We strongly suspect that advanced oral obesity medicines may be a defining milestone for 2026. This is because they have the potential to fill an important gap in obesity therapy – the unmet need for therapies that people can persistently take to maintain control of this chronic disease. Late yesterday, FDA granted approval for the first contender to meet this need in obesity – a Wegovy tablet.

It will come in strengths that range from 1.5 mg up to 25 mg. Novo Nordisk will be marketing it under the Wegovy brand and will sell the starting dose for as little as $149 per month. The price for the full dose of 25 mg has not been announced. But news reports lead us to suspect the cost of the full dose could be more like $400 per month. Price and insurance coverage for GLP-1s are sore points. So both of those factors are subject to sudden changes.

A Headstart on Orforglipron

This approval gives Novo a headstart on Lilly and its orforglipron tablets – which were just submitted to FDA for an expedited approval that could come early next year.

Oral semaglutide has been out in strengths of 3, 7, and 14 mg since Rybelsus was approved in 2019. But it has never sold as briskly as the injectable form, Ozempic. In fact, Ozempic sales were almost three times higher than Rybelsus in 2024.

Hype and Reality

Of course the 2024 Rybelsus sales of $3.4 billion are not nothing. And perhaps all the hype around “the first and only oral GLP-1” for obesity will pave the way to a different story for Wegovy tablets. It is probably smart to bring it into the market under the Wegovy brand. That may help.

But then there is reason for a little doubt. These tablets have to be taken first thing in the morning, at least 30 minutes before eating or drinking anything but water. That does not help with getting people to stick with this medicine over the long term. Speaking with the New York Times, medical professor Scott Hagen was blunt:

“For me, there’s no way I’m going to take a pill and then not drink coffee for 30 minutes.”

In fact, a 2024 observational study of real world data showed significantly lower persistence with Rybelsus compared to Ozempic. After 18 months, it was 46% with oral semaglutide and 84% with the injectable.  Similarly, research published in JMPC found that oral semaglutide had the lowest adherence of all the GLP-1 medicines studied in that research. Bummer.

Will the excitement about an oral GLP-1 tablet for obesity overcome issues with dosing that have held this formulation back before? We shall see.

Click here, here, and here for more on this new approval. For the updated Wegovy prescribing information, which now includes Wegovy tablets, click here.

The Mouth of Mona Lisa, detail from the painting by Leonardo da Vinci / Wikimedia Commons