forbes.com
CVS Drops Eli Lilly's Zepbound from Preferred Formulary
CVS Health will remove Eli Lilly's weight-loss drug Zepbound from its preferred formulary starting July 1, 2025, prioritizing Novo Nordisk's Wegovy; this impacts 90 million CVS Caremark members and highlights the power of PBMs in shaping drug access and affordability.
- What is the immediate impact of CVS Health's decision to remove Zepbound from its preferred formulary on patient access and affordability?
- CVS Health will remove Eli Lilly's weight-loss drug, Zepbound, from its preferred formulary starting July 1, 2025, prioritizing Novo Nordisk's Wegovy instead. This impacts 90 million CVS Caremark members, potentially limiting Zepbound access or increasing out-of-pocket costs for many. Lilly is mitigating this by offering Zepbound through its own direct-to-consumer pharmacy and telehealth partnerships, bypassing traditional gatekeepers.
- How do the financial incentives of PBMs influence formulary decisions, and what are the consequences for patients and the pharmaceutical industry?
- This decision highlights the power dynamics between pharmaceutical companies, PBMs, and insurers. PBMs negotiate discounts and rebates, influencing formulary placement based on financial incentives rather than solely on clinical efficacy. This case exemplifies how PBM decisions, driven by profit, can impact patient access to potentially beneficial medications.
- What are the potential long-term implications of pharmaceutical manufacturers bypassing PBMs through direct-to-consumer strategies, and how might this affect the healthcare system?
- This situation foreshadows a potential shift in the pharmaceutical landscape. Manufacturers may increasingly bypass PBMs using direct-to-consumer models, particularly for high-demand drugs. This trend could lead to the disintermediation of traditional pharmacy benefit management, reshaping drug access and affordability.
Cognitive Concepts
Framing Bias
The article's framing emphasizes the financial and strategic aspects of the CVS decision, portraying it as a strategic move in a larger business conflict. While this is a valid perspective, the framing somewhat downplays the potential negative impact on patients and the ethical considerations involved in prioritizing cost-cutting over patient access to effective medication. The headline (if there were one) might emphasize the business conflict over the patient impact.
Language Bias
The language used is generally neutral and informative. However, terms like "skirmish," "battles," and "high-stakes competition" inject a slightly adversarial tone, potentially shaping the reader's perception of the situation as more confrontational than it might actually be. While these words aren't inherently biased, more neutral alternatives such as "dispute," "negotiations," and "competitive market" could provide a more objective perspective.
Bias by Omission
The article focuses heavily on the business dynamics and financial implications of CVS's decision, but gives less attention to the potential long-term health consequences for patients who may lose access to Zepbound or face higher costs. The perspectives of patients directly affected by the formulary change are underrepresented. While the article mentions potential difficulties, it lacks detailed accounts of patient experiences or the broader societal impact of reduced access to weight-loss medication.
False Dichotomy
The article presents a somewhat simplified view of the conflict, primarily framing it as a battle between CVS, Lilly, and other players in the pharmaceutical supply chain. It doesn't fully explore the nuances of different stakeholders' perspectives or the potential for collaborative solutions. The narrative implicitly suggests a zero-sum game where one party's gain is another's loss, overlooking the possibility of win-win scenarios.
Sustainable Development Goals
The article discusses CVS Health removing Eli Lilly's weight loss drug Zepbound from its preferred formulary, potentially reducing patient access to an effective medication. This impacts the ability of patients to manage their weight and improve metabolic health, negatively affecting SDG 3 (Good Health and Well-being) which aims to ensure healthy lives and promote well-being for all at all ages.