Does CVS Caremark cover Zepbound, Wegovy and Foundayo?

What Caremark changed, and when

Caremark's template formularies are the standard drug lists that employers and health plans can adopt. A CVS spokesman told the Boston Globe in May 2026 that the standard commercial template covers roughly 25 to 30 million Americans ^[5]. Here is how the weight-loss GLP-1s moved. For every insurer, see the GLP-1 insurance coverage tracker.

• May 1, 2025: Healthcare Dive reported that Caremark would stop preferring Zepbound on its standard formulary and make Wegovy the preferred option from Jul 1 ^[10].
• Jul 1, 2025: Caremark preferred Wegovy and removed Zepbound. In CVS's words: "On July 1, 2025, we will take a formulary action to prefer Wegovy and remove Zepbound" ^[2]. Members with an active Zepbound prior authorization could move to Wegovy without a new one, and formulary exceptions were allowed after Wegovy intolerance or not enough weight loss ^[2].
• Sep 2025: Patients who lost Zepbound coverage filed a class action, arguing the two drugs were not medically interchangeable ^[5]. The lawsuit says about 200,000 people were affected; that is the plaintiffs' figure, not one from CVS ^[11].
• May 28, 2026: CVS announced Zepbound's return and the Foundayo change ^[1]. Wegovy injection and pill keep preferred status ^[3], and CVS said Wegovy and Zepbound will carry the same copay ^[5].
• Jun 1, 2026: Caremark removed its new-to-market block on Foundayo ^[1].
• Oct 1, 2026: Zepbound returned as an additional preferred option. One plan sponsor, NRECA, told members they need a new prescription and a new prior authorization to switch back ^[4].

Coverage by drug and use

A plan judges each request by the reason the drug is prescribed. Weight loss, heart risk, sleep apnea and diabetes run under different criteria, so the same drug can be approved for one use and denied for another.

CVS Caremark template coverage by drug and use, checked Oct 18, 2026

Drug	Weight loss	Heart risk	Sleep apnea	Type 2 diabetes	Plan types
Wegovy (pen, HD, pill)	Preferred; PA: BMI 30+ or 27+ with a condition, 6 months in a weight program [6][3]	PA in default criteria: established heart disease, BMI 27+, no type 2 diabetes [6]; Aetna's specific-states policy also covers it with established heart disease and BMI 27+ [7]	Not confirmed	Not confirmed	Commercial template formularies, if the plan covers weight loss [1]
Zepbound (pens)	Back as preferred Oct 1, 2026; PA: BMI 30+ or 27+ with a condition, 6 months in a weight program [1][8][9]	Not confirmed	PA: AHI 15+ and BMI 30+; 6-month first approval, then 12 months [9]	Not confirmed	Commercial template formularies; vials and KwikPens excluded from these criteria [9]
Foundayo	Block lifted Jun 1, 2026; only where the plan approves coverage [1]	Not confirmed	Not confirmed	Not confirmed	Commercial template formularies [1]
Ozempic	Not confirmed	Not confirmed	Not confirmed	Not confirmed: we could not find Caremark's diabetes GLP-1 criteria	Not confirmed
Mounjaro	Not confirmed	Not confirmed	Not confirmed	Not confirmed: we could not find Caremark's diabetes GLP-1 criteria	Not confirmed

What the prior authorization asks for

These are Caremark's default criteria for Wegovy (4774-C) and Zepbound (6947-C). Caremark also publishes a separate policy for Aetna plans in certain states, covered in the last item below ^[7].

• Age and BMI: 18 or older, with a baseline BMI of 30+, or 27+ with a weight-related condition ^[6].
• Lifestyle program first: at least 6 months in a comprehensive weight management program before drug therapy ^[6].
• First approval: 8 months for Wegovy injection in adults, 6 months for the Wegovy tablet ^[6].
• Renewal: at least 3 months at a stable maintenance dose and at least 5% weight loss, then 12 months at a time ^[6][9].
• Zepbound for sleep apnea: AHI of at least 15 and a current BMI of 30 or more ^[9].
• Stricter Aetna states: Aetna's policy for certain states asks for a current BMI of 40+, or 35+ with at least one condition, and lists Foundayo and Wegovy tablets ^[7]. The document does not name the states.

What your employer decides

Caremark sets the template; the employer or plan sponsor decides whether weight-loss drugs are in the benefit at all. CVS says sponsors that adopt its templates "retain discretion to customize coverage for their members" ^[1]. That means the Oct 1, 2026 Zepbound return does not reach every plan, and a plan can still exclude weight-loss drugs entirely. Aetna, for example, says many of its benefit plans specifically exclude weight-reduction drugs ^[16].

• Opt in or out of weight-loss coverage: a plan sponsor decision on every template ^[1].
• Adopt or skip a template change: NRECA adopted the Zepbound return for Oct 1, 2026 ^[4]; other sponsors may not.
• Foundayo: after Jun 1, 2026, covered only where plans approve coverage ^[1].
• Federal employees: FEP Blue's prior authorization forms are hosted by Caremark, but FEP sets its own rules. On FEP Blue Standard and Basic, Zepbound requires trying Saxenda and Wegovy first ^[17]. See Blue Cross Blue Shield coverage.

How to check your Caremark plan

1. Sign in to your Caremark account or call the pharmacy number on your member card, and search Wegovy, Zepbound and Foundayo by name.
2. Ask whether your plan uses a Caremark template formulary or a custom one, and whether weight-loss drugs are a covered benefit.
3. Ask which Zepbound form is covered. Caremark's Zepbound criteria exclude vials and KwikPens, which Lilly sells through LillyDirect ^[9].
4. If you want to move from Wegovy back to Zepbound, ask your prescriber for a new prescription and a new prior authorization ^[4].
5. Ask for the renewal rule in writing. Under the default criteria it is 5% loss after 3 months at a stable maintenance dose ^[6].

If Caremark says no

• Read the denial. Ask for the reason and the appeal deadline in writing, and have your prescriber add missing BMI, program or sleep study records.
• Ask about an exception. When Caremark removed Zepbound in 2025, it allowed formulary exceptions after Wegovy intolerance or not enough weight loss ^[2]. Ask whether your plan has a similar path.
• Check another use. Sleep apnea has its own Zepbound criteria ^[9].
• Pay yourself. Self-pay prices are below; full breakdowns on Zepbound cost, Wegovy cost and GLP-1 cost.
• On Medicare Part D: see the Medicare GLP-1 Bridge ^[15].

If Caremark says no: self-pay prices, checked Oct 17, 2026

Drug and channel	Price a month	Conditions	Source
Zepbound, LillyDirect (vial or KwikPen)	$299 to $449	$449 for 7.5 to 15 mg needs a refill within 45 days	LillyDirect [12]
Wegovy pen, NovoCare	$349	$199 for the first two fills of 0.25 mg or 0.5 mg for new patients, through Dec 31, 2026	NovoCare [13]
Foundayo, LillyDirect	$149 to $299	Top doses need a refill within 45 days	LillyDirect [14]
Medicare GLP-1 Bridge	$50	Medicare Part D enrollees who qualify, Jul 1, 2026 to Dec 31, 2027	CMS [15]

More on each drug's coverage: Zepbound insurance, Wegovy insurance and Ozempic insurance. Other plans: Aetna, Cigna and Express Scripts, UnitedHealthcare.