Millions of people use injectable drugs like Wegovy to reach a healthier weight. But the weekly injections aren't for everybody — or every wallet.
That's why experimental pills that could achieve similar results are drawing so much attention.
The medicines haven't yet won approval from the Food and Drug Administration, but the first one could get the green light by the end of the year.
"The patient community in the obesity space has … gone without treatment for so long," says Tracy Zvenyach, director of policy strategy and alliances at the nonprofit Obesity Action Coalition. "So new innovations, new treatments to treat this chronic disease — all are welcome. All are exciting." The coalition receives financial support from multiple drugmakers, including Novo Nordisk, Eli Lilly and Pfizer.
Here's what you need to know — from how much the pills might cost to how they work.
1. Two new pills are (probably) coming
Novo Nordisk's obesity pill is expected to be approved first. It has the same ingredient — semaglutide — that's in Wegovy, Ozempic and also in Rybelsus, the company's Type 2 diabetes pill that was approved in 2019.
The difference between this new pill and Rybelsus is the dose. There's more semaglutide in the new pill.
Novo Nordisk's main competitor is Eli Lilly, which makes Zepbound and Mounjaro. And it's working on an obesity pill, too. But instead of using the same ingredient that is in its blockbuster injectables, tirzepatide, the company is working on a new one for its obesity pill that is called orforglipron.
2. Patients will take the pills daily, not weekly
The pills need to be taken every day, but the injectables are once a week.
For Novo Nordisk, it was a challenge making a semaglutide pill that wasn't immediately broken down in the stomach before the medicine could be absorbed. So the scientists there added an ingredient that would protect the pill for 30 minutes while it is being absorbed. It's a mouthful: sodium N-(8-[2-hydroxybenzoyl]amino)caprylate, or SNAC for short.
"If you think about dropping an Alka-Seltzer tablet in a glass of water, that immediate fizzy reaction that occurs, that is what happens in your stomach," says Andrea Traina, one of Novo Nordisk's obesity directors. "It creates this little foamy environment directly around the tablet."
That foam prevents a stomach enzyme from breaking the tablet down, lowers the stomach's acidity ever so slightly, and makes the cells under the pill a little bit more permeable so the semaglutide can get absorbed into the bloodstream more easily. The process takes about 30 minutes. It has to be taken on an empty stomach.
Eli Lilly's orforglipron is a little different. It's not as vulnerable to being broken down in the stomach.
"It has no food or water restrictions," says Dr. Max Denning, one of Eli Lilly's senior medical directors. "You can take it orally, and it's very effectively absorbed without any additional absorption enhancers or administration restrictions."
3. They both work, but one appears to have an edge
In a study published in September in the New England Journal of Medicine, a 25 mg semaglutide pill led to a 16.6% reduction in weight on average over 64 weeks. That's about the same as Wegovy.
Eli Lilly's obesity pill, orforglipron, had a 12.4% average weight loss at its highest dose over 72 weeks, which means it's less effective than injections on the market.
The drugs have similar side effects to the injectables, including nausea and diarrhea.
4. These pills should cost less than the injectables
Pills tend to be cheaper than injectables, so patients are hoping they'll be more affordable than the brand-name injected medicines with list prices of over $1,000 a month — and that insurance companies will be more likely to cover them.
"It's easier to manufacture and the cost ultimately should 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 of the medicines in this arena has been the cost. And can we equitably get these medicines to the millions, really, of people who might benefit from them?"
According to a recent poll by KFF, a nonprofit health policy research organization, 1 in 8 people is currently taking an injectable drug in this class. While most of them have at least some insurance coverage, more than half said they had difficulty affording the drugs.
Since early 2025, the drugmakers have made these medicines available at a discount to patients not using their health insurance, and the prices have come down a bit over time. As of early November, when Novo Nordisk and Eli Lilly announced deals with the Trump administration, the starting dose of Zepbound will be available for $299 a month for people buying without using insurance. And Wegovy will now be available for $349 a month.
While neither company has announced an official list price for the experimental pills, their Trump administration deals say that if their oral obesity medicines are approved, they'll sell them directly to consumers for $149 a month. That means patients can get this price if they don't use their health insurance.
Still, if the pills get better insurance coverage, copays could be significantly lower than that.
5. The FDA could act soon on the first two, and more new drugs are in the works
Novo Nordisk's obesity pill is expected to win approval before the end of the year.
Eli Lilly, on the other hand, has said it will submit orforglipron for FDA approval this year. The drug won a priority review voucher from the agency, which could mean the agency will make a decision "within months."
Novo Nordisk and Eli Lilly are also working on the next generation of these drugs, which could prove to be even more effective than the ones 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 its pipeline, though none is in late-stage clinical trials yet. Novo Nordisk tried to acquire the company, but it ultimately lost out to Pfizer, which completed the acquisition that could ultimately be worth more than $10 billion.
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