When insurance says no, we help you get covered
You have options
You have a federal right to appeal formulary changes like the one from CVS Caremark
The right arguments
We combine your medical and personal history with clinical studies, policies and laws to make your appeal as strong as possible
Strong appeals win
Over 80% of Claimable appeals are successful – getting you back on your treatment, fast
Why appeal with Claimable?
Patient-led, provider supported
Doing your own appeal puts you in the drivers seat – and offers more legal rights than provider appeals
Evidence-first, zero guesswork
Appeals are complicated. Our proven formula makes sure your appeal includes everything you need to win
Guaranteed delivery, fast responses
Your appeal is faxed instantly to your insurer, getting you an answer in just 72 hours
From start to send in minutes
How to prepare, create, and submit your appeal with Claimable
FAQs and
Resources
To make the case that you need to stay on Zepbound, you'll submit an appeal letter requesting a formulary exception from CVS Caremark.
On July 1, you'll be able to create this formulary exception appeal with Claimable, using a series of short questions to build your unique case. We recommend asking your provider for a Letter of Medical Necessity as soon as possible so you'll have it on hand when you start your appeal.
Creating and sending your appeal with Claimable takes just minutes.
Once you've submitted, CVS Caremark will have 72 hours to review and respond to the appeal, so you'll know quickly whether you'll be able to stay on Zepbound. And if they deny it again, you have the right to appeal multiple times and with multiple levels of review – including an independent review.
Both options can work, but generally we recommend that you appeal with your provider's Letter of Medical Necessity attached. Patient appeals have stronger legal rights, are entitled to multiple appeals, and typically mandate responses on faster timelines.
Starting July 1, 2025, CVS Caremark is removing Zepbound from its formulary after making Wegovy the preferred GLP-1. This is a business decision based on rebate contracts – not patient outcomes or medical necessity.
No. Zepbound and Wegovy are different medications and not interchangable. Zepbound uses dual GIP/GLP-1 receptor agonists, while Wegovy is GLP-1 only. Zepbound may offer greater weight loss and better tolerability, especially for patients with obstructive sleep apnea (OSA).
If you're on Zepbound and it's working well for you, there's no medical reason for you to switch to Wegovy – and it could cause negative effects.
A strong appeal letter should include the following:
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Your medical results on Zepbound (weight loss, symptom control, etc.)
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Any prior medications that you’ve tried and failed
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Specific medical conditions like OSA that Zepbound uniquely treats
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A letter from your doctor supporting continued use
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Clinical studies, applicable laws and insurance regulations, and precedents from successful appeals with similar cases to yours
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Supporting evidence like lab results, weight logs, dosing history and medical records
Claimable's appeals are custom built to include all of these things, personalized with your specific medical history and situation.
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Yes. Under federal law, you have the right to request a medically necessary exception when a formulary change puts your care at risk.
On top of federal productions, many states have laws preventing insurers from forcing stable patients to switch medications mid-year. Check the laws in your state to find out if you have additional protections to support your case to stay on what's working for you.