Americans beginning weight-loss treatment for the first time are increasingly seeking more affordable and convenient options, particularly as they consider pill-based medications from Novo Nordisk and Eli Lilly, according to seven obesity specialists.
Novo Nordisk’s Wegovy pill has been available since January, while Eli Lilly’s newly approved Foundayo is entering the market this week, adding to the growing range of treatment options.
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Danish pharmaceutical company Novo Nordisk first introduced the injectable version of Wegovy in 2021. The newer pill form, like injectable Wegovy and the diabetes drug Ozempic, contains the same active ingredient, semaglutide.
According to doctors, the oral version has gained interest among patients in the months following its approval, mainly due to its lower cost and greater convenience.
Unlike injections, the pills do not require refrigeration, are easier to use discreetly, and eliminate the need for needles, as noted by Dr. Christina Nguyen, an obesity and family medicine physician based in Atlanta.
“One person said I’d rather stay fat than ever use a needle. That’s a true fear,” she said.
Lilly’s Foundayo pill, with active ingredient orforglipron, will begin shipping on Monday.
PILLS VS INJECTIONS
All seven doctors reported that they have started prescribing the oral version of Wegovy, with three of them noting that around 10% of their patients are currently using the pill form.
Of those patients, most are taking a GLP-1 for the first time, rather than switching from injectables, and have not yet reached the highest dose, the doctors said.
“It is expanding access to people who are not sure that an injectable is something they would feel comfortable doing on themselves, might be leery of needles, and they’re excited to have an option that is easier and more familiar to take,” said Dr. Stefie Deeds, an internal and obesity medicine specialist in Seattle.
If patients are tolerating an injectable GLP-1, doctors are reluctant to switch them to pills unless requested.
“The patients we see who are taking medicines, whether it’s Wegovy or (Lilly’s) Zepbound, we’re not telling them to switch to oral Wegovy if they’re doing well,” said Dr. Louis Aronne, director of the Comprehensive Weight Control Center at Weill Cornell Medical College. Aronne has consulted for Lilly and was an investigator on the orforglipron clinical trial, and is an advisory board member of both Lilly and Novo.
Zepbound, with the active ingredient tirzepatide, has been shown in trials to reduce weight by some 20% or more. That makes it the preferred option for treating patients with severe obesity, especially those with more complex cases, doctors said.
“For somebody who is in the lower end of the weight spectrum, people who are more likely to be seen by primary care physicians, they would be more likely to use the orals,” Aronne said.
Foundayo resulted in an average body weight reduction of around 12%, while Wegovy in its oral form achieved approximately a 14% reduction.
LILLY PILL EXPANDS OPTIONS
Several doctors said they are looking forward to the approval of Eli Lilly’s pill, chemically known as orforglipron, as it would give them a more flexible treatment option for patients.
The oral version of Wegovy must be taken on an empty stomach with a small sip of water at least 30 minutes before consuming any food, drink, or other medications. In contrast, Foundayo can be taken at any time of the day without restrictions related to food or water, making it more convenient for patients.
Nguyen said that if the Lilly pill is competitive on price with oral Wegovy, “most likely everyone will go with the orforglipron.”
A spokesperson for Novo Nordisk, Liz Skrbova, stated that survey findings suggest most patients do not consider the timing requirements to be inconvenient.
Additionally, semaglutide—the active ingredient in Wegovy—has been shown in clinical trials to offer added health benefits, including a reduction in cardiovascular risk.
“I can’t guarantee that this totally different type of molecule is going to carry the same benefits,” Dr. Michael Weintraub, an endocrinologist at NYU Langone Health, said of the new Lilly drug.
A spokesperson for Eli Lilly said the company is continuing to study Foundayo, adding that many participants in its clinical trials showed some improvement in markers linked to cardiovascular risk.
DRUGS STILL PRICEY
Doctors say patients consider several factors when choosing a GLP-1 medication, but cost remains the most important. In this area, pill-based options tend to have an advantage.
The self-pay price for both oral Wegovy and Foundayo starts at about $149 per month for the lowest dose, compared to roughly $299 for Zepbound and $349 for Ozempic and injectable Wegovy.
Due to stricter insurance coverage rules for GLP-1 medications, doctors also spend considerable time discussing affordability with their patients. When insurance does cover these treatments, out-of-pocket costs can drop significantly, sometimes to as low as $25 to $50 per month.
“I feel more like a financial planner these days than a physician,” said Dr. Catherine Varney, an obesity medicine physician and associate professor at the University of Virginia School of Medicine who is also part of the Lilly speakers bureau and advisory board.
Varney and other doctors expressed concern that even with lower-cost pills, weight-loss drugs are still largely unaffordable.
“This still is a market for upper-middle-class and above,” Varney said.
