds generic liraglutide, orlistat and phentermine-topiramate, and the brand Qsymia.¹ “Preferred” means Caremark considers the brand clinically appropriate and cost-effective. The list says it “does not guarantee coverage.”¹

The drug list doesn’t say which Zepbound forms are covered. Caremark’s Zepbound criteria document leaves out vials and KwikPens. It says these “are covered under the LillyDirect manufacturer program.”⁵ That copy was online when we checked, so ask your plan which forms it covers now.

What has CVS Caremark changed, and when?

Caremark made Wegovy its preferred weight-loss GLP‑1 and removed Zepbound on July 1, 2025, then added Zepbound back on October 1, 2026.^2,3

1. May 1, 2025Novo Nordisk, Wegovy’s maker, said Wegovy would become the preferred obesity GLP‑1 on Caremark’s “largest commercial template formularies.”⁷
2. Jul 1, 2025Caremark took a “formulary action to prefer Wegovy and remove Zepbound” on its commercial template lists.² An active Zepbound approval carried over if a member moved to Wegovy.²
3. Jun 1, 2026Caremark removed its “new-to-market block” on Foundayo.³ Caremark’s list says newly approved drugs “may not be covered immediately.”¹
4. Oct 1, 2026Zepbound returned to Caremark’s commercial formularies “as an additional preferred option.”³

In 2025, Caremark said drug makers “are solely responsible for setting the price.” It said it had partnered with Novo Nordisk, Wegovy’s maker, to make Wegovy more affordable for its members.²

What approval rules has CVS Caremark published?

Caremark publishes its prior authorization criteria: for weight, Wegovy and Zepbound both need 6 months in a weight program and a qualifying BMI.^4,5

Prior authorization means your prescriber asks the plan to approve a drug before it pays. Caremark takes these requests electronically or by phone.⁸ For adults using either drug for weight, the criteria ask for all of these, with documents:^4,5

• A weight program first: at least 6 months in a program covering behavior change, a reduced-calorie diet and more physical activity, with follow-up.^4,5
• A BMI of 30 or more (body mass index, your weight compared with your height), or 27 or more with a weight-related condition. Examples given: high blood pressure, type 2 diabetes, high cholesterol.^4,5
• Your starting BMI before any earlier weight-loss drug, if you are switching.^4,5

To renew, both documents ask for at least 3 months on a steady maintenance dose. You must also have lost at least 5% of your starting weight, or kept that loss off.^4,5 For someone who started at 220 lb (100 kg), 5% is 11 lb (5 kg).

First approvals for weight last 8 months, and renewals 12 months; for Wegovy tablets, the first approval lasts 6 months.^4,5 Quantity limits allow one 28-day supply every 21 days, to leave time for refill processing.^4,5 For Wegovy tablets, it’s 30 tablets every 25 days.⁴

Other uses. The Wegovy document also covers heart-risk reduction. It asks for a past heart attack or stroke, blocked leg arteries that cause symptoms, or a past procedure to open or bypass blocked arteries, and a BMI of 27 or more.⁴ It also asks that you’re on standard heart treatment, unless there’s a medical reason not to be.⁴ People with type 2 diabetes are pointed to Ozempic instead.⁴ It covers MASH, a liver disease, if a liver or gut specialist prescribes or advises, and a scan or biopsy confirms moderate to advanced liver scarring (stage F2 to F3).⁴ The Zepbound document covers sleep apnea. It asks for a sleep test showing at least 15 breathing pauses an hour, and a BMI of 30 or more.⁵

A separate document, 6410-C, covers only these non-weight uses of Wegovy and Zepbound.⁹ More on those uses: Wegovy for heart and fatty liver and Zepbound for sleep apnea.

Teens. For ages 12 to 17, the Wegovy injection criteria also ask for 6 months in a weight program. The BMI must be at or above the 95th percentile for age and sex.⁴

How do you find your own plan’s version?

Sign in to Caremark.com for your plan’s own coverage and costs, and ask your plan which criteria document applies to you.¹

1. 1Sign in at Caremark.com. Caremark’s list says to choose Plan Summary on the Plan & Benefits menu.¹
2. 2Check the drug. Caremark’s member drug-list page links to a cost-check tool and to your plan’s current and next formulary.⁶
3. 3Call the number on your card. Ask whether Wegovy or Zepbound is covered for weight, which forms, and which criteria apply.
4. 4Your prescriber sends the request electronically or by phone.⁸
5. 5Watch the quarter dates. Lists change on the first day of January, April, July and October.⁶

What can you do if your plan says no?

Ask for the reason in writing, check it against the plan’s criteria, and appeal: federal rules give you at least 180 days after the denial to file an internal appeal.^11,12

If your coverage comes through a job, a federal rule says the denial must give you the guideline used. Or it must say one was used, and that you can have a free copy.¹² You can also ask for free copies of the documents behind your claim.¹²

Caremark says a plan may use the term prior authorization to include exception reviews.⁸ In 2025, it said members who had tried Wegovy and had severe side effects or too little weight loss could ask for a formulary exception for a different weight-loss drug.²

Caremark’s Zepbound exception document, 6981-A, names Wegovy as the formulary alternative. It asks that Wegovy hasn’t worked, isn’t tolerated or can’t be used, and approvals last 12 months.¹⁰ That document was still online on Oct 14, 2026, but the October 2026 list names Zepbound as preferred, so ask your plan whether it still uses it.^10,1

If the plan still says no after its internal appeal, you can ask for an independent external review.¹¹ Exceptions are explained in reading your drug list and asking for an exception. Appeals are in how GLP‑1 appeals work. If weight-loss drugs aren’t a benefit at all, see GLP‑1 costs without insurance.

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