Two New York residents have filed a lawsuit against CVS after the company’s pharmacy benefit manager, Caremark, denied coverage for Zepbound in favor of Wegovy.  The plaintiffs — Dennis Larkin of Mahopac, N.Y., and Danielle Gosline of Auburn, N.Y. — said the coverage denials were “arbitrary and capricious” and that Zepbound was medically necessary,” according to the lawsuit filed Sept. 3. The lawsuit alleges CVS Caremark violated ERISA, the Employee Retirement Income Security Act. 

In July, CVS Caremark chose Wegovy as the preferred GLP-1 medication for its largest commercial template formularies after the PBM secured a lower net price for the Novo Nordisk drug compared to Zepbound.  Mr. Larkin was prescribed Zepbound for weight management and severe obstructive sleep apnea, and Ms. Gosli

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