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

Millions of people use injectable drugs like Vegovi to reach a healthy weight. But weekly injections aren’t for everyone – or every wallet.

That’s why experimental pills that can achieve similar results are gaining so much attention.

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

“The patient community in the obesity field has been without a cure for so long,” says Tracy Zevenyacht, director of policy strategy and coalitions at the nonprofit Obesity Action Coalition. “So new inventions, new treatments to treat this old disease – all are welcome. All are exciting.” The alliance receives financial support from several drugmakers, including Novo Nordisk, Eli Lilly and Pfizer.

Here’s what you need to know – from how much the pills might cost to how they work.

1. Two new tablets are (probably) coming

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

The difference between this new pill and Rybelsus is the dosage. The new pill contains more semaglutide.

Novo Nordisk’s main competitor is Eli Lilly, which makes Zepbound and Monjaro. And it is also working on obesity pill. But instead of using the same ingredient that is in its blockbuster injectables, tirazepide, the company is working on a new one for its obesity pill called orforgaliprone.

2. Patients will take pills daily, not weekly

The pills have to be taken every day, but the injections are once a week.

For Novo Nordisk, it was a challenge to create a semaglutide pill that did not immediately break down in the stomach before the drug was absorbed. So the scientists there added an ingredient that would keep the pill safe for up to 30 minutes while it was being absorbed. It’s a mouthful: sodium N-(8-(2-hydroxybenzoyl)amino)caprylate, or SNAC for short.

“If you think about putting an Alka-Seltzer tablet in a glass of water, there’s an immediate fizzy reaction, the same thing happens in your stomach,” says Andrea Traina, one of Novo Nordisk’s obesity directors. “This creates a little foamy environment directly around the tablet.”

That foam prevents stomach enzymes from breaking down the pill, slightly reduces the acidity of the stomach, and makes the cells at the bottom of the pill a little more permeable so that semaglutide can be more easily absorbed into the bloodstream. This process takes about 30 minutes. It has to be taken on an empty stomach.

Eli Lilly’s orforglipron is a little different. It is not as susceptible to breakage 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 absorbed very effectively without any additional absorption enhancers or administration restrictions.”

3. They both work, but one seems to have the edge

In a study published in September New England Journal of Medicine, The 25 mg semaglutide tablet resulted in an average weight loss of 16.6% over 64 weeks. It’s almost the same as Wegovi.

Eli Lilly’s obesity pill, orforgalipron, resulted in an average weight loss of 12.4% over 72 weeks at the highest dose, meaning it is less effective than injections available on the market.

The drugs have similar side effects as injections, including nausea and diarrhea.

4. The price of these pills should be less than injections

The pills are cheaper than injections, so patients are hoping they’ll be more affordable than brand-name injection drugs with list prices of more than $1,000 a month — and insurance companies will be more likely to cover them.

“It’s easier to make and should ultimately cost less,” says Dr. Richard Siegel, co-director of the Diabetes and Lipid Center at Tufts Medical Center. “A big problem with all medicines in this area has been cost. And can we get these medicines equitably to the millions of people who could really benefit from them?”

According to a recent survey by KFF, a non-profit health policy research organization, 1 in 8 people in this category are currently taking an injection drug. While most of them have at least some insurance coverage, more than half said they were having difficulty affording medications.

Beginning in 2025, drug manufacturers have made these drugs available at a discount to patients who do not use their health insurance, and prices have decreased slightly over time. In early November, when Novo Nordisk and Eli Lilly announced the deal with the Trump administration, initial doses of Zepbound will be available for $299 a month for people buying without insurance. And Wegovi will now be available for $349 per month.

While no company has made any official announcement List Price of experimental pills, their deals Trump administration says if their oral obesity drugs Are Approved, they will sell them directly to consumers for $149 per month. This means patients may get charged this price if they don’t use their health insurance.

Still, if the pills get better insurance coverage, copayments may be significantly lower than that.

5. FDA may take action on the first two soon, and more 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, has said it will submit orforgaliprone for FDA approval this year. The drug won a priority review voucher from the agency, which could mean the agency will make a decision “within months.”

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

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

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