Lower-priced Wegovy and Foundayo pills pull some patients off compounded GLP-1s, doctors say

Cheaper branded weight-loss pills are pulling some patients away from compounded GLP-1 drugs, according to interviews with nine U.S. doctors. The doctors told Reuters that low cash prices for oral Wegovy (semaglutide) and Foundayo (orforglipron) are now close to what compounding pharmacies charge, five years after the compounded market grew ^[1].

The lowest doses of both pills cost about $149 a month, according to company and White House websites cited by Reuters. Injectable Wegovy pens start at $199 a month, and vials and pens of Zepbound (tirzepatide) can cost $299 or more for people paying cash ^[1]. Novo Nordisk began selling oral Wegovy in the U.S. in January, and Eli Lilly launched Foundayo in April; both companies have reported strong demand from new patients ^[1].

Doctors said most of the switchers are choosing the pills rather than injectables, because the pill prices line up more closely with compounded versions ^[1].

"I am seeing people are switching from compounds," said Dr. Michael Weintraub, assistant clinical professor of endocrinology at NYU Langone in New York. "I have patients increasingly coming to me saying, 'I hear it's not as expensive to get the pharmaceutical-grade branded version, can we switch over?'" ^[1]

Two pills, different profiles

Among the two pills, doctors said oral Wegovy has an early edge. It uses the same medicine and name as the injectable and has established heart-protective data, which some prescribers prefer for patients at risk of heart disease. Foundayo is a different type of medication and has no heart-benefit data yet ^[1].

"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. "It's a small sample, but they've opted for the Wegovy (pill)." ^[1]

Trial results differ. Oral Wegovy led to about a 14% reduction in body weight over 64 weeks, and Foundayo led to about an 11% reduction over 72 weeks. GLP-1 injections produced 15% to 20% weight loss in trials ^[1]. Foundayo does not need to be taken on an empty stomach, unlike oral Wegovy, and that convenience plus more time on the market is expected to help Lilly narrow the gap ^[1]. Citi analysts said prescribers surveyed projected an even split between the two pills, while doctors at academic medical centers expected Foundayo to eventually account for about 70% of prescriptions between the two ^[1].

Insurance remains the biggest hurdle. All nine doctors said coverage is a challenge ^[1].

"Every day, I get a message from a patient saying 'my insurance company didn't approve or denied it again,'" Moreno said ^[1].

Physicians often do not code the diagnosis properly for the appropriate prescription, leading to rejections, he said, and insurance companies do not cover preventive care as readily as existing conditions ^[1]. A Lilly spokesperson said two of the three largest U.S. pharmacy benefit managers have begun covering Foundayo, and the company is working to expand coverage ^[1].

Not everyone is switching. Some patients already doing well on injectables are staying with them, though not in large numbers, according to most doctors interviewed ^[1].

"Right now only a small percentage are switching to the pill," said Dr. Christina Nguyen, an obesity specialist in Atlanta. "The injectables are working well and people don't want to mess anything up." ^[1]

Doctors also said the pills are bringing in patients who had never tried a GLP-1. "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." ^[1]

The FDA allows compounding in personalized formulations and doses but has sought to tighten limits since shortages of the branded drugs ended ^[1]. Novo said it has expanded access to its GLP-1 drugs through its NovoCare Pharmacy and retail partnerships, aimed at steering patients toward FDA-approved treatments ^[1]. 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" ^[1].

Why it matters for patients

Compounded GLP-1 drugs are not FDA-approved, while the branded pills are subject to greater oversight ^[1]. For people who were paying cash for compounded versions, the lowest-dose branded pills are now priced at par with what compounding pharmacies charge, and below the cost of the injected brand-name medicines ^[1].

The choice between the two pills involves trade-offs rather than a clear winner. Oral Wegovy must be taken on an empty stomach; Foundayo does not have that requirement ^[1]. Wegovy's pill has heart-protective data behind it, while Foundayo does not yet ^[1]. The two produced different average weight-loss results in separate studies ^[1].

Price is not the only barrier. All nine doctors said insurance coverage remains a problem, and denials were described as a daily occurrence ^[1]. Doctors said they hope broader coverage will follow the government's Medicare program ^[1].

What happens next

The U.S. government's initial program providing GLP-1 coverage to Medicare patients is set to begin in July and last through 2027 ^[1]. Doctors said they hope it will spur commercial coverage for a larger population ^[1]. Lilly is working to expand coverage beyond the two pharmacy benefit managers that now cover Foundayo ^[1], and Novo is promoting its NovoCare Pharmacy and retail partnerships ^[1]. Whether the shift away from compounded drugs continues at the same pace has not been reported.