To: CVS Caremark Leadership

We, the undersigned healthcare providers, patients, and concerned citizens, urgently petition CVS Caremark to reverse its decision to remove Zepbound (tirzepatide) from its standard commercial formularies, effective July 1, 2025. This move, which forces many patients onto Wegovy (semaglutide) as the preferred GLP-1 medication for weight management, is a disservice to patient health, a disregard for clinical evidence, and an impediment to personalized medical care.

CVS Caremark's decision is not in the best interest of patients, and here’s why:

1. Zepbound Demonstrates Superior Efficacy: Clinical evidence, most notably the head-to-head SURMOUNT-5 trial, showed that patients on Zepbound achieved significantly greater average weight loss (20.2%) compared to those on Wegovy (13.7%) over 72 weeks. Forcing patients off a more effective medication is clinically unsound and undermines their progress.
2. Patients Report Significantly Better Tolerability with Zepbound: As clinicians on the front lines, and as echoed by countless patient testimonials, Zepbound is often much better tolerated. Many patients experience markedly fewer and less severe gastrointestinal side effects, such as nausea and vomiting, compared to Wegovy. This improved tolerability is critical for long-term adherence and sustained success in managing obesity, a chronic disease. My own practice has seen countless patients who have tried both medications unequivocally prefer Zepbound for its combination of efficacy and tolerability.
3. Zepbound Offers Unique Health Benefits:
   1. Obstructive Sleep Apnea (OSA): Tirzepatide (Zepbound) is the only medication in its class FDA-approved to treat moderate-to-severe obstructive sleep apnea in adults with obesity. Removing it from formulary denies patients access to a crucial, approved therapy for this serious comorbidity.
   2. Broader Metabolic Improvements: As a dual GIP and GLP-1 receptor agonist, Zepbound often leads to more significant improvements in various metabolic parameters, including blood sugar, blood pressure, and lipid levels, compared to GLP-1 only agonists like Wegovy.
4. Greater Dosing Flexibility for Personalized Care: Zepbound offers a wider range of dosing strengths and is approved for maintenance at 5 mg, 10 mg, and 15 mg. This allows clinicians to better tailor treatment to individual patient needs, adjust for plateaus, and maintain long-term success. Wegovy’s maintenance dosing is more limited (only 1.7mg and 2.4mg), restricting this crucial flexibility.
5. Forcing Non-Medical Switching is Harmful: Mandating that stable patients, who have often struggled for years before finding success with Zepbound, switch to a different medication for non-medical (i.e., contractual) reasons is disruptive and potentially harmful. It risks:
   1. Weight regain and worsening of obesity-related comorbidities.
   2. Increased side effects leading to treatment discontinuation.
   3. Significant patient distress, frustration, and loss of trust in the healthcare system.
   4. Wasted healthcare resources as providers and patients navigate unnecessary transitions and potential appeals.
   5. This forced switch also creates significant challenges for providers in safely converting dosages between these distinct drug molecules, risking potential side effects for patients.
6. PBM Decisions Should Prioritize Clinical Evidence, Not Just Bottom Lines: While we understand the need for cost management, formulary decisions for chronic, complex diseases like obesity must be driven by clinical evidence, patient outcomes, and provider expertise. The current decision appears to prioritize a partnership with Novo Nordisk over the well-being of countless patients who benefit more from Eli Lilly's Zepbound. When multiple FDA-approved, effective medications exist, the choice should remain with the prescribing provider in consultation with their patient, not dictated by PBM contracts that limit access to superior or better-tolerated options.

Our Plea to CVS Caremark:

Dr. Michelle Gourdine (Chief Medical Officer of CVS Caremark) stated in correspondence that Caremark's formularies are "evidence-based" and developed to "assure clinically appropriate coverage." We contend that the exclusion of Zepbound, given the overwhelming clinical data and real-world patient experience, directly contradicts this assertion.

We urge CVS Caremark to:

• Immediately reconsider and reverse the decision to remove Zepbound from its standard formularies.
• Reinstate Zepbound as a covered option for weight management, allowing providers and patients to choose the most clinically appropriate therapy.
• Ensure that formulary decisions truly reflect the most current clinical evidence, prioritize patient well-being and tolerability, and support continuity of care.
• Acknowledge the significant clinical differences between available treatments and avoid one-size-fits-all mandates.

The fight against obesity requires access to the best available tools. Do not restrict access to a medication that is demonstrably superior and better tolerated for a significant portion of the patient population. Stand by your stated commitment to patient health and evidence-based medicine.

Sincerely,

Joseph Zucchi, PA-C - Clinical Supervisor & Obesity Medicine Physician Assistant at Transition Medical Weight Loss

Sign this petition to tell CVS Caremark: Put Patients First! Keep Zepbound on Formulary!

Updates:

• Podcast Interviews:

Joe did a video podcast with "Downsized" regarding "Losing Access to GLP-1s? Here’s What to Do Next" - https://www.youtube.com/watch?v=ljU826-_lHM

Joe also discussed these concerns and why Zepbound access is vital on the "On The Pen" podcast with Dave Knapp in the video below. The interview starts around the 22-minute mark: https://youtu.be/bJKEC_GWvZU?t=1343

• Featured in The New York Times: nytimes.com/2025/05/11/health/zepbound-wegovy-weight-loss-drugs.html
• Mentioned in Bloomberg: https://www.bloomberg.com/news/articles/2025-05-09/zepbound-patients-fear-switch-to-wegovy-after-cvs-deal