A fierce competition is unfolding in the U.S. pharmaceutical market over access to GLP-1 weight-loss drugs. New data reveals a significant shift in coverage and patient options, creating a complex landscape for manufacturers, insurers, and patients.
According to the latest information from DRG Fingertip, a Clarivate solution, Eli Lilly’s Zepbound has dramatically increased its market share. In just one year, it has nearly caught up to its rival, Novo Nordisk’s Wegovy. Both drugs now account for approximately two out of every five weight-loss prescriptions.
This competition is heavily influenced by decisions from major pharmacy benefit managers (PBMs). Since July 1, CVS Caremark has favored Wegovy on its national formularies. At the same time, it removed Zepbound. This move caused Zepbound’s formulary coverage to drop 17 percentage points to 83% in a single month.
For health plans that use CVS Caremark, Wegovy is now more widely covered, but it is often listed as a “non-preferred” drug that comes with restrictions.
Beyond simply listing a drug, insurance companies are increasingly using strict management tools. For example, even as CVS Caremark expanded Wegovy’s coverage, it also made the “prior authorization” process more demanding. Many insurers are now offering these drugs only as an opt-in benefit. They are also adding weight management programs or providing cost guarantees to employers.
Patients are responding to these hurdles in different ways. Many are increasingly willing to pay out-of-pocket to bypass insurance entirely. Others are seeking holistic and lifestyle-based interventions instead of, or in addition to, prescription drugs.
This trend has created an opportunity for a growing number of telemedicine companies. These vendors offer convenient access, particularly for patients who can afford to pay without insurance.
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