FILE - patient injects GLP-1 weight loss drug (Photo by Niall Carson/PA Images via Getty Images)
CVS Caremark is facing a class-action lawsuit over its decision to stop covering Zepbound, Eli Lilly’s blockbuster GLP-1 weight-loss drug.
The suit was filed on behalf of two people who lost Zepbound coverage through their employer-sponsored health care plan, though the lawsuit says some 200,000 people were impacted by Caremark’s decision. Zepbound patients whose employers use CVS Caremark as a pharmacy benefits manager were told they’d have to switch to Wegovy, a similar drug that studies have shown is less effective than Zepbound for treating obesity.
Why is CVS Caremark being sued?
The lawsuit accuses Caremark, the nation’s largest pharmacy benefit manager, of denying medically necessary drugs in violation of federal law. CVS Caremark stopped covering Zepbound on July 1 after reaching a deal with Novo Nordisk, the maker of Wegovy. As part of the deal, Caremark agreed to remove Zepbound from its formulary.
RELATED: Zepbound vs. Wegovy: Here's which weight loss drug worked best in first trial
The lawsuit claims Caremark cannot deny Zepbound as "not medically necessary" while approving Wegovy as a necessary treatment for the same condition, particularly when Zepbound has been proven to be more effective and has a lower list price than Wegovy. Wegovy’s list price is about $1,350 a month, while Zepbound’s is roughly $1,100 for a month’s supply. But both drugmakers offer it for about $500 a month to people without insurance coverage.
What they're saying:
According to the lawsuit, one of the plaintiffs switched from Zepbound to Wegovy in August after exhausting all appeals to Caremark, then "experienced a number of side effects, including the return of his Gastroesophageal Reflux Disease, stomach pain, hunger, and, most notably, weight gain."
"Because of their different methods of action, different clinical outcomes, and different side effects for individual patients, Zepbound and Wegovy are not clinically interchangeable," the lawsuit states.
RELATED: Eli Lilly's new GLP-1 weight loss pill showed success in clinical trial
CVS Caremark disagrees. A spokesperson told FOX TV Stations in May that despite what studies have shown, "real-world evidence suggests that they are comparable in actual use."
Wegovy-maker Novo Nordisk says that’s not true.
"The notion that all GLP-1s are the same and ‘interchangeable’ is not correct," Jason Brett, executive medical director for Novo Nordisk, said in a statement to CNN.
The other side:
A CVS Caremark spokesperson told Bloomberg Law the lawsuit is "without merit."
"We’ll defend ourselves vigorously against those claims," the spokesperson said.
Big picture view:
The lawsuit highlights ongoing issues with access and affordability as GLP-1 drugs become more popular. The medications still amount to around $500 per month for those without insurance, and even for people with insurance, some plans don’t cover the obesity medications at all.
Dr. Brett Osborn, a Florida neurosurgeon and longevity expert, called the medications "the holy grail of modern medicine."
"These medications don’t just treat obesity — they’re already showing promise in everything from cardiovascular disease to neurodegenerative disease to addiction," he told Fox News Digital.
"I’ve said it before, and I’ll say it again: These are not amenities. They are the holy grail of modern medicine."
Zepbound vs. Wegovy
Dig deeper:
Zepbound and Wegovy are both GLP-1 drugs approved for weight loss, but Zepbound targets two hormones, GIP and GLP-1, while Wegovy only targets GLP-1.
According to a study funded by Eli Lilly and published in the New England Journal of Medicine, people taking Zepbound lost nearly 50% more weight than those using rival Wegovy.
Clinical trial participants who took Zepbound lost an average of 50 pounds over 72 weeks, while those who took semaglutide, or Wegovy, lost about 33 pounds.
Zepbound is also FDA-approved to treat sleep apnea in patients with obesity, while Wegovy is FDA-approved to treat cardiovascular disease.
How do GLP-1 drugs work?
The backstory:
GLP-1s, a class of drugs that include semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro and Zepbound), were initially prescribed to treat Type 2 diabetes, but have soared in popularity because of weight loss. Wegovy and Zepbound are FDA approved for weight loss, while Ozempic and Mounjaro are approved for Type 2 diabetes.
The drugs work by mimicking the actions of hormones, found primarily in the gut, that kick in after people eat. The hormones help regulate blood sugar by triggering the pancreas to release insulin, another hormone, and slowing the release of sugar from the liver. People who are overweight or have obesity can become insulin-resistant, which means the body doesn’t respond to insulin properly.
The obesity drugs lower blood sugar and slow down digestion, so people feel full longer. They also affect signals in the brain linked to feelings of fullness and satisfaction, tamping down appetite, food-related thoughts and cravings.
Because people feel full longer, they eat less and lose weight.
However, it appears that if people taking the drugs stop, most regain the weight they lost — and the health problems that come with weight gain.
The Source: This report includes information from the class-action lawsuit against CVS Caremark filed in the Southern District of New York, a CVS Caremark spokesperson, The Associated Press, CNN and Bloomberg Law.