Americans beginning prescription weight‑loss therapy are gravitating toward lower‑cost, more convenient oral pills from Novo Nordisk and Eli Lilly, according to seven obesity specialists interviewed by Reuters, even as questions about long‑term benefits and affordability persist. Novo’s oral form of semaglutide, sold as Wegovy, was launched in January and, doctors say, has quickly attracted patients who want to avoid injections. Lilly’s newly approved pill, Foundayo (orforglipron), is due to begin shipping on Monday.
Clinicians said oral options appeal for practical reasons: pills do not require refrigeration, are more discreet and spare patients needle use. “One person said I’d rather stay fat than ever use a needle. That’s a true fear,” said Dr. Christina Nguyen, an obesity and family medicine physician in Atlanta. Of the seven physicians Reuters spoke with, all had started prescribing oral Wegovy; three estimated they have prescribed the pill to roughly 10% of their patients who are receiving drug therapy for obesity. Most of those patients are first‑time users of a GLP‑1 class medicine rather than people switching off injectables.
Efficacy in the pivotal trials differs across products, and that is shaping prescribing decisions. Lilly’s Foundayo produced about a 12% average body‑weight reduction in trials and oral Wegovy about 14%, while tirzepatide injections (sold as Zepbound) have shown reductions of roughly 20% or more, doctors noted. “For somebody who is in the lower end of the weight spectrum… they would be more likely to use the orals,” said Dr. Louis Aronne, director of the Comprehensive Weight Control Center at Weill Cornell Medical College, adding that clinicians are generally not moving patients who are doing well on injectables to oral therapy unless patients request it.
Convenience differences between the pills may also influence uptake. Oral Wegovy must be taken on an empty stomach with only a sip of water 30 minutes before other food, drink or medications, while Lilly says Foundayo can be taken any time of day without food or water restrictions. “It is expanding access to people who are not sure that an injectable is something they would feel comfortable doing on themselves,” said Dr. Stefie Deeds, an internal and obesity medicine specialist in Seattle.
Cost remains the primary barrier. Self‑pay pricing for the lowest dose of both oral Wegovy and Foundayo starts at about $149 per month, materially cheaper than Zepbound’s roughly $299 monthly price and the approximately $349 price for Ozempic or injectable Wegovy. But doctors said many patients still cannot afford even the lower pill prices because insurers have tightened coverage, forcing clinicians to spend substantial time helping patients navigate affordability. “I feel more like a financial planner these days than a physician,” said Dr. Catherine Varney of the University of Virginia School of Medicine, who added that the market remains largely for upper‑middle‑class patients and above unless coverage improves.
Manufacturers stressed ongoing study and context. Novo Nordisk spokeswoman Liz Skrbova said company surveys indicate most patients would not find the oral Wegovy timing restrictions disruptive. A Lilly spokesperson said the company is continuing to study Foundayo and noted some trial participants experienced reductions in cardiovascular risk markers; Dr. Michael Weintraub, an endocrinologist at NYU Langone Health, cautioned that it is too soon to know whether the new chemical class carries the same cardiovascular benefits seen with semaglutide.
Analysts and clinicians foresee intense competition as companies jockey for share in a market analysts project could top $100 billion a year within the next decade, but they say broader insurance coverage will be key to making these therapies accessible beyond higher‑income patients.