Changes will occur in 2026 GLP-1 drugs.
Long defined high prices, deficit and weekly injections, medications, including Vegovi and Zepbound they are expected to be more affordable and accessible. There are new options for people who don't like needles.
“The use of GLP-1 is expected to expand significantly,” said Dr. Christopher McGowan, a gastroenterologist who runs a weight loss clinic in Cary, North Carolina. “For the first time, drug treatment of obesity will move away from a one-size-fits-all model.”
Diet pills
GLP-1 weight loss pills may mark the most significant shift yet.
Last month Novo Nordisk received approval from the Food and Drug Administration for the first GLP-1 weight loss pill. The drug, marketed as Wegovy tablet, is expected to become widely available this month.
Another Eli Lilly GLP-1 Tabletis expected to receive approval later this year.
Dr. Shawna Levy, medical director of the Tulane Weight Loss Center, said the pills would be an excellent option for patients who prefer oral medications or who have difficulty accessing injectable versions.
“With so many products on the market, I hope competition will drive prices down further,” Levy said.
A month's supply of pills is expected to be cheaper than a month's supply of injections.
Novo Nordisk has not yet announced a list price for the Wegovy pill, but said the two lowest doses will cost $149 a month for people paying cash and without insurance. By comparison, the lowest dose Wegovy injection is $349 a month for people paying cash.
Starting Monday, the two higher dose pills will cost $299 a month for people paying cash. For those with insurance that covers the drugs, out-of-pocket costs could be as low as $25 a month, according to the company.
Dr. Daniela Hurtado Andrade, an endocrinologist at the Mayo Clinic in Jacksonville, Florida, said lower prices would likely increase access. However, she noted that the most dramatic weight loss in the trial was seen with the highest dose, meaning people will likely have to pay more if they want to lose more weight.
Even $149 a month is still too expensive for some, she said.
“This needs to be discussed with patients,” Andrade said, “because they may have unrealistic expectations.”
Levy said one of the downsides of the pill is that for best results, it must be taken on a strict schedule: every morning on an empty stomach. In a late-stage clinical study, people who stuck to the schedule lost an average of 16.6% of their body weight. This figure dropped to 13.6% when people did not take the pills exactly as prescribed.
“I think we need to consider that the effectiveness of these drugs decreases if they are not taken consistently, and I'm curious to see how they work in real life,” Levy said. Lilly's tablets are more flexible and still need to be taken daily, but can be taken at any time of the day.
Chris Mertens, 35, of Menominee Falls, Wis., said he had no trouble remembering to take a Wegovy pill every morning, which he did as part of a clinical study in late 2022. Although he didn't know it at the time, he received the real medicine and not a placebo.
When he started the challenge, he weighed about 260 pounds with a body mass index of about 32 and was hoping to get closer to 200 pounds. After a year and a half of taking the medication, Mertens said he lost about 40 pounds, eventually stabilizing at 220 pounds. He says losing weight has given him more energy at work and at home and changed his relationship with food.
Stronger injection
Lilly is nearing completion of clinical trials of what may be its most powerful GLP-1 drug yet. called retatrutide.
Like Wegovy and Zepbound, retatrutide is administered weekly. It targets GLP-1 and GIP, the same two hormones targeted by blockbusters Lilly Mounjaro and Zepbound. Retatrutide also targets a third hormone called glucagon, which may further speed up weight loss.
Lilly said in December that in a phase 3 clinical study, patients taking the highest dose of the experimental injection lost nearly 29% of their body weight after an average of about 16 months—more than was observed with any GLP-1 drug currently on the market.
The study involved approximately 450 obese or overweight adults with knee osteoarthritis.
“Just a few years ago we just didn’t think these numbers were possible,” McGowan said.
However, the high effectiveness of the drug may be accompanied by more pronounced side effects, such as nausea, diarrhea, constipation and vomiting. Lilly said the dropout rate for patients taking the drug was 18.2%, compared with 4% for the placebo group. By comparison, the dropout rate for the highest dose group in the separate Zepbound study was only 6.2%.
“More is not always better,” McGowan said. “In real-world practice, these discontinuation rates may be even higher.”
Andrade said the drug could be useful for people with severe obesity who may still have trouble losing weight with existing GLP-1 drugs, although she would like to see more data on side effects.
A Lilly spokesman said the company is completing seven additional studies of retatrutide, which are expected to be completed in 2026. The company could apply for FDA approval as early as this year.
Prices and partnership
Access to medicines has also increased through cash payment programs.
Lilly first began offering discounts on certain doses of Zepbound in 2024 through its LillyDirect program. Novo Nordisk later launched NovoCare Pharmacy in March, selling Wegovy at a discounted price to cash payers.
Some major retailers followed in 2025. In October, Costco announced it would sell Wegovy and Ozempic for $499 a month to cash-paying customers, and Walmart struck a similar deal with Lilly for Zepbound.
The Trump administration will launch a self-pay platform in 2026 TrumpRx.gov. The website will not sell prescription drugs directly, but will link people to drug manufacturers' discount sites.
The average monthly cost of weight loss injections on TrumpRx is expected to start at about $350 and drop to about $250 over the next two years, President Donald Trump said. when announcing agreements with drug manufacturers. Starting doses of GLP-1 tablets are expected to cost $149.
Dr. Susan Spratt, a professor of medicine at Duke University School of Medicine, said the partnership “will only improve access.” The question, she added, is whether the rebates will be enough to improve access to medications for everyone who could benefit. “They’re still pretty expensive,” Spratt said.
Levy said the self-pay option would make it easier to get medications, especially for people whose insurance doesn't cover them.
Many of the self-pay options connect patients with telemedicine doctors who will determine whether they are eligible for the medications and write a prescription.
“I think there is potential for increased access to lower-cost products at Walmart and Costco,” Levy said, “but I really want patients to be treated and monitored by specialists or health care providers who really know what they are doing with obesity medications.”
