Express Scripts Drops Zepbound's Once-a-Month KwikPen From Its National Formulary

Express Scripts, the pharmacy benefit manager owned by Evernorth, publishes a list of drugs it will not cover for the employers and health plans that use its National Preferred Formulary.

The current version of that list carries the internal revision stamp EXCL-NPF-26 (07/01/2026). Under the weight loss heading, two products sit in the excluded column: Zepbound KwikPens and Zepbound vials. The alternatives the document steers prescribers toward are generic liraglutide, Foundayo, Wegovy HD, the Wegovy pens, Wegovy tablets, and the single-dose Zepbound pens.

That is a change from what the same company told plans a year earlier. Its notice describing exclusions taking effect January 1, 2026 listed only Saxenda and Zepbound vials in the weight loss row, with Wegovy and Zepbound pens named as the covered alternatives. The KwikPen was added after that notice went out. Saxenda came off the list over the same stretch, and generic liraglutide now appears as an alternative instead.

The KwikPen is a delivery device, not a different medicine. Lilly began selling it on February 23, 2026 as a single-patient pen holding four weekly doses of tirzepatide, so one device covers a month rather than four separate single-dose injectors. CNBC reported at launch that cash prices through the company's direct-to-consumer service started at $299 a month for the lowest dose.

Two limits are worth stating plainly. The National Preferred Formulary applies only to the plans that adopt it, and plan sponsors can customize their own lists. And an exclusion is not an absolute bar. The document tells patients whose doctors identify a clinical reason to stay on a medication that the prescriber can request a coverage review through the Express Scripts prior authorization portal.

The exclusions document gives no reason for the change, and the version reviewed here does not spell out a transition rule for people already using the KwikPen. Express Scripts attaches continuation-of-therapy footnotes to some rows in its change notices, but no such footnote appears on the weight loss row of the January 2026 notice.

Coverage depends on each plan's adopted formulary

If your plan runs on this formulary and you were hoping to consolidate to one pen a month, your plan most likely will not pay for it. Tirzepatide itself remains covered in the weekly single-dose pen format, so this is a question of which device you pick up, not whether the drug is available to you. Zepbound vials stay excluded as well.

Anyone in that position should check their own plan's drug list rather than the national one, since employers often customize. It is also reasonable to ask the pharmacy to run both formats before assuming, and to talk with the prescriber about a coverage review if there is a clinical reason the multi-dose pen matters, such as dexterity, travel, or refrigerator space.

The exclusion is commercial, not a safety action

This is not a safety action and not an FDA decision. A formulary exclusion says nothing about whether a product is safe, effective, or recalled, and the KwikPen holds the same tirzepatide as the covered pens. It also does not mean coverage is gone for every Express Scripts member, because plan-level lists differ and can change during the year, and the exclusions document says on its face that it is not a complete list. Formulary decisions are commercial, and this one publishes no rationale, so any explanation involving rebates, pricing, or manufacturing would be guesswork. Finally, Foundayo's appearance among the alternatives reflects a coverage choice by the plan manager, not a finding that it works as well as tirzepatide for any individual patient.