Weight Loss Drugs Listed By Health Insurers Aren’t Necessarily Covered

Eli Lilly says its obesity drugs are now listed on the three biggest PBM formularies, including OptumRx, Express Scripts, and CVS Caremark.

But formulary placement only means a drug can be covered; actual payment still depends on employers, health plans, Medicaid, or Medicare.

Many plan sponsors are still limiting or refusing obesity-drug coverage because of cost, so access remains uneven.

CMS also delayed its access model for older adults after weak participation, underscoring the slow adoption of weight-loss drug coverage.