Lawsuit Filed Against Caremark for Zepbound

A recent class action lawsuit has been filed against the pharmacy benefit manager Caremark by two residents of New York for denying coverage of the weight-loss drug Zepbound in favor of Wegovy.

In July 2025, Caremark decided to make Wegovy, a glucagonlike peptide-1 (GLP-1) medication manufactured by Novo Nordisk, its preferred drug due to a negotiated lower price compared to Zepbound from Eli Lilly. While Wegovy is approved for chronic weight management, cardiovascular disease, and liver disease, Zepbound is a dual gastric inhibitory polypeptide (GIP)/GLP-1 medication approved for chronic weight management and obstructive sleep apnea.

The two plaintiffs in the lawsuit were both prescribed Zepbound. One plaintiff used it for weight management, while the other used it for weight management and severe obstructive sleep apnea, with both having health plans administered by Caremark.

The plaintiff using Zepbound for weight management was unable to refill his prescription once Caremark changed its preferred drug to Wegovy. Despite appealing to Caremark multiple times, he was forced to switch to Wegovy, which led to adverse effects like gastroesophageal reflux disease, stomach pain, and weight gain.

The second plaintiff, who suffered from sleep apnea, also faced a denial of her Zepbound prescription refill after July 1, 2025. Despite arguing that Zepbound was not clinically interchangeable with other drugs, her appeal was rejected under the claim that Zepbound was not deemed “medically necessary.”

According to the complaints of the plaintiffs, the denial of coverage by Caremark caused them to delay or forego essential medical care, incur out-of-pocket costs for services covered under their health plans, and suffer additional expenses due to delays in receiving care.

The lawsuit accuses Caremark of a pattern of formulary changes that negatively impact patients and includes allegations of breach of fiduciary duty, prohibited transactions violating the Employee Retirement Income Security Act (ERISA), and violations of plan terms. Alongside seeking class certification, the lawsuit requests injunctive relief and equitable outcomes against Caremark.

The legal action was initiated on September 3, 2025, and at the time of writing, Caremark had not responded to the lawsuit.

In summary, the lawsuit against Caremark raises concerns about the denial of coverage for the weight-loss drug Zepbound in favor of Wegovy, highlighting the adverse effects faced by individuals who relied on Zepbound for medical reasons, including weight management and obstructive sleep apnea.