Vemlidy no longer in formulary effective July for major prescription coverage

[hb1231]

It is Oct 2025, i was told by CVS Caremark that Vemlidy will not be in formulary starting January 2026. Can anyone confirm?

[Bansah1]

Hi @hb1231,
Welcome to the community. I cannot find any information on this. Please have a conversation with your doctor about such changes so you can plan a switch ahead of time.. Keep us posted. Bansah1

[ThomasTu]

Thanks for the heads up, @hb1231, and welcome to the community. I too have not heard about this: just wondering if our US colleagues can shed light on this (@Suwang88 @SuzanneBlock @chari.cohen @CFreeland)

Cheers,

Thomas

[Hb8120]

Just got the notice from CVS Caremark a few days ago in the mail. Vemlidy will not be covered starting January 1, 2026.

[Caraline]

Welcome @Hb8120

This must be an unexpected inconvenience and worry for you. Hopefully we can help.

@ThomasTu @Suwang88

[Bansah1]

Hi @Hb8120 and @hb1231,
This also occurred about a year or two ago, and the Hepatitis B Foundation led an advocacy campaign that led to CVS Caremark changing its course. Perhaps we need to mount a stronger petition and advocate for Vemlidy to remain covered. But we will need to act before January. Bansah1

[sdcmma]

Hello, I am new here and just wanted to add to this thread. I am based in the U.S. and also just received a notice from CVS letting me know Vemlidy will no longer be covered as of Jan 1st, 2026.

[ThomasTu]

Thanks for the confirmation @sdcmma and @Hb8120.

@et5656 has made some relevant comments in another thread that might be an alternate approach:

Afraid to begin treatment

I am not a doctor, but I am a patient on treatment for HBV, and I work in the health insurance industry in the US. I would personally say that it would be best to try one of the generic options for treatment (entecavir or TDF), unless you have contraindications that would require you to use Vemlidy, just because they are so much cheaper. Insurance will usually give you less of a hard time about filling prescriptions for generic drugs, but even if they refuse to fill it, there are several options…

[dhoang1212]

I received a letter from cvs Caremark on Oct 27 with the same notification.

[dhoang1212]

Hi. I received the same notice . I’ve reached out to Michaela Jackson michaela.jackson@hepb.org

I think she was one of the people that led the petition last time . I haven’t heard back yet. Please email her as well . I think the more people she hears from , maybe a new petition can be created .

[bornwithhepb]

Hi everyone,

I also have Aetna with CVS Caremark and just got the letter saying they will no longer cover Vemlidy. I contacted my doctor right away, but her response was pessimistic — she said it’s unlikely Caremark will approve an exception unless I have kidney or bone-density issues.

Can the experts and long-time patients here share your thoughts? I’m preparing information to support my case.

Other context: My other option is Kaiser Permanente, where Vemlidy is on formulary but still requires Prior Authorization and Quantity Limit.

Questions:

• Would switching to Kaiser be easier? Is their PA process simpler than a non-formulary exception under Aetna/Caremark?

• Is it still worth trying for an exception with Caremark, given my doctor’s tone?

• What else could strengthen my request that my doctor didn’t mention?

Background about me:

• On Vemlidy since 2016, with good AST/ALT numbers and <10 viral load

• Past antivirals: adefovir → entecavir (out of range AST/ALT, higher viral load) → TDF (low viral load but higher AST/ALT) → Vemlidy

• HBeAg-positive and have not seroconverted yet, though it seems I am close (HBsAg <20, HBeAg 1.106)

• My doctors noted it is uncommon for patients like me to remain HBeAg-positive after years on Vemlidy, which underscores the importance of continuing this potent therapy

• Current organ status: stable mild kidney cyst, small liver hemangioma, and a 4 mm gallbladder polyp (family history of gallbladder cancer)

• Planning to get pregnant, so safety is important

• Early antiviral exposure in my teens in Asia under non-standard care, which may affect treatment response

Any insight or experience with CVS Caremark exceptions or Kaiser’s PA process would be very appreciated.

Thank you all.

[bornwithhepb]

I also emailed Hep B org and got this response from Michaela. It doesn’t sound like there’s advocacy efforts in progress unfortunately….

Thank you for informing us, and we are incredibly sorry that this is occurring. We are aware, and are currently seeing what can be done to address this. In the meantime, I would recommend speaking with your provider about a potential alternative that you can safely switch to if this plan does go into effective in January. We will certainly let the community know when an advocacy opportunity arises.

Best,

Michaela

[Bansah1]

Hi @bornwithhepb,
Welcome to the community. I am sorry to hear about CVS Caremark. Every new year, most insurance companies remove many helpful medications from their formulary. This helps them save money and make a profit, as such medicines tend to be a bit expensive. If the medication is not on the formulary, not even prior authorization will help.

Please, try to speak with one of those healthcare managers. Your local health department or social services should have someone there who can guide you as you consider this decision. If switching won’t affect your current care or loss of your care team, then yes, I would say look into making a switch. My only concern with making the switch is that Kaiser might turn around and do the same thing. They seem to follow suit once this change happens at one company. Slowly, they all follow sadly.

Please discuss with your doctor and explore the options available to you. I hope this helps, and keep us posted on how things go. Best, Bansah1

[bornwithhepb]

we fought hard with the petition in 2019 to put it back on their formulary list

How do we mobilize again? If we succeeded once, we should be able to succeed again. Can anyone share what was done in 2019? They need to understand that removing it this time will not be an easy fight.

[ThomasTu]

Thank you all for sharing this information with each other and for any people looking for advice. I’ve reached out to the hepatitis B foundation and they will be putting up some more information about steps forward and the advocacy they’re going to lead on this.

Cheers,

Thomas

[chari.cohen]

Hi everyone. I wanted to chime in here from the Hepatitis B Foundation. I see that Michaela has posted a few days ago - she is a program director with the Hepatitis B Foundation, and she is leading our advocacy efforts towards overturning the CVS Caremark decision. This has happened every year for the past 5 or so years. Pharmacy Benefit Managers remove Vemlidy from the formulary for the following year. They do this as a negotiating tactic, to bring down the price of the medication - and also as a tactic to try and persuade people with hepatitis B to choose a different insurance company. Each year, we respond with strong advocacy - most of the time, they overturn their decision and add Vemlidy back - but not always.

We will be responding again this year. We will be doing two things. First, we are sending a letter to the CVS Caremark leadership, signed by our Scientific and Medical Advisors, urging them to add Vemlidy back, and to allow treatment decisions to remain within the provider/patient space. Second, we are creating a public sign-on letter through our advocacy platform. This will be publicly announced on our social media - anyone can sign onto this public letter to CVS Caremark. And the more people we get signing on and sharing our posts, the better! We hope these strategies help convince CVS Caremark that people living with hepatitis B need to have every treatment option available to them!! If you follow us on social media, you will see the public letter available shortly - https://www.facebook.com/hepbfoundation https://www.instagram.com/hepbfoundation/#