CareFirst, CVS Beat Lawsuit Over Zepbound Sleep Apnea Exclusion

CareFirst BlueCross BlueShield and CaremarkPCS Health’s exclusion of popular GLP-1 weight loss drug Zepbound for sleep apnea does not violate the Employee Retirement Income Security Act, a federal court in Washington ruled.

Martin Hamburger filed a proposed class action against the insurer and pharmacy benefit manager in September 2025 in the US District Court for the District of Columbia, alleging the exclusion amounted to an illegal denial of benefits and breach of fiduciary duty under ERISA. The case stems from CVS Caremark’s preference for rival obesity drug Wegovy, which is not approved for sleep apnea.

The decision is ...