Obesity pills are coming. Here are 5 things to know about them : NPR

Drugmakers have developed pill versions of GLP-1 drugs to treat obesity.

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Millions of people use injectable medications like Wegovy to achieve a healthy weight. But weekly injections aren’t for everyone – or every wallet.

That’s why experimental pills that may achieve similar results are attracting so much attention.

The drugs have not yet won approval from the Food and Drug Administration, but the first could get the green light by the end of the year.

“The obesity patient community has gone untreated for so long,” says Tracy Zvenyach, director of policy strategy and alliances at the nonprofit Obesity Action Coalition. “New innovations, new treatments to treat this chronic disease are all welcome. All are exciting.” The coalition receives financial support from several drugmakers, including Novo Nordisk, Eli Lilly and Pfizer.

Here’s what you need to know: from the price of the pills to how they work.

1. Two new pills are coming (probably)

Novo Nordisk’s obesity pill should be approved first. It contains the same ingredient – ​​semaglutide – found in Wegovy, Ozempic and also in Rybelsus, the company’s type 2 diabetes pill that was approved in 2019.

The difference between this new pill and Rybelsus is the dose. There is more semaglutide in the new pill.

Novo Nordisk’s main competitor is Eli Lilly, which makes Zepbound and Mounjaro. And he’s also working on an anti-obesity pill. But instead of using the same ingredient in its successful injectable products, tirzepatide, the company is working on a new one for its obesity pill, called orforglipron.

2. Patients will take the pills daily and not weekly

Pills should be taken every day, but injectables should be taken once a week.

For Novo Nordisk, it was a challenge to make a semaglutide tablet that was not immediately broken down in the stomach before the drug could be absorbed. The scientists therefore added an ingredient that would protect the pill for 30 minutes while it was absorbed. That’s a mouthful: sodium N-(8-[2-hydroxybenzoyl]amino)caprylate, or SNAC for short.

“If you think about dropping an Alka-Seltzer tablet into a glass of water, that immediate fizzy reaction that happens is what happens in your stomach,” says Andrea Traina, one of Novo Nordisk’s obesity directors. “It creates this little foamy environment right around the tablet.”

This foam prevents a stomach enzyme from breaking down the tablet, reduces stomach acid very slightly, and makes the cells under the pill a little more permeable so that semaglutide can be absorbed into the bloodstream more easily. The process takes approximately 30 minutes. It must be taken on an empty stomach.

Eli Lilly’s orforglipron is a little different. It is not as vulnerable to breakdown in the stomach.

“There are no restrictions on food or water,” says Dr. Max Denning, one of Eli Lilly’s senior medical directors. “You can take it orally and it is very efficiently absorbed without any additional absorption enhancers or administration restrictions.”

3. They both work, but one seems to have an advantage

In a study published in September in the New England Journal of Medicine, a 25 mg semaglutide pill resulted in a 16.6% weight reduction on average over 64 weeks. It’s pretty much the same as Wegovy.

Eli Lilly’s obesity pill, or forglipron, produced an average weight loss of 12.4% at its highest dose over 72 weeks, meaning it is less effective than commercially available injections.

The medications have side effects similar to injectables, including nausea and diarrhea.

4. These pills should cost less than injectables

The pills tend to be less expensive than injectables, so patients hope they will be more affordable than brand-name injectables with list prices above $1,000 a month — and that insurance companies will be more likely to cover them.

“It’s easier to make and the cost should ultimately be lower,” says Dr. Richard Siegel, co-director of the Diabetes and Lipid Center at Tufts Medical Center. “One of the big problems with all drugs in this area is their cost. And can we really equitably provide these drugs to the millions of people who could benefit from them?”

According to a recent survey by KFF, a nonprofit health policy research organization, 1 in 8 people currently take an injectable drug in this class. Although most have at least some insurance coverage, more than half reported difficulty affording the medications.

Since the beginning of 2025, pharmaceutical companies have offered these drugs at reduced prices to patients who do not use their health insurance, and prices have fallen slightly over time. In early November, when Novo Nordisk and Eli Lilly announced deals with the Trump administration, the initial dose of Zepbound will be available for $299 per month for people purchasing without using insurance. And Wegovy will now be available for $349 per month.

Although neither company has announced an official decision list prices of experimental pills, their agreements with the Trump administration stipulate that if their oral obesity drugs are approved, they will sell them directly to consumers for $149 per month. This means that patients can benefit from this price if they do not use their health insurance.

Still, if the pills have better insurance coverage, co-pays could be significantly lower than that.

5. The FDA may soon act on the first two, and other new drugs are in the works

Novo Nordisk’s obesity pill is expected to be approved before the end of the year.

Eli Lilly, on the other hand, said it will submit orforglipron for FDA approval this year. The drug was granted a priority review voucher from the agency, which could mean the agency will make a decision “within a few months.”

Novo Nordisk and Eli Lilly are also working on the next generation of these drugs, which could prove even more effective than those already on the market.

Novo Nordisk is studying another compound called cagrilintide and a combination of cagrilintide and semaglutide. And Eli Lilly is studying retatrutide. Both are in phase 3 clinical trials.

Meanwhile, another company, Metsera, has several obesity drugs in its pipeline, although none are yet in late-stage clinical trials. Novo Nordisk attempted to acquire the company, but ultimately lost to Pfizer, which completed the acquisition that could ultimately be worth more than $10 billion.