Dear Supporters,

Thank you for your incredible, continued support. I’m writing to provide an update on our collective efforts as our petition has now grown to over 14,000 signatures. This powerful number reflects the significant concern felt across the patient and provider communities.

Update on Communication with CVS Caremark

Since my last update, I have reached out to the CVS Caremark executive team, including their Chief Medical Officer Dr. Gourdine, three separate times. My inquiries have specifically focused on seeking clarity about the formulary exception process: what the criteria will be, and who will be eligible to request continued coverage for Zepbound after July 1st.

After some initial responsiveness, I have unfortunately not received a response to these specific and critical questions. I have also been in contact with the Obesity Action Coalition, and they have confirmed they are experiencing a similar lack of communication from Caremark.

This silence is deeply frustrating for both patients and providers. While we advocate for a reversal of the formulary decision, the least Caremark can do is provide clear, transparent information so that we can all prepare for the upcoming changes. We believe patients deserve answers. I will, of course, share any updates immediately if I hear back.

A Helpful Tool for Your Advocacy

While we continue our push, a fantastic resource has been developed to help you advocate for yourself. The Tri-State Obesity Society has created a webpage that automatically generates a custom Letter of Medical Necessity (LOMN) for Zepbound after you fill in your information. This is a document you can provide to your healthcare prescriber to help them formally request coverage from your insurance.

Generate Your Letter of Medical Necessity Here: https://www.tristateobesitysociety.org/lomn

Your Advocacy Can Make a Difference: Encouraging Examples

While the lack of direct clarity from Caremark is frustrating, I want to share some encouraging news I've seen from patients online. 

• Success Through State Law: Members in Iowa have successfully cited a state law (House File 626) that protects patients from mid-year formulary changes, compelling their insurance to maintain Zepbound coverage.
• Success Through Employer Negotiation: Several State of Illinois employees reported that after many of them voiced their concerns, their Central Management Services (CMS) team negotiated directly with Caremark to keep Zepbound on their plan's formulary.
• Custom Formularies: It's important to understand that while Caremark's decision affects their standard formulary, some employers or state plans have custom formularies that may not be affected by this Caremark decision or can negotiate.

These stories show that a top-down decision from a PBM doesn't always have to be the final word.

Speaking up to your HR department, benefits manager, or even state legislators can make a real difference. If you are covered through your employer, especially a large one, let them know how this change affects you. The Illinois example shows that large employers have negotiating power and may not even be aware of the issue until employees speak up.

These pathways are not guaranteed for everyone, but they are worth pursuing. Keep making your voices heard!

The Broader Challenge We Face

Unfortunately, the issue of access extends beyond this specific formulary change. We are now seeing a troubling trend where other insurers, such as Blue Cross Blue Shield of Massachusetts, are dropping coverage for all GLP-1 medications for obesity altogether. This is a significant step backward, prioritizing short-term costs over the proven long-term health benefits and savings that these life-changing treatments provide. I recently published an editorial on this broader issue in the Commonwealth Beacon.

Read the Op-Ed Here: https://commonwealthbeacon.org/opinion/blue-cross-dropping-coverage-of-anti-obesity-drugs-sacrifices-long-term-health-for-short-term-savings/

Your support remains crucial as we navigate these challenges. Please continue to share the petition and these resources. Every conversation and every share raises awareness and strengthens our collective voice.

Thank you!

Sincerely,

Joseph Zucchi, PA-C