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CVS Caremark

CVS Health · 7 documents cited · Read October 2026

October 2026 template formularies list Zepbound again; your employer still decides whether your plan covers weight-loss drugs.

American GLP, Publisher · Who writes this site

CVS Caremark made the loudest GLP-1 formulary move of 2025: on July 1 of that year it preferred Wegovy and took Zepbound off its standard lists. In May 2026 it said Zepbound comes back as an additional preferred option on October 1, 2026.

Caremark has now published October 2026 editions of Advanced Control and Value. Both list Zepbound and Foundayo. That updates our September finding, when the available editions did not carry those options in the same way.

And none of it decides whether your plan covers weight loss. Caremark says in its own release that plan sponsors keep the discretion to customize coverage.

When does Zepbound come back, and on which list?

Caremark's May 2026 release says Zepbound returns to its commercial formularies as an additional preferred option on October 1, 2026. Its Standard Control list for October 2026 is the document that shows the change.

The October Advanced Control antiobesity section lists Zepbound, Foundayo, Wegovy and Wegovy HD, among other drugs. The October 1 Value chart also lists those four medicines; its Zepbound entry continues onto page 37. A template listing still does not override your plan’s exclusions or authorization requirements.

What about Foundayo?

Caremark removed its new-to-market block on Foundayo from June 1, 2026, where a plan approves it for coverage. That's permission for a plan to cover it, not a promise that yours does.

What do Caremark's prior-authorization criteria ask for?

Caremark's published Wegovy and Zepbound criteria for weight loss ask for an adult BMI of at least 30, or at least 27 with a weight-related condition, and at least six months in a weight-management program of diet, activity and behavior change before the drug.

To keep going, the Wegovy criteria want you to have lost at least 5 percent of your starting weight, or to have kept that loss. The first approval runs 8 months for the injection and the renewal 12. The Zepbound criteria cover every form except vials, which Caremark sends to Lilly's own program.

Every claim above, with the document behind it

These are the policies we opened and the month we opened them. Each one carries its own policy number and effective date on its face, and those are printed here as the document shows them.

Read September 2026

"CVS Caremark will add Zepbound back to our commercial formularies as an additional preferred option October 1, 2026 ... Additionally, effective June 1, 2026, CVS Caremark will remove the new-to-market block on Foundayo™(orforglipron), a new oral GLP-1 therapy, where approved for coverage by plans." The release adds: "Plan sponsors that adopt CVS Caremark template formularies retain discretion to customize coverage for their members."

CVS Health newsroom, release on GLP-1 weight-management coverage options, effective May 2026 · source

The 2025 move, in Caremark's words: "On July 1, 2025, we will take a formulary action to prefer Wegovy and remove Zepbound."

CVS Health, "Improving access and affordability to high-cost weight management drugs", effective June 2025 · source

Caremark's Wegovy weight-loss criteria (4774-C) ask for at least six months in a weight-management program before drug therapy and an adult BMI of at least 30, or 27 with a weight-related condition. Continuation requires that "The patient has lost at least 5 percent of baseline body weight OR the patient has continued to maintain their initial 5 percent weight loss." Adult injection approvals run 8 months initially and 12 months on renewal.

CVS Caremark, Initial Prior Authorization with Quantity Limit – Wegovy – Weight Loss Management (4774-C) · source

Caremark's Zepbound criteria (6192-C) cover "all dosage forms and strengths except the vials, which are covered under the LillyDirect manufacturer program," and apply the same weight-management and BMI tests as Wegovy's.

CVS Caremark, Initial Prior Authorization with Quantity Limit – Zepbound – Weight Loss Management (6192-C) · source

Caremark's 2026 outlook for plan sponsors suggests they "Limit member out-of-pocket costs with a weight-management-specific copay tier (up to $200 per month)" and forecasts "a ~15% decrease in the per prescription net cost in 2026 compared to 2025 for commercial template formulary clients with Standard Utilization Management (UM)."

CVS Caremark, "2026 GLP-1 outlook: A strategic roadmap to manage spend and trend", effective February 2026 · source

Read October 2026

The October 2026 Advanced Control Formulary lists Zepbound, Foundayo, Wegovy and Wegovy HD under antiobesity drugs on page 5.

CVS Caremark, Advanced Control Formulary, effective October 2026 · source

The Value Formulary chart dated October 1, 2026 lists Foundayo, liraglutide, orlistat, Wegovy and Wegovy HD in its antiobesity section on page 36, followed by Zepbound on page 37.

CVS Caremark, Value Formulary – Chart, effective October 2026 · source

What these documents cannot tell you

Everything above is what CVS Caremark publishes as a template. Your employer or carrier picks the list, can customize it, and decides whether weight loss is covered at all.

  • Caremark runs several template lists that change on different dates. Which one your plan uses isn't public; your plan's own drug list or the member site will show it.
  • The October Advanced Control and Value editions now list Zepbound. Confirm that your plan adopted the relevant template and covers the weight-loss benefit.
  • The prior-authorization criteria only matter if your plan covers weight-loss drugs in the first place.
  • A copay tier capped at $200 is an option the employer chooses, not a member benefit you can ask for.

Where this comes from

Read September 2026 unless marked.

  1. CVS Health newsroom, release on GLP-1 weight-management coverage options, effective May 2026 — Open the document
  2. CVS Health, "Improving access and affordability to high-cost weight management drugs", effective June 2025 — Open the document
  3. CVS Caremark, Advanced Control Formulary, effective October 2026 — Open the document (read October 2026)
  4. CVS Caremark, Value Formulary – Chart, effective October 2026 — Open the document (read October 2026)
  5. CVS Caremark, Initial Prior Authorization with Quantity Limit – Wegovy – Weight Loss Management (4774-C) — Open the document
  6. CVS Caremark, Initial Prior Authorization with Quantity Limit – Zepbound – Weight Loss Management (6192-C) — Open the document
  7. CVS Caremark, "2026 GLP-1 outlook: A strategic roadmap to manage spend and trend", effective February 2026 — Open the document

Where to go next

American GLP is not a law firm, an insurer, a government office or a clinician, and nothing here is legal or medical advice. This page describes what CVS Caremark publishes. It is not affiliated with CVS Health, and your own plan documents and your own notice govern your case. Policies carry effective dates and change — read the sources before you act.