CVS Caremark’s Boosting of Wegovy Over Zepbound Fuels Lawsuits

CVS Caremark is facing multiple federal lawsuits by patients challenging its decision to remove weight-loss drug Zepbound from its list of preferred medications after signing a rebate agreement with Wegovy maker Novo Nordisk A/S.

CVS Caremark is accused of improperly ending coverage for Eli Lilly & Co.'s Zepbound earlier this year after negotiating price concessions for Wegovy. Health plan participants say this move overlooks important differences in the two drugs, including the fact that Zepbound is the only treatment for obstructive sleep apnea that’s been approved by the US Food & Drug Administration.

“The company is effectively saying, ‘we’re not going to cover this FDA-approved drug for sleep apnea, and instead we’ll make you take Wegovy, which is not FDA-approved for that condition,” said D. Brian Hufford, one of the attorneys representing patients Dennis Larkin and Danielle Gosline. “That’s a breach of the health insurance contract as well as a breach of the fiduciary duty CVS owes its members.”

The lawsuits, filed this week in federal courts in New York and Washington, challenge CVS Caremark’s actions under federal benefits law, saying the company is violating health-care plan terms that generally require coverage for medically necessary drugs prescribed by doctors.

Martin Hamburger, the plaintiff suing CVS Caremark and CareFirst BlueCross BlueShield in Washington, says the companies ignored his requests for Zepbound coverage without ever considering whether it’s medically necessary for his sleep apnea.

“Mr. Hamburger has excellent health coverage, on paper,” said Brock J. Specht of Nichols Kaster PLLP, one of the law firms representing him. “But in reality, both CareFirst and CVS failed to provide the promised coverage and deprived Mr. Hamburger of a full and fair review of his claim. CareFirst and CVS breached their duties under ERISA by categorically denying all coverage of Zepbound, regardless of medical necessity, and by failing to follow the plan’s review process for medically necessary prescription drugs that are not on the plan’s formulary.”

Wegovy and Zepbound belong to the same class of medications, known as GLP-1s, and they cost more than $1,000 for a one-month supply. About one in eight US adults reported haven taken a GLP-1 drug in a 2024 poll conducted by the health policy research and polling organization KFF.

Recent studies have shown Zepbound to be more effective than Wegovy in achieving weight loss, according to the lawsuit by Larkin and Gosline.

A CVS Caremark spokesman called the drugs “clinically similar products” and said the lawsuits are without merit.

“By forcing the drug manufacturers to compete with one another on price, CVS Caremark was able to unlock significant cost savings for the employers and unions that hire us to manage their pharmacy benefits,” David Whitrap, vice president of external affairs for CVS Health, said over email Thursday. “That savings will enable those same employers and unions to broaden access to this entire GLP-1 drug category: where they previously could provide access to none, now they can provide access to Wegovy.”

The company expects that this move will “encourage both Eli Lilly and Novo Nordisk to more aggressively compete with one another in the future and continue to lower the U.S. prices for their products,” Whitrap said. He added that the company designs many drug formularies to meet various needs, and that the exclusion of Zepbound doesn’t apply to all 90 million Americans for whom CVS Caremark is their pharmacy benefit manager.

Larkin and Gosline, who filed suit in the US District Court for the Southern District of New York, are represented by Hufford Law Firm PLLC and Berger Montague PC. They seek to represent a class of thousands of people seeking coverage for Zepbound as a treatment for obesity, including those with and without sleep apnea.

Hamburger, whose suit is pending in the District of Columbia, is represented by Nichols Kaster and Virtue Law Group. His proposed class includes people who require Zepbound to treat obstructive sleep apnea and whose health-care and pharmacy benefits are administered by CareFirst and CVS Caremark.

The lawsuits bring claims under the Employee Retirement Income Security Act.

The cases are Hamburger v. CVS Caremark, D.D.C., No. 1:25-cv-03000, complaint 9/4/25; Larkin v. Caremark RX LLC, S.D.N.Y., No. 1:25-cv-07307, complaint 9/3/25.