Novo + Caremark Deal Ousts Zepbound, Aetna Exits ACA Exchanges, Another Suit Against MA Plans + Brokers

Hey all,

Happy Monday! I was struck last week by Novo’s discounting strategy successfully getting Zepbound off of the Caremark formulary. While Zepbound is demonstrably superior, its advantage isn't going to be substantial enough to sway many employers and health plans. Enjoy the rundown!

Jacob Brody (Co-Founder & CEO, ZorroRX)

(Fierce Pharma) Novo Nordisk Secures CVS Caremark Formulary Preference for Wegovy

Novo Nordisk has struck a significant deal granting its obesity drug Wegovy preferred status on CVS Caremark’s largest commercial formularies, sidelining Eli Lilly’s competing drug Zepbound starting July 1, 2025. This move enhances Wegovy’s accessibility to tens of millions of Americans, bolstering Novo’s foothold in the booming obesity market while intensifying pressure on Lilly, whose product will be excluded from standard CVS drug lists; it also coincides with Novo’s broader strategy of expanding affordable access to Wegovy through pharmacy and telehealth partnerships — and with Ozempic’s net price already at $290 for essentially the same molecule, it’ll be fun to watch how many health plans line up to happily pay double just to get the “for obesity” sticker slapped on the box. Full Article

(Modern Healthcare) Aetna Exits ACA Exchanges

Aetna’s decision to leave the Affordable Care Act exchanges in 2025 reflects more on CVS Health’s internal financial challenges than on the broader stability of the marketplaces. While Aetna struggled with persistent losses and strategic misalignment, the exchanges overall have remained profitable and competitive, with record enrollment and insurer participation continuing to rise — but with subsidies on the chopping block, Aetna saw the writing on the wall that the exchanges were about to get smaller, sicker, and uglier, and decided to dip before they got stuck holding the check. Full Article.

(STAT News) Justice Department Sues Medicare Advantage Insurers Over Kickbacks
The U.S. Justice Department has sued CVS Health’s Aetna, Elevance Health’s Anthem, Humana, and brokerages eHealth, GoHealth, and SelectQuote, alleging they orchestrated a multimillion-dollar kickback scheme to steer seniors into specific Medicare Advantage plans. This case highlights growing scrutiny over unethical marketing and sales practices in the rapidly expanding Medicare Advantage market, which now covers the majority of Medicare enrollees and has been criticized for misleading tactics and discriminatory enrollment practices. This was a shock to me, I thought Medicare Advantage brokers always put the client first… right after commissions, carrier bonuses, and a quick consultation with their trade group’s lobbyist about why fiduciary rules are just way too much paperwork. Full Article