Our desk reads the formulary documents, pricing terms, and program notices. You get the client-ready version within 72 hours.
The five changes hitting self-funded renewals this fall, with the questions to take to your PBM, plus the change ledger by email each month. After signup, reply with your dominant PBM and typical group-size band and we send the current alert for it, with the editable client memo, free. Never send client names or files.
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As soon as a formulary, pricing, or policy change forces a plan decision, we send you a one-page alert on what it means for your clients. Five blocks, every time: what changed, who's affected, dollar impact, what to tell clients, and three questions for your PBM. Verified against the primary documents. If it doesn't force a decision, we don't send it.
Known. CVS Caremark will add Zepbound (tirzepatide) back to its template commercial formularies as an additional preferred option effective October 1, 2026, reversing the July 2025 exclusion. Plan sponsors on template formularies retain discretion to customize, and custom-formulary groups are unaffected unless they opt in.
Self-funded groups on Caremark's standard formularies. Any group that added Wegovy-preferred step edits or member communications after July 2025. Groups mid-renewal whose 2027 rebate assumptions were modeled on a single-agent exclusion.
Estimate. Net plan cost on covered GLP-1s commonly runs $400 to $700 per member per month, while Lilly's direct cash price now sits at $299 to $449 and the Medicare Bridge benchmark at a $50 copay. Your client's CFO has already seen both numbers. The change's own dollars run through agent mix, utilization, and rebates, and none of the three are public. Group-specific modeling belongs with your PBM.
Open. Each needs written confirmation from the PBM; the announcement alone settles none of them.
CVS Health press release, May 28, 2026. Express Scripts 2026 NPF exclusions, EXCL-NPF-26. Novo Nordisk price announcement, February 24, 2026, effective January 1, 2027. CMS Medicare GLP-1 Bridge program terms, July 2026. Every delivered alert links every source and labels each claim Known, Estimate, or Open.
The same intelligence rewritten to the employer, in your voice: what this means for your plan, and the questions your firm is taking to the PBM. An editable, source-backed draft for your review: your logo at the top, our name nowhere in it, and nothing reaches a client until you approve it.
What this means for your plan. If your plan uses Caremark's standard formulary, Zepbound is covered automatically on October 1 unless you opt out. If your formulary is custom, nothing changes by default, and keeping the exclusion is now a choice to re-make.
Three questions we are taking to the PBM on your behalf, covering the opt-out mechanics, the January 1 list-price change and its effect on rebate guarantees, and the utilization-management criteria that come with reinstatement.
No member communication goes out until the adopted formulary and plan rules are confirmed in writing.
Every material change that month in one table, including where nothing changed at your PBM, which is itself something clients want to hear from you. The free email carries the table; subscribers get the implications behind each line.
| OCT 01 26 | ▲ | CVS Caremark returns Zepbound to template formularies as an additional preferred option (announced May 28), reversing the July 2025 exclusion. Standard-formulary groups face a renewal decision. |
| JUL 01 26 | ● | Medicare GLP-1 Bridge live at $50 a month for Foundayo, Wegovy, and the Zepbound KwikPen through December 2027. |
| JAN 01 27 | ● | Novo cuts Wegovy's list price to a $675 monthly WAC (about 50%, announced February 24; self-pay unchanged). Rebate guarantees written against 2026 list prices need re-reading. |
| 2026 NPF | ▼ | Express Scripts 2026 formulary excludes Zepbound vials and KwikPens. Zepbound pens, Wegovy, and Foundayo are preferred; custom formularies vary. |
The one-page overview of the quarter's changes and the questions to take to your PBM. Free for any advisor, along with the monthly ledger by email.
How we work. Primary documents only, never trade coverage alone. Every alert names its sources with dates and links, and carries the date we verified them. Corrections run in the next ledger and are noted on the alert itself. The 72-hour clock runs from when we detect a change to when the alert publishes, and every live alert shows both timestamps. We are subscriber-funded, with no PBM, carrier, or manufacturer sponsorship; any material relationship to a covered organization is disclosed in the item. Onboarding is one email naming your PBMs and states; we never ask for client names or data.
Built for advisors and consultants at independent and regional agencies serving self-funded employers of 100 to 5,000 lives, where the advisor is the pharmacy team.
Not for national houses with in-house pharmacy practices, and not a source of clinical or legal advice.
One seat covers one advisor; firm licenses for additional advisors on request. White-label rights cover sending to your own clients and prospects, not reselling the feed. KFF publishes coverage rates by firm size; what nobody publishes is self-funded plan design by size band, and founding subscribers' books seed that benchmark. It publishes only when the panel is large enough to be real. Not ready? Start with the free report.