Dear Supporters,

Thank you for your continued dedication. As we are now past the July 1st deadline, I want to provide an important update on what we are seeing on the ground and a potential, albeit frustrating, pathway for continued access to tirzepatide.

First, your advocacy continues to build. Our petition is now over 15,000 signatures strong.

The First Days of Denials & a Bizarre Discovery

As feared, I began receiving immediate denials for Zepbound formulary exception requests on July 1st, even for patients with documented histories of failure or intolerance to Wegovy. However, after extensive time spent with Caremark's prior authorization questions set and speaking with their support team, I have discovered a confusing and counterintuitive workaround.

It appears there is a potential pathway for patients to get coverage, but it requires their provider to request Mounjaro, not Zepbound.

Here’s a simplified breakdown of this odd process:

1. A provider must still initiate a prior authorization for Zepbound.
2. The form asks if the patient can be treated with the preferred formulary alternative, which is Wegovy. (Note that if you and your provider determine that Wegovy is suitable, then they do not need to do a prior auth at this time since the original Zepbound prior auth carried over to Wegovy). If Wegovy is not suitable, then the provider must state "No" and provide clinical documentation of why (Caremark requires specific chart notes and documentation showcasing inadequate treatment response, intolerance or a contraindication to Wegovy).
3. The form then asks if the patient can be treated with a secondary alternative, Mounjaro. By answering "Yes," a new set of questions appears which are for weight management, not for Type 2 Diabetes.
4. After following these specific steps, I have now successfully gotten ten patients approved for Mounjaro for weight management so far, allowing them to stay on tirzepatide.

Why Mounjaro? And What Does This Mean?

This is the most frustrating part. As many of you know, Mounjaro has the exact same active ingredient (tirzepatide) as Zepbound, but it is only FDA-approved for Type 2 Diabetes. This means Caremark has created a system where they are essentially approving Mounjaro for "off-label" use for weight loss, while denying the officially approved brand, Zepbound. The likely reason for this convoluted process comes down to money; it's probable that Caremark has a more favorable rebate agreement for Mounjaro, as it has been on the market longer.

At the end of the day, a win is a win. Mounjaro is the same medication (with the same injection pen and same dosages) as Zepbound, and getting it covered is a huge relief for many of my patients. However, this process is deeply flawed.

Our Continued Frustration with This Process

This workaround is not a solution. It is an infuriating, inefficient system that forces providers to spend hours navigating a non-obvious process, all while patients are left in a state of stress and anxiety. This entire situation, created by Caremark, has led to unnecessary paperwork, confusion, and distress for the very people they are supposed to serve.

What This Means For You:

If you are affected by this, here is what you can do:

• Talk to your healthcare provider. You can share this update with them. They need to be aware of this potential "Mounjaro pathway."
• Remember the Wegovy Requirement: It seems that to even be eligible for this Mounjaro exception, you still need a documented clinical reason why Wegovy is not appropriate for you (e.g., you've tried it and had bad side effects, or you have a medical contraindication).
• This is not a guarantee. This process is new and may not work for everyone, but it is a pathway worth exploring with your provider. Switching to Wegovy remains the primary option Caremark is pushing.

Ultimately, both Zepbound and Wegovy are excellent, life-changing medications. My goal is not to play favorites, but to advocate for a system where patients and their providers (not a PBM) have the ability to choose the most appropriate obesity treatment, especially when a patient is already stable and succeeding on a particular therapy.

Thank you for your continued support. We are making a difference by sharing information and advocating together. Please continue to share the petition and your stories.

Sincerely,

Joseph Zucchi, PA-C, CPT
Clinical Supervisor
Transition Medical Weight Loss