Starting January 1, 2027, Zepbound Single-Dose Auto-Injector (SDAI) will move to non-preferred on the New York and California Select Small Group and Individual Formularies. Members will be required to try the preferred product, Zepbound KwikPen, before they’re approved for the SDAI. Both versions are still considered non-formulary. This applies to all dosages. Executing this change will drive significant cost of care savings.
For California, members and their prescribers will receive letters on November 1 and December 1 explaining the preferred product change and the need for a new KwikPen prescription and compatible pen needles.
- New members requesting prior authorization (PA) on or after January 1, 2027, must start on Zepbound KwikPen.
- Existing members must transition to Zepbound KwikPen on January 1, 2027. For members whose active SDAI PA extends beyond January 1, 2027, the PA will transition automatically to the KwikPen through the original PA end date.
Members whose SDAI PA expires before January 1, 2027, must submit a new PA through the current process. For New York, members with a paid claim between April 1 and October 1, 2026, for the Zepbound SDAI — and their prescribers — will receive notices on November 1 and December 1. The change is effective upon the plan’s renewal date in 2027.
- Members with an active prior authorization (PA) at the time of transition may continue using the single-dose auto-injector until the PA expires.
- New members enrolling in the New York 2027 Select Formulary will be required to start with the Zepbound KwikPen.
- Members whose PA expires before their 2027 renewal date will need a new PA through the existing process.
If you have questions, please reach out to your Anthem or CarelonRx account representative.