PoundsPunch Periodical 2025.05: Novo Nordisk CEO Shake-Ups and Formularies on Fire in the Obesity-Drug Wars

Novo Nordisk ousts CEO Lars Fruergaard Jørgensen while CVS Caremark crowns Wegovy its preferred weight-loss drug

As Novo Nordisk pushes out its longtime CEO and CVS backs Wegovy over Zepbound, the battle for obesity drug dominance enters a new phase of power plays and price maneuvers.

Novo Nordisk CEO Steps Down After Tumultuous Tenure

On May 16, 2025, Novo Nordisk announced that CEO Lars Fruergaard Jørgensen will step down after eight years at the helm. The company framed the move as a mutual agreement between Jørgensen and the board. But the context tells a more strategic story.

The announcement came two weeks after Novo secured a headline-grabbing deal with CVS Caremark, which designated Novo’s GLP-1 drug Wegovy as the preferred weight-loss medication across its standard commercial formularies. Jørgensen will remain in his role for now to facilitate a transition, as the board searches for new leadership.

Why now? The company didn’t cite specific failures, but a combination of factors has strained confidence:

• Stock market pressure: Novo shares are down over 50% from their 2024 highs, with investors increasingly uneasy about Wegovy’s plateauing growth.

• Manufacturing woes: Persistent supply shortages tarnished Novo’s first-mover advantage in the GLP-1 space and opened the door for compounding pharmacies to gain ground.

• Pipeline concerns: Analysts responded poorly to underwhelming results from Novo’s next-generation candidate, CagriSema.

• Foundation influence: The Novo Nordisk Foundation, which controls the majority of voting rights, reportedly played a central role in pushing for succession planning and greater board representation.

While not officially linked to the CVS deal, the timing of this executive shakeup suggests the company is recalibrating its leadership profile just as it doubles down on payer partnerships and cost-containment strategies.

CVS Caremark Picks Wegovy, Drops Zepbound

On May 1, 2025—two weeks before the CEO news broke—CVS Health’s PBM arm, Caremark, announced it would designate Wegovy as the exclusive preferred GLP-1 for weight loss starting July 1. Eli Lilly’s Zepbound will be removed from preferred coverage and relegated to non-preferred status, which typically means higher out-of-pocket costs for patients and lower reimbursement rates for providers.

The decision impacts approximately 30 million commercial lives under CVS Caremark’s default formularies. CVS framed the move as part of a broader affordability strategy, noting it would also offer cash-pay Wegovy pricing at around $500/month for the uninsured—less than half the list price of $1,349.

Why Wegovy? The decision was likely driven by three key considerations:

1. Rebate economics: Novo reportedly offered more aggressive discounts to secure preferred status and protect volume.

2. Supply confidence: With U.S. manufacturing ramping up in Clayton, North Carolina, CVS may view Novo as a safer long-term bet for inventory availability.

3. Bundled services: CVS now offers weight management coaching and chronic condition programs that integrate with Wegovy prescriptions, enhancing member engagement.

Eli Lilly responded with a measured public statement emphasizing “access and affordability,” but the hit was unmistakable—Zepbound, which had overtaken Wegovy in new starts earlier this year, just lost a critical channel.

PoundsPunch Comment: The DTC Backchannel Is No Longer a Backup

It’s easy to get distracted by headlines about CEOs stepping down and PBMs shifting drug preferences. But look closely, and you’ll see a deeper transformation underway—one that could rewrite how Americans access obesity care altogether.

This isn’t just a formulary war. It’s a channel war. And both Novo Nordisk and Eli Lilly have quietly opened a new front.

• Novo Nordisk now offers Wegovy directly to consumers at around $500/month via its NovoCare digital pharmacy platform.

• Eli Lilly launched LillyDirect, a telehealth-to-doorstep model that includes Zepbound, Mounjaro, and obesity coaching services—aimed at patients frustrated with prior auth delays and patchy insurance coverage.

In other words, while PBMs are deciding which brand to prefer, both manufacturers are building pathways to make that decision increasingly irrelevant.

This is more than a marketing strategy—it’s a hedge. The DTC approach lets Novo and Lilly bypass the bureaucracy of formularies, circumvent specialty pharmacy bottlenecks, and control both margins and messaging. And unlike the old coupon-card programs, these new platforms offer full fulfillment, behavior coaching, and auto-refill functionality. They’re not just selling drugs; they’re selling ecosystems.

So what does this mean for patients?

It means you might be able to get the same GLP-1 drug that your insurer rejected—if you can afford to pay out-of-pocket and navigate the new digital storefronts. It also means patients are being nudged into two distinct lanes: one for those with generous insurance, and one for those willing to self-pay for simplicity and speed.

Meanwhile, the formulary chess continues.

CVS has made its move, but UnitedHealth’s Optum and Cigna’s Express Scripts are still weighing their next steps. Will they side with Lilly? Cut separate deals with Novo? Or open up to other emerging players like Pfizer or Viking Therapeutics down the road?

For now, one thing is clear: the obesity drug boom is maturing into a phase where supply chains, pricing portals, and pharmacy benefits matter as much as clinical data.

The fact that the CEO of the world's leading obesity drug company was asked to leave just two weeks after the company's biggest payer win to date? That’s not a contradiction—it’s a sign of how high the stakes have become.

Novo Nordisk got the deal. But investors wanted more: stability, delivery, and a future-proof pipeline. They’ll be watching the next CEO closely—and so will we.