Lower monthly prices for oral GLP-1 weight-loss medications produced by Novo Nordisk and Eli Lilly are prompting some U.S. patients to leave pharmacy-compounded formulations in favor of the branded pills, according to interviews with nine U.S. physicians.
Doctors said that the lowest-dose oral versions of Novo’s Wegovy and Lilly’s Foundayo are often priced below their injected counterparts and are comparable in cost to compounded medicines made by pharmacies. As coverage from insurers has tightened for many patients, that pricing dynamic has helped drive uptake of the branded oral products, the physicians said.
Novo Nordisk and Eli Lilly introduced their oral GLP-1 medicines to the U.S. market in January and April, respectively, and company executives have reported notable demand among new patients. Both companies have also voiced concerns about compounded GLP-1 formulations. The U.S. Food and Drug Administration allows compounding in personalized doses and mixtures, but has moved to rein in compounding activity after shortages of the branded drugs eased.
Doctors describe patient behavior and preferences
"I am seeing people are switching from compounds," said Dr. Michael Weintraub, assistant clinical professor of endocrinology at NYU Langone in New York. He noted that while he does not prescribe compounded GLP-1s, he has encountered patients who were already taking them and are now asking about switching to the branded, pharmaceutical-grade versions because of the lower out-of-pocket cost.
Several other clinicians interviewed for this piece echoed that experience. They said many patients who earlier declined a GLP-1 therapy because of price are now opting to try the branded pills. "This is expanding the market of GLP-1," said Sarah Ro, medical director of the University of North Carolina Health’s weight-management program. "Patients who have been offered a GLP-1, but due to price, declined... now, they’re wanting to try."
Price comparisons and product positioning
Physicians described a clear price differentiation between pills and injectables that helps explain patient choices. According to the companies and U.S. government information cited by physicians, lower doses of oral Wegovy are priced at about $149 per month, while Wegovy injector pens start at $199 per month. Lilly’s Foundayo also begins at $149 per month, the doctors said, while vials and pens of Lilly’s injectable GLP-1 obesity drug Zepbound can cost $299 or more per month for self-pay patients.
Because the pills’ starting prices line up more closely with what compounding pharmacies charge, many patients find the branded oral products financially attractive compared with the bounded cost of compounded alternatives. Novo has said it is expanding access to its GLP-1 drugs through its NovoCare Pharmacy and retail partnerships to encourage the use of FDA-approved treatments over compounded versions. A Lilly spokesperson said the company was "encouraged by the early momentum, growing prescriber interest and intent to prescribe, and by patients choosing authentic, FDA-approved treatments like Foundayo."
Brand familiarity, clinical data and patient hesitancy
Physicians noted that brand recognition plays a role in patient and prescriber preferences. Novo’s Wegovy benefits from the same name and active medicine as the injectable formulation, which has established cardiovascular-protection data. That history, doctors said, can make Wegovy more reassuring for patients who face elevated heart-disease risk.
"Something about saying it is new creates a little hesitation in at least a handful of patients I’ve spoken about it with," said Dr. Jorge Moreno, a Yale Medicine obesity specialist. He added that in his small sample, some patients opted for the Wegovy pill rather than trying Foundayo, which is a somewhat different medication without heart-benefit data yet. The clinical trial results cited by physicians put oral Wegovy at around a 14% reduction in body weight over 64 weeks, and Foundayo at about an 11% reduction over 72 weeks in separate studies. By contrast, the injectable GLP-1s recorded weight losses of about 15% to 20% in trials.
Physicians also highlighted practical differences between the two oral pills. Foundayo does not require an empty stomach at dosing, while Wegovy does, and that convenience may help Lilly close some of Novo’s advantages. Citi analysts, referencing a survey of 120 doctors who prescribe GLP-1 medicines, reported that prescribers projected an even split between Foundayo and Wegovy pills. The same survey showed that physicians at academic medical centers expect Foundayo to eventually account for roughly 70% of prescriptions between the two pills, citing the lack of a fasting requirement as a major benefit.
Insurance and access remain barriers
Despite the lower list prices for the pills, every physician interviewed said insurance coverage continues to limit access for many patients. Yale’s Moreno described frequent denials, noting, "Every day, I get a message from a patient saying 'my insurance company didn’t approve or denied it again.'" He said that incorrect coding for a given diagnosis can lead to rejections and that insurers are generally less likely to cover preventive therapies than treatments for established conditions.
Lilly said that two of the three largest U.S. pharmacy benefit managers have begun covering Foundayo, and that the company is working to expand coverage further. Many doctors expressed hope that the U.S. government’s planned initial program to provide GLP-1 coverage for Medicare patients, scheduled to begin in July and run through 2027, will encourage broader commercial coverage for a larger population.
Switches from injectables and market expansion
While some patients who are already on injectable GLP-1 therapies have moved to the oral alternatives, most doctors said those switches are limited. "Right now only a small percentage are switching to the pill," said Dr. Christina Nguyen, an obesity specialist in Atlanta, adding that many patients on injectables are reluctant to change something that is already working.
Physicians nonetheless agreed with statements from company officials that the pills are helping to open the GLP-1 market to new patients. The lower-priced oral options, clinicians said, are drawing patients who previously declined treatment due to cost, suggesting that the overall pool of GLP-1 users is expanding even as questions about insurance coverage and long-term comparative outcomes remain.
Summary
Lower-cost oral GLP-1 drugs from Novo Nordisk and Eli Lilly have led some patients away from compounded preparations, aided by price parity with compounded options and the convenience of pills. Brand familiarity, clinical data, and insurance coverage continue to shape patient and prescriber choices. Doctors report modest switching from injectables to pills, and see the oral products as broadening the GLP-1 market despite continuing access hurdles.