Class Action Lawsuit Filed Against Caremark Over Zepbound

Two New York residents have filed a proposed class action lawsuit against the pharmacy benefit manager (PBM) Caremark over the denial of coverage for the weight-loss drug Zepbound in favor of Wegovy.

Just the Facts

In July 2025, Caremark chose Novo Nordisk’s Wegovy as its preferred glucagonlike peptide-1 (GLP-1) medication after it negotiated a lower price for the drug compared to Eli Lilly’s Zepbound. Wegovy is a GLP-1 medication approved for chronic weight management, cardiovascular disease, and liver disease, while Zepbound is a dual gastric inhibitory polypeptide (GIP)/GLP-1 medication approved for chronic weight management and obstructive sleep apnea.

The 2 plaintiffs were prescribed Zepbound. One was prescribed the medication for weight management; the other was prescribed Zepbound for weight management and severe obstructive sleep apnea. Both plaintiffs have health plans administered by Caremark.

The plaintiff who was prescribed Zepbound for weight management was unable to refill his prescription once Caremark changed its preferred drug. After exhausting every appeal to the PBM, he was required Wegovy instead, which he alleges caused him several adverse effects, including gastroesophageal reflux disease, stomach pain, and weight gain.

The second plaintiff, who had sleep apnea, was also unable to refill her Zepbound prescription after July 1, 2025. She appealed Caremark’s denial, arguing that Zepbound is not clinically interchangeable with other agents. Her appeal was denied on the basis that Zepbound wasn’t “medically necessary.”

In their complaint, the plaintiffs assert that the denial of coverage caused them to “delay and/or forego medically necessary care, to pay out-of-pocket for health and medical services that were in fact covered under their health plans, and to incur additional costs and economic losses related to the delay in receiving care.”

The lawsuit alleges that Caremark has a history of making formulary changes that have serious consequences for patients. It seeks class certification and alleges multiple causes of action, including breach of fiduciary duty, prohibited transactions in violation of the Employee Retirement Income Security Act (ERISA), and violation of plan terms. In addition to class certification, the lawsuit requests injunctive relief and appropriate equitable relief against Caremark.

The complaint was filed on September 3, 2025. At the time of this writing, Caremark had not responded to the action.

Reference

Dennis Larkin and Danielle Gosline v Caremark Rx, LLC. No 1:25-cv-07307. United States District Court for the Southern District of New York; 2025. https://www.bloomberglaw.com/public/desktop/document/LarkinetalvCaremarkRXLLCDocketNo125cv07307SDNYSep032025CourtDocke