eatment market seen topping $100 billion a year in the next decade. Danish drugmaker Novo Nordisk launched injectable Wegovy in 2021. The pill, like injectable Wegovy and Ozempic for diabetes, has the active ingredient semaglutide. In the three months since its approval, the oral version has appealed to patients for its lower cost and ease, the doctors said. The pills don’t need refrigeration, are more discreet and don’t require the use of needles, said Dr. Christina Nguyen, an obesity and family medicine physician 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, has just begun shipping. Pills vs injections All seven doctors said they had begun prescribing oral Wegovy, and three said they have prescribed the pill to about 10 per cent of their patients. 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 per cent 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. In trials, Foundayo led to an 11 per cent reduction in body weight over 72 weeks and oral Wegovy led to about a 14 per cent reduction over 64 weeks. Lilly pill expands options Several of the doctors said they were eager for Lilly’s pill, chemically known as orforglipron, to be approved so they would have a more flexible option to present to patients. Oral Wegovy must be taken on an empty stomach with just a sip of water 30 minutes before any other medications or food and drink. Lilly’s Foundayo can be taken any time of day without food or water restrictions. Nguyen said that if the Lilly pill is competitive on price with oral Wegovy, “most likely everyone will go with the orforglipron.” Novo spokesperson Liz Skrbova said that based on its survey results, most patients would not find the timing restrictions to be disruptive. Semaglutide has also been found in trials to have other health benefits like reducing cardiovascular risks. “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 Lilly spokesperson said the company is still studying Foundayo and that many participants in its clinical trial saw some reduction in markers of cardiovascular risk. Drugs still pricey Patients consider many factors when picking a GLP-1, but by far the most significant is cost, the doctors said. And there, pills have an advantage. The self-pay price for both oral Wegovy and Foundayo starts at $149 per month for the lowest dose, compared to $299 for Zepbound and $349 for Ozempic and injectable Wegovy. Because of restrictions introduced on insurance coverage for GLP-1 medications, doctors said they spend significant time discussing with patients how to afford the drugs. When covered, out-of-pocket costs could be as little as $25 or $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. Further reading: How are GLP-1 drugs reshaping the condiments market?