340B’s ‘Cost’ To Health Plans, Zepbound Exclusion Syndrome, Wegovy Loses To Zepbound

Hey all,

Happy Tuesday! The recent New York Times story about Caremark excluding Zepbound struck a profound chord with me. After transitioning from Florida Blue to UnitedHealth, I was forced to change insulin pumps and endured a grueling five-month wait for my Mounjaro approval. When a treatment that's working well is suddenly taken away, the emotional toll is devastating—a special kind of heartbreak that only those navigating our fragmented healthcare system truly understand. Enjoy the rundown! 

Jacob Brody (Co-Founder & CEO, ZorroRX)

(National Pharmaceutical Council) 340B Program’s Impact on Employer Health Costs

The report finds that between 2017 and 2023, the growth of 340B hospital sites and purchases—rising from $20 billion to over $60 billion—contributed to roughly 8% of the increase in employer-sponsored insurance premiums, translating into an estimated $23 billion in additional healthcare costs in 2023 alone. Funded by the National Pharmaceutical Council—which represents drug manufacturers that are required to provide 340B discounts and may have a vested interest in curbing the program’s expansion—the study underscores how growth in 340B, originally intended to support vulnerable populations, is indirectly increasing costs for employers and workers, with employees bearing about $4.5 billion annually in higher premium contributions. Because sure, 340B could lower drug costs for patients—but then how would safety-net hospitals scrape together the cash for those absolutely essential Super Bowl commercials? Full Article.

(The New York Times) CVS Caremark’s Exclusion of Zepbound Hurts Patients

Tens of thousands of patients prescribed Zepbound, a highly effective obesity drug, will lose insurance coverage as CVS Caremark removes it from its formulary in favor of Wegovy, despite evidence that Zepbound yields greater weight loss. Caremark justifies the move by citing a negotiated 10%–15% reduction in Wegovy’s cost. If Novo Nordisk and Eli Lilly could price these drugs closer to their estimated net of $250–$300 (as with Ozempic), and we removed convoluted rebate-driven deals with middlemen like Caremark, OptumRx, and Express Scripts—who extract billions through such negotiations— these types of deals would become unnecessary and patients wouldn’t face harmful treatment disruptions. Full Article

(Reuters) Zepbound Outperforms Wegovy in Head-to-Head Weight-Loss Trial

According to the latest trial data, Eli Lilly announced on Sunday that its weight loss drug Zepbound demonstrated superiority to Novo Nordisk's Wegovy across five weight-loss targets, including waist circumference reduction, in a head-to-head trial. The trial showed Zepbound patients achieved an average waist circumference reduction of 18.4 centimeters compared to 13 centimeters for those on Wegovy, and helped nearly 25% more participants lose more than 15% of their weight. Novo Nordisk contends that the weight loss results for Wegovy in this trial were lower than in their 2021 studies. This data emerges just days after CVS Health decided to drop Zepbound from some of its reimbursement lists in favor of Wegovy, in an obesity drug market projected to reach over $150 billion annually within the next decade. Full Article