What employers need to know about the new oral GLP-1 Wegovy 

The treatment of obesity and cardiometabolic-related conditions has been transformed by GLP-1 medications, and new developments in this rapidly evolving market tend to make headlines. That was the case this December, when the FDA approved an oral version of Wegovy, the first-ever oral GLP-1 medication specifically indicated for weight loss. These pills are now available on pharmacy shelves. How significant is this milestone for patients and employers? In the post, we’ll consider the impact of the new medication in terms of clinical performance and patient experience, cost and utilization.  

Oral vs injectable Wegovy: Clinical effectiveness and patient experience

Clinical data show that oral Wegovy delivers meaningful weight loss, although slightly less than the injectable form. There have been no head-to-head studies comparing the weight loss results of the weekly injection to the daily tablet formulation. However, the Institute for Clinical and Economic Review has reviewed the available data and concluded that oral Wegovy achieves an average weight loss difference of 11.4% compared to placebo, while the injectable version offers a 13.1% difference. This difference may influence patient and prescriber preferences depending on individual goals and tolerability. While some patients and providers may be interested in trying microdosing, there’s not currently sufficient data to support that type of regimen. 

Oral Wegovy comes in multiple strengths, and like its injectable counterpart, patients should start on lower doses and gradually titrate up to minimize side effects. Unlike the once-weekly injectable Wegovy, the oral form requires daily dosing on an empty stomach with only water, and patients must wait at least 30 minutes before eating or drinking anything else. This regimen may pose adherence challenges for some, while others may appreciate the convenience of avoiding injections altogether. Unlike the injectable, the oral tablets do not require refrigeration and do not require access to a sharps container for disposal, which may allow for more storage and travel convenience. For patients who find injections difficult or undesirable, oral Wegovy offers a valuable alternative.  

Pricing remains in flux

The list price for oral Wegovy mirrors that of the injectable, at approximately $1,350 per month. Although it was hoped that, given lower manufacturing costs, the oral version would be priced lower than the injectable, currently that is not the case. Pharmacy Benefit Managers are expected to negotiate rebates for employer purchasers, but the exact net pricing remains to be seen.  

Oral Wegovy will also be available through Direct-to-Consumer channels such as Novocare, GoodRx, coupon programs, and TrumpRx, which directs patients to Novocare. 

For the DTC option, Wegovy is currently offering an introductory price of $149 per month for the two lowest doses of the oral tablet, with higher doses — typically needed for significant weight loss — priced at $299 per month. By comparison, the injectable Wegovy is priced at $199 for the two lowest doses and $349 for higher doses.  

The pricing available to employer plans is typically based on the list price less a rebate, and the net of rebate price is expected to be similar to the net of rebate price for the injectable version of Wegovy. That said, the pricing dynamics in the DTC channel may influence prices available to group health plans — and may also create new opportunities for employers to assist members in achieving their weight loss goals without making coverage available through a medical or pharmacy plan. Some employers are exploring options such as HRA accounts to subsidize the cost of the medication while limiting their financial exposure. Others are exploring emerging Direct-to-Employer options that aim to allow employers a way to access lower prices without the limitations presented by rebates. In both cases, there are important compliance and PBM contractual considerations that need to be explored and fully vetted as part of decision making. 

What this new option may mean for GLP-1 utilization 

While the new oral version of Wegovy is generating buzz in the marketplace, it is not expected to have a major impact on either cost or utilization in the weight loss medication category. GLP-1 utilization and spending are expected to continue growing as more prescribers and patients embrace the popular injectable formulations of these treatments, and, while the oral option may attract patients previously hesitant to try GLP-1 therapies due to injection concerns, it is unlikely to surpass injectables in market share. For evidence, consider Rybelsus, the oral form of Ozempic for diabetes, which holds minimal share compared to injectable Ozempic. Wall Street Analysts Goldman Sachs predicts that the oral GLP-1s (including oral Wegovy, Lilly’s orforglipron, and other pipeline products) will capture only a combined 24% of the GLP-1 market by 2030.   

An important consideration with an oral product is the higher risk that members may share medication with friends or family members, which could lead to inappropriate use or safety concerns. Employers should be aware of this potential risk when designing coverage and utilization management policies.  

Implications for employers

Employers should anticipate continued utilization growth and ongoing shifts in the weight loss market and prepare to reassess their strategies regularly. To navigate this evolving landscape, employers should consider these actions: 

• Engage with PBMs to clarify the formulary placement of oral Wegovy and understand how net pricing compares to the injectable version. 
• Investigate how oral Wegovy’s pricing compares to DTC options and whether any programs allow members to access DTC pricing through their benefits. 
• Assess how existing lifestyle management or point solutions will integrate with the availability of oral Wegovy. 
• Monitor new approvals, such as another oral GLP-1 expected by the end of Q1 2026, and adjust benefit strategies accordingly. 
• As with any new medication, ensure that coverage policies and utilization management approaches support appropriate use of these medications while limiting potential for waste and misuse.  

The approval and launch of oral Wegovy represent an important development in weight loss treatment, offering patients and employers a new tool in the fight against obesity. While the pill is not expected to replace injectable GLP-1s, it broadens options and may reduce barriers to adherence for some patients. Employers who proactively engage with their PBMs and stay informed about market changes will be best positioned to optimize health outcomes and manage costs in this dynamic space.