CVS formulary drop—are GLP-1 prices finally softening?

I read that Bloomberg piece too. The list price vs net price gap is the whole story, and it’s the same deal with vendors—prices vary a ton depending on who you’re looking at. PBMs say they’re cutting costs, but rebates often just get pocketed.

I wouldn’t trust any static number anyway; just check the live listings when you’re actually comparing.

Right, and the member prmeium doesn't always track the rebate. My employer plan moved Ozempic to tier 3 in January and my copay doubled.

Doubled? Ouch. Did your PA renewal also get lost twice?

The A1c drop in the OP is impressive, but market access is a different beast. A formulary exclusion can force a switch even if the clinical data looks good.

Yep. I work in benefits and we got a vendor pitch promising 22% savings by excluding one GLP-1. Nobody could tell us what happens to patients already stable.

That's the part that scares me. Switching isn't always plug-and-play. I've seen people stall for weeks waiting on new PA.

And switching stalls are part of why demand looks inelastic. I've been following the earnings calls, and the message keeps being that demand is still outstripping supply.

If that's true, formularies are less about shortage and more about rebate leverage. The news angle is real, but I don't think list prices fall much. They'll just give bigger discounts behind the scenes while cash-pay people still see the scary number.

The OP's A1c change is the kind of outcome that makes these decisions politically messy, honestly.

So what do we watch—net price, not list?

My scale sat at the same number for almost five weeks and I was ready to swear off my Renpho, but my old jeans went from oh-hell-no to actually-buttoned in that stretch, so now I log waist at the navel every Sunday instead of weighing daily. I'm on this since March, 34 pounds down but the tape has told a better story than the scale for a while now.

Point being, if premiums do shift around it's worth tracking the free stuff too, because the mirror moved way before the number did.

I keep a dumb little spreadsheet: out-of-pocket, pharmacy, days until refill, plus protein, water, and strength days. When my scale stalled for almost six weeks, my waist measurement was the only thing that moved, so I stopped letting the number run the whole show.

For the formulary stuff, I’m calling my plan in early December to ask if the 2025 list affects me or just new starts. Has anyone gotten a straight answer from their plan yet, or is everyone hearing “check back in January”?

Tbh this feels like the 2022 insulin tier shuffle—lots of noise, but my actual copay only changed when my employer carved out a separate diabetes category. The formulary drop is just one lever.

I’d watch whether the CVS move hits commercial plans or also Medicare Part D; that’s where the patient shock usually shows up. Anyone seen the plan documents yet, or just the Bloomberg headline?

I pulled my own plan’s 2025 formulary PDF, and the headline exclusion came with a “covered alternative” that needed step therapy, so it was more paperwork than savings. The thing I’m watching now is whether the PBM passes rebates through at the counter or keeps them as admin fees—if it’s the latter, copays won’t budge.

Has anyone here actually gotten an exception approved for the excluded brand? That feels like the only real-world test of whether this is price relief or just a rebate shuffle.

maintenance perspective: the headline matters less to me than continuity. I track strength workouts and waist, not just scale, and I asked my prescriber to document “continuation of therapy” in my prior auth.

My worry is that these formulary moves target new weight-only starts but could accidentally catch established patients at goal. Has anyone actually seen a plan deny continuation just because your BMI or A1c looks “fine” now? That’s the part I’d want to know before celebrating softer prices.