declining insurance coverage, the lower-priced options have been a boon for the drugmakers, the doctors said. Denmark’s Novo and Indianapolis-based Lilly began selling the oral medications in the US in January and April, respectively, and have boasted of strong demand from new patients. Still, they have complained about compounded versions, which are allowed by the US FDA in personalized formulations and doses. The Food and Drug Administration has sought to tighten limits after shortages of the branded drugs that allowed compounding to flourish ended. Doctors and health experts have hoped that lower pricing would turn people toward the branded drugs, which are subject to greater oversight. “I am seeing people are switching from compounds,” said Dr. Michael Weintraub, assistant clinical professor of endocrinology at NYU Langone in New York. He said he does not prescribe the compounded drugs but has seen patients who were already on them. “I have patients increasingly coming to me saying, ‘I hear it’s not as expensive to get the pharmaceutical-grade branded version, can we switch over?’” A Lilly spokesperson said the company was “encouraged by the early momentum, growing prescriber interest and intent to prescribe, and by patients choosing authentic, FDA-approved treatments like Foundayo.” Novo said it has expanded access to its GLP‑1 drugs through its NovoCare Pharmacy and retail partnerships, aimed at steering patients toward FDA‑approved treatments over compounded versions. Wegovy, a known brand While doctors said some are switching to injectable GLP‑1s, most are turning to the pills because the prices of those medications are more comparable to the compounded versions. Lower doses of Novo’s Wegovy pills cost around $149 per month, while the injector pens start at $199 per month, according to the company and the White House’s websites. Lilly’s Foundayo also starts at $149 per month, while vials and pens of its GLP‑1 obesity drug Zepbound can cost $299 or more for self-pay patients. Doctors said Novo’s Wegovy pill benefits from stronger brand recognition, as it is the same medicine and name as the injectable. It also has established heart-protective data, making some patients and prescribers more comfortable with it, especially for people at risk of heart disease. Doctors also said some patients are reluctant to try less familiar Foundayo as it is a somewhat different type of medication with no heart-benefit data yet. “Something about saying it is new creates a little hesitation in at least a handful of patients I’ve spoken about it with,” said Dr. Jorge Moreno, a Yale Medicine obesity specialist. “It’s a small sample, but they’ve opted for the Wegovy (pill).” Oral Wegovy led to about a 14 per cent reduction in body weight over 64 weeks, and Foundayo about an 11 per cent reduction over 72 weeks, in separate studies. Patients on the GLP‑1 injections shed 15 per cent–20 per cent of body weight in trials. Foundayo’s convenience – it doesn’t need to be taken on an empty stomach like Wegovy – and more time on the market are expected to help Lilly narrow Novo’s advantages for the oral offerings. Citi analysts said prescribers projected an even split between Foundayo and Wegovy pills based on a survey of 120 doctors who prescribe GLP‑1 medicines. Survey findings also showed that doctors at academic medical centers expect Foundayo to eventually account for about 70 per cent of prescriptions between the two pills. They cited Foundayo’s lack of a fasting requirement as a key advantage. Insurance hurdles Still, prices are too high for many and all the doctors interviewed said insurance coverage remains a challenge. “Every day, I get a message from a patient saying ‘my insurance company didn’t approve or denied it again,’” said Yale’s Moreno. Often, physicians do not code the diagnosis properly for the appropriate prescription, leading to rejections, he said. And insurance companies don’t as readily cover preventive care as they do existing conditions. Lilly’s spokesperson said two of the three largest US pharmacy benefit managers have begun covering Foundayo, and the firm is working to expand coverage further. Many doctors said they are eager to see the start of the US government’s initial program providing coverage of GLP‑1s to Medicare patients, set to begin in July and last through 2027. They said they hope the government program will spur commercial coverage for a larger population. Some patients already on injectables are switching to the pills, but not en masse, according to most doctors interviewed. “Right now, only a small percentage are switching to the pill,” said Dr Christina Nguyen, an obesity specialist in Atlanta. “The injectables are working well and people don’t want to mess anything up.” Doctors also back up what the drugmakers’ executives have said so far: the pills are opening the market to new patients. “This is expanding the market of GLP‑1,” said Sarah Ro, medical director of the University of North Carolina Health’s weight-management program. “Patients who have been offered a GLP‑1, but due to price, declined… now, they’re wanting to try.” Reporting by Bhanvi Satija in London and Chris Prentice in New York. Editing by Caroline Humer and Bill Berkrot. All courtesy of Reuters. Further reading: Why the pill revolution is good news for rivals Novo Nordisk and Eli Lilly