Deadline Extension for GLP-1 Formulary Change
In early May, NRECA Medical Plan participants with prescriptions for Zepbound® (a popular GLP-1 medication used for weight loss) received a letter from CVS Caremark® informing them of a forthcoming formulary change effective July 1.
This change would remove Zepbound from the formulary. The letter outlined additional alternative GLP-1 medications, such as Wegovy® and Saxenda® (among others), that are available at more advantageous pricing. The letter also outlined next steps for the participants.
NRECA is providing an extension of the effective date for this formulary change to September 1, 2025. This provides additional time for impacted patients to consult their medical professionals to discuss their options: submit new prescriptions for another GLP-1 or request prior authorization for medical necessity to continue using Zepbound.
While this extension provides additional time for participants using Zepbound to determine their options, after July 1, participants filling Zepbound prescriptions will likely see an increase in their cost share. Additionally, safeguards are being put in place to prevent simultaneous dispensing to participants using these medications.
Continued access while controlling costs
As the marketplace continues to witness skyrocketing increases in utilization and cost, CVS is pursuing opportunities consistent with NRECA’s desire for the plan to continue providing coverage for this important class of medications while mitigating its cost impact. We recognize the need and benefits for participants who use this particular class of drugs, but with over $11M in year-to-date spend, we will continue to explore opportunities to mitigate the cost impacts to our membership.
Reviews of the NRECA Medical Plan’s prescription drug formulary occur regularly and are done to ensure participants have continued access to reliable and cost-effective medications. These cost containment measures directly benefit your co-op and its employees as we are able to minimize increases to the plan expenses paid by co-ops and participants without impacting coverage unlike other entities in the industry.
Participant notification
NRECA will be sending a letter to impacted participants the week of June 2 notifying them of this extension. Participants with questions should be directed to CVS Caremark Customer Care at 888.796.7322.