The GLP-1 revolution is entering a new phase: cheaper pills, tougher insurance battles, and a growing understanding of who benefits most—and why.
New Drug Approvals and Product Developments
Oral Wegovy (Novo Nordisk)
The FDA approved an oral formulation of Wegovy (semaglutide) for chronic weight management, making it the first daily oral GLP-1 medication for obesity. The pill contains 25 milligrams of semaglutide and must be taken on an empty stomach, followed by a 30-minute wait before eating or drinking. Clinical trials reported an average weight loss of 13.6% to 16.6% over 64 weeks.
- Pricing: Starting dose at $149 per month for cash-paying patients; higher doses up to $299 per month.
- Also approved to reduce the risk of major adverse cardiovascular events.
Higher-Dose Injectable Wegovy
The FDA approved a 7.2-milligram dose of injectable Wegovy, up from the previous maximum of 2.4 milligrams. In a study, this dose resulted in an average weight loss of approximately 19% (nearly 47 pounds) over 17 months, compared to about 16% (39 pounds) with the lower dose. Side effects including nausea, vomiting, and constipation were reported in over 70% of users.
Foundayo (Eli Lilly)
The FDA approved Foundayo (orforglipron), a once-daily oral GLP-1 from Eli Lilly that is a non-peptide small molecule. Unlike the Wegovy pill, it can be taken at any time without food or water restrictions. Clinical trials showed an average weight loss of 12.4% (27.3 pounds) over 72 weeks.
- Pricing: Starting cash price of $149 per month, with higher doses up to $299 per month for renewing prescriptions.
- Fast-tracked: The FDA processed the approval in 50 days as part of a pilot program for drugs aligned with national health priorities.
- Also being investigated for type 2 diabetes, obstructive sleep apnea, and osteoarthritis knee pain.
Retatrutide (Eli Lilly)
Eli Lilly’s investigational "triple G" agonist—mimicking GLP-1, GIP, and glucagon—completed an initial late-stage trial in patients with Type 2 diabetes. The drug demonstrated an average reduction in hemoglobin A1c of 1.7% to 2% and average weight loss of up to 16.8% (36.6 pounds) at 40 weeks. Prior trials showed an average weight loss of up to 29% over 68 weeks. The drug has not yet been submitted for regulatory approval.
Cost, Pricing, and Insurance Landscape
Pricing Reductions and Direct-to-Consumer Options
Novo Nordisk announced plans to reduce the list prices of Wegovy, Ozempic, and Rybelsus to $675 per month by January 2027. Both Novo Nordisk and Eli Lilly have introduced cash-pay options for their oral medications, with starting doses available for $149 per month. Eli Lilly’s injectable Zepbound has a cash price of $299 per month. These lower prices are partly a result of agreements with the Trump administration.
Medicaid and Public Employee Coverage
Several U.S. states and cities have restricted or ended coverage for GLP-1 drugs for weight loss due to rising costs. National spending on GLP-1 drugs increased from $13.7 billion in 2018 to $71.7 billion in 2023.
- As of January 2026, California, New Hampshire, Pennsylvania, and South Carolina ended Medicaid coverage for weight loss.
- Michigan restricted coverage to individuals with a BMI above 40.
- New York City ended coverage for city employees in 2025, and Boston is considering similar limits.
- In Pennsylvania, Medicaid spending on GLP-1 drugs was $1.3 billion in 2025—double the previous year.
Medicare Coverage
A new Medicare pilot program, the Medicare GLP-1 Bridge, will offer coverage for certain weight loss drugs starting July 1, 2026 through December 31, 2027. Beneficiaries enrolled in Medicare Part D may pay a flat $50 copay per month for medications such as Wegovy, Zepbound, and Foundayo. A survey found that 82% of older Americans are unaware of the upcoming coverage.
Pharmacy Benefit Manager (PBM) Actions
CVS Caremark announced it will resume coverage of Eli Lilly's Zepbound starting October 1, 2025, and will add Foundayo to its formulary. Both Zepbound and Novo Nordisk's Wegovy will be co-preferred options on CVS Caremark's standard commercial formulary template, which covers 25 to 30 million Americans. Research by GoodRx indicates that 12 million people lost coverage for Zepbound and 12 million for Wegovy from 2025 to 2026.
Scientific Research and Developments
Genetic Factors Influencing Drug Response
A study published in Genome Medicine (March 29) found that approximately 10% of the population carries genetic variants in the PAM gene associated with reduced effectiveness of GLP-1 medications for blood sugar control. Individuals with these variants showed higher-than-normal GLP-1 levels but less biological activity—a condition termed GLP-1 resistance. In clinical trials, after six months, only 11.5% to 18.5% of carriers achieved recommended HbA1c targets, compared to 25% of non-carriers.
Separate research published in Nature, using data from nearly 28,000 23andMe users, identified a genetic variant linked to increased weight loss on GLP-1s and other variants associated with higher risk of side effects like nausea.
Benefits Beyond Weight Loss
A study led by Dr. Daniel Drucker at the University of Toronto identified a mechanism by which GLP-1 drugs improve liver health independently of weight loss. The research, conducted in mice, found that semaglutide reduced inflammation in the liver by stimulating a rare population of blood vessel cells. This finding provides a biological explanation for clinical evidence showing benefits for conditions like MASH and cardiovascular disease, even in patients who do not lose significant weight.
Sexual Health
A review published in Obesity Pillars (March 2026) proposed that GLP-1 medications may influence sexual desire by affecting brain chemistry. Dr. James Simon noted that the brain regions controlling appetite are also involved in other reward-seeking behaviors, potentially explaining anecdotal reports of decreased interest in sex among some users.
Potential for Cancer Risk Reduction
Multiple observational studies presented at the American Society of Clinical Oncology (ASCO) meeting in June 2025 reported associations between GLP-1 use and reduced cancer risk or improved outcomes. One study of over 110,000 women found a 30% lower risk of developing breast cancer. A Cleveland Clinic study of over 10,000 patients with early-stage cancer found GLP-1 use linked to lower risk of metastatic progression for six of seven cancer types. Researchers note these findings are observational and do not establish causation.
Potential Side Effects and Risks
A review of studies indicates GLP-1 drugs may be associated with side effects including hair loss, muscle loss, droopy skin, vision problems, dental concerns, and gallbladder disease. A study of over 200,000 patients found a 2- to 2.5-times higher risk of drug-induced pancreatitis. Two women reported that symptoms of colorectal cancer were initially attributed to GLP-1 medication side effects, delaying their diagnoses.
Market Competition and Industry Outlook
Market Dynamics
Novo Nordisk and Eli Lilly are competing in the oral GLP-1 market with their respective pills. Novo Nordisk’s Wegovy pill launched in January with over 50,000 weekly prescriptions by late January. Eli Lilly’s Foundayo entered the market in April. Analysts project the global weight loss drug market could reach approximately $100 billion by the 2030s.
Pricing Pressure
Novo Nordisk forecasted a 5% to 13% revenue decline for the current year, citing "unprecedented pricing pressure" from agreements with the Trump administration, patent expirations, and competition from cheaper compounded versions. Eli Lilly projected stronger sales growth, forecasting 2026 sales between $80 billion and $83 billion.
Personalized Medicine
Pharmaceutical executives and researchers anticipate a shift towards more personalized obesity treatments. Companies like Phenomix Sciences are developing genetic tests to categorize individuals into obesity phenotypes (e.g., "Hungry Gut," "Hungry Brain") to guide more targeted treatment selection. Early research suggests certain genetic markers may predict patient response to GLP-1 medications.