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

Millions of people use injectable medications like Wegovy to achieve a healthier weight. But weekly injections are not suitable for everyone and not every budget.

That's why experimental pills that can achieve similar results are getting so much attention.

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

“The obesity community… has gone without treatment for so long,” says Tracy Zvenyachdirector of political strategy and alliances for a non-profit organization Obesity Action Coalition. “So new innovations, new treatments for this chronic disease are all welcome. All this is interesting.” Coalition receives financial support from several drug manufacturersincluding Novo Nordisk, Eli Lilly and Pfizer.

Here's what you need to know, from how much the pills can cost to how they work.

1. (probably) two new tablets will appear

Novo Nordisk's obesity pill is expected to be the first to be approved. It contains the same ingredient — semaglutide — found in Wegovy, Ozempic, as well as Rybelsus, the company's Type 2 diabetes pill approved in 2019.

The difference between this new pill and Ribelsus is the dose. The new tablet contains more semaglutide.

Novo Nordisk's main competitor is Eli Lilly, which produces Zepbound and Mounjaro. And he's also working on an anti-obesity pill. But instead of using the same ingredient used in the blockbuster injectable drug tirzepatide, the company is working on a new ingredient for its obesity pill called orforglyprone.

2. Patients will take the pills daily rather than weekly.

Tablets should be taken every day, and injections should be taken once a week.

It was a challenge for Novo Nordisk to create a semaglutide tablet that would not immediately break down in the stomach before the drug could be absorbed. So the scientists added an ingredient that will protect the pill for 30 minutes while it digests. This is a sip: 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, there's an immediate fizzy reaction, and that's what's happening in your stomach,” says Andrea Traina, co-director of obesity at Novo Nordisk. “It creates a little foamy environment directly around the tablet.”

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

Eli Lilly's Orforglipron is a little different. It is not as vulnerable to destruction in the stomach.

“He has no food or water restrictions,” says Dr. Max Denning, Eli Lilly's senior medical director. “You can take it orally and it is absorbed very efficiently without any additional absorption enhancers or dosage restrictions.”

3. They both work, but one has an advantage.

In a study published in September in the journal New England Journal of Medicine, taking semaglutide at a dose of 25 mg led to Weight reduction by 16.6% on average more than 64 weeks. This is about the same as Wegovy.

Eli Lilly's anti-obesity pill, orforgliprone, had a therapeutic effect. Average weight loss 12.4% at the highest dose for 72 weeks, which means it is less effective than injections on the market.

The drugs have side effects similar to injectable ones, including nausea and diarrhea.

4. These tablets should cost less than injections.

The pills are generally cheaper than injectable drugs, so patients hope they will be more affordable than brand-name injectable drugs with a list price of more than $1,000 a month, and that insurance companies will be more likely to cover them.

“It's easier to produce 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 the drugs in this arena is the cost. And can we equitably deliver these drugs to the millions of people who could benefit from them?”

According to recent KFF pollnon-profit health policy research organization, one in eight people currently inject drugs of this class. While most have at least some insurance, more than half said they have difficulty affording their medications.

Since early 2025, drug makers have made these drugs available at a discount to patients without health insurance, and prices have dropped slightly over time. As of early November, when Novo Nordisk and Eli Lilly announced deals with the Trump administrationA starting dose of Zepbound will be available for $299 per month for people buying without insurance. And now there will be Vegas available for $349 per month.

Although no company has officially announced list the price of the experimental pills, their agreements with the Trump administration say that if their oral obesity drugs are approved, they will sell them directly to consumers for $149 per month. This means that patients may receive this price if they do not use their health insurance.

However, if the pills get better insurance coverage, copayments could be significantly lower.

5. The FDA may soon take action on the first two drugs, and more drugs are in development.

Novo Nordisk's obesity pill is expected to receive approval before the end of the year.

Eli Lilly, on the other hand, said it will submit orforgliprone for FDA approval this year. The drug has received recognition priority check 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 may be 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 development, although none are in late-stage clinical trials. Novo Nordisk attempted to acquire the company but ultimately lost out to Pfizer, which completed the deal. could ultimately be worth more than $10 billion.