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Americans newly turning to weight-loss medications are prioritizing affordability and convenience, with many showing interest in pill-based options from Novo Nordisk and Eli Lilly, according to seven physicians specializing in obesity care.

Interviews with those doctors suggest growing optimism around oral treatments as the two pharmaceutical companies vie for position in a rapidly evolving obesity drug market projected to exceed $100 billion annually within the next decade.

Novo Nordisk introduced its injectable drug Wegovy in 2021. Its pill version, like Wegovy and the diabetes medication Ozempic, contains the active ingredient semaglutide.

Since receiving approval three months ago, the oral formulation has drawn patients due to its lower price and simpler use, physicians said.

Unlike injections, the pills do not require refrigeration, can be taken discreetly and eliminate the need for needles, said Dr. Christina Nguyen, an obesity and family medicine specialist based in Atlanta.

"One person said I'd rather stay fat than ever use a needle. That's a true fear," she said.

Eli Lilly’s pill, Foundayo, which contains orforglipron, is scheduled to begin shipping on Monday.

Pills Gain Ground Against Injections

All seven physicians reported prescribing oral Wegovy, with three estimating that roughly 10% of their patients are using the pill form.

Most of those patients are new to GLP-1 therapies rather than switching from injectable drugs and have yet to reach the highest dosage levels, the doctors said.

"It is expanding access to people who are not sure that an injectable is something they would feel comfortable doing on themselves, might be leery of needles, and they're excited to have an option that is easier and more familiar to take," said Dr. Stefie Deeds, an internal and obesity medicine specialist in Seattle.

Doctors noted they generally avoid transitioning patients who are responding well to injectable GLP-1 treatments unless patients specifically request a change.

"The patients we see who are taking medicines, whether it's Wegovy or (Lilly's) Zepbound, we're not telling them to switch to oral Wegovy if they're doing well," said Dr. Louis Aronne, director of the Comprehensive Weight Control Center at Weill Cornell Medical College. Aronne has consulted for Lilly, participated as an investigator in the orforglipron clinical trial, and serves on advisory boards for both companies.

Zepbound, which uses tirzepatide, has demonstrated weight reductions of around 20% or more in clinical trials, making it a leading choice for patients with severe obesity or more complex conditions, physicians said.

"For somebody who is in the lower end of the weight spectrum, people who are more likely to be seen by primary care physicians, they would be more likely to use the orals," Aronne said.

Clinical data show Foundayo resulted in about an 11% reduction in body weight over 72 weeks, while oral Wegovy achieved roughly a 14% decrease over 64 weeks.

New Pill Adds Flexibility for Patients

Several physicians said they are anticipating the broader rollout of Lilly’s orforglipron pill, which they believe will offer more flexibility when discussing treatment options with patients.

Oral Wegovy must be taken on an empty stomach with a small amount of water at least 30 minutes before consuming food, beverages or other medications. Foundayo, by contrast, can be taken at any time without such restrictions.

Nguyen said that if the Lilly pill is priced competitively with oral Wegovy, "most likely everyone will go with the orforglipron."

Novo Nordisk spokesperson Liz Skrbova said company survey data indicate most patients do not consider the timing requirements burdensome.

Semaglutide has also shown additional health benefits in studies, including reducing cardiovascular risks.

"I can’t guarantee that this totally different type of molecule is going to carry the same benefits," said Dr. Michael Weintraub, an endocrinologist at NYU Langone Health, referring to the Lilly medication.

A spokesperson for Lilly said research on Foundayo is ongoing and that many clinical trial participants experienced improvements in cardiovascular risk markers.

Cost Remains a Major Barrier

While patients weigh multiple considerations when selecting a GLP-1 treatment, physicians said cost remains the most decisive factor.

In that regard, oral medications offer a pricing advantage. Monthly self-pay costs for both oral Wegovy and Foundayo begin at $149 for the lowest dose, compared with $299 for Zepbound and $349 for Ozempic and injectable Wegovy.

Insurance coverage limitations for GLP-1 drugs have forced doctors to spend significant time helping patients navigate affordability. When coverage is available, out-of-pocket expenses can drop to between $25 and $50 per month.

"I feel more like a financial planner these days than a physician," said Dr. Catherine Varney, an obesity medicine specialist and associate professor at the University of Virginia School of Medicine who also serves on Lilly’s speakers bureau and advisory board.

Varney and other physicians expressed concern that, despite the relatively lower prices of pills, these treatments remain out of reach for many patients.

"This still is a market for upper-middle-class and above," Varney said.