Pharmaceutical giants Novo Nordisk and Eli Lilly are projecting that pill versions of their coveted weight loss medications could come to market as soon as next year, increasing treatment options for obesity.
Novo's semaglutide and Lilly's orforglipron pills are both in stage three of clinical trials and have shown promising results. Both pills function similarly to the injection-based products Ozempic, Wegovy, Mounjaro, and Zepbound, mimicking the GLP-1 hormone that makes people feel full.
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Often these pills, medically known as small molecules, are more cost-effective to produce and can be made in larger quantities due to their less-complicated chemical structure compared to large molecule injectables. Injectable products, such as obesity medications or insulin, also must be refrigerated to preserve their temperature and prevent chemical deterioration.
Obesity Medicine Association Angela Fitch told the Washington Examiner that small molecule versions of the drugs will be a significant advancement in the accessibility of treatment for areas that either do not have refrigeration or where refrigeration in transport can be difficult.
Different costs in production, however, have not translated into the list price of Novo's product Rybelsus, a pill version of semaglutide, which is the active ingredient in Ozempic. Rybelsus and Ozempic cost $936 without insurance for a monthly dose.
A high-dose Rybelsus specifically for weight loss is under review in Europe, with late-stage trials showing that a once-daily dose contributed to a 15% loss of body weight in less than 16 months.
Although the obesity-managment Rybelsus trials indicated that there were more gastrointestinal side effects with the oral medication than in the injectable Wegovy, Fitch said the difference could be attributable to the drug's method of action.
Rybelsus must be taken on an empty stomach in order to be absorbed. Fitch said stomach pains and discomfort could be a side effect of any medication taken without food.
Because of the success of Novo and Lilly and with the market projected to reach $100 billion within seven years, competitors Pfizer and AstraZeneca are also seeking to enter the weight loss drug market.
Fitch said the variety of treatment options for obesity is an exciting prospect.
"The exciting piece will be that there are going to be more opportunities, more achievement for different people," Fitch said. "The world thinks of obesity as a problem of 'I just eat too much and don't move enough,' and that makes it very homogenous when it is actually very heterogeneous."
Although there have been several studies finding that Novo's semaglutide has been proven to reduce the risk of cardiovascular death, the majority of health insurance plans do not cover weight loss drugs such as Wegovy and Zepbound. Fitch said this is because they are mischaracterized as "vanity weight loss drugs."
"This is about health gains, not weight loss," Fitch said. "Stop talking about weight loss drugs and start talking about obesity drugs."
Bipartisan legislation was introduced in both houses of Congress in July to expand access to weight management drugs by incorporating coverage under Medicare.
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Three physicians, Sen. Bill Cassidy (R-LA), Rep. Brad Wenstrup (R-OH), and Rep. Raul Ruiz (D-CA), supported the legislation, noting that the direct and indirect costs of obesity to the Medicare program were $428 billion in 2014 alone.
Two in 5 Americans can be diagnosed with obesity, and another roughly 1 in 3 fits the medical definition of overweight, according to the National Institutes of Health.