PBMs Force Zepbound Switch, PEO Health Costs Climb 9%, and CMS Plans National Provider Directory

Hey all,

Happy Tuesday! If you’re one of the 200,000 unlucky CVS Caremark members who got yanked off Zepbound and shoved onto Wegovy, you already know the drill: “We’re doing this to save you money!”—while somehow charging more for a drug that works less. The part that fries my circuits (and probably yours) is that Lilly’s own cash-pay price for Zepbound is hundreds cheaper than CVS’s so-called post-rebate “deal” on Wegovy. Once again, American healthcare proves it serves health insurance companies first and patients somewhere around last… but hey, at least the PBMs are getting their steps in running circles around common sense.

Enjoy the rundown! 

Jacob Brody (Co-Founder & CEO, ZorroRX)

(WSJ) Patients Forced to Switch from Zepbound to Wegovy

CVS Caremark has dropped coverage of Eli Lilly’s Zepbound in favor of Novo Nordisk’s Wegovy, forcing about 200,000 patients to switch even though studies show Zepbound leads to greater weight loss. Patients and doctors say this “nonmedical switching” disrupts care, while CVS argues it negotiated lower prices to control costs. And sure, considering Lilly’s own cash-pay prices are still hundreds cheaper than CVS’s post‑rebate “deals,” clearly PBMs must be working overtime to make drugs more expensive—what a bargain! Full Article

(BenefitsPro) Rising Health Costs for PEOs

TriNet, a professional employer organization that manages benefits for 338,000 workers, reports that its health costs have risen about 9% in 2025 despite employers cutting back on coverage generosity and shifting more costs to employees. The company says these increases, coupled with an uncertain economy, are slowing sales growth and reflect a broader trend of rising group health expenses, showing that even firms built to control costs are struggling to manage them; at this point, just keeping health insurance affordable feels like the new victory. Given that PEOs are one of the few groups still able to price small employers based on their claims history like it’s a pre-existing condition penalty, it’s no shock that some businesses are realizing they can get a fairer deal by going straight to a plan that can’t play that game. Full Article

(Modern Healthcare) CMS National Provider Directory Effort 

The Centers for Medicare and Medicaid Services (CMS) is renewing efforts to create a national provider directory to replace error-prone insurer lists, aiming to give patients accurate information on in-network doctors while cutting administrative costs. Although such a directory could solve widespread “ghost network” issues and improve transparency, insurers, providers, and experts warn that without careful implementation it could add bureaucracy and strip insurers of competitive advantages, and honestly it will be a win if I can just find an in-network therapist that isn’t a figment of some insurance company’s hallucination. Full Article