The FDA approved oral Wegovy (semaglutide) on December 22, 2025. Eli Lilly received approval for its pill, Foundayo (orforglipron), on April 1, 2026. It will be a fight for America\u2019s fat. Instead of an injection, people who want to shed pounds with a GLP-1 medication can choose between oral medications. That may seem like a huge win for people who hate needles. But the reality may be a bit more complicated.<\/p>\n
Many people may assume that pills are way easier than shots. But as you will see shortly, the instructions that come with oral Wegovy could be a bit challenging for some people. And a once-weekly shot may be easier to remember and implement than a daily pill.<\/p>\n
A diabetes expert we interviewed on our People\u2019s Pharmacy radio show\/podcast suggested that weekly injections might actually be easier for some people than a daily pill that has fairly strict timing rules, especially with regard to food and other medications.<\/p>\n
Pills or Shots? A Reader Votes for Shots!<\/p>\n
Q. When it comes to weight loss drugs, I would prefer to use an injection. It\u2019s much more convenient than waking up early to take the pill long before breakfast. The pill didn\u2019t work as well for me to suppress my appetite, but it also didn\u2019t cause nausea.<\/p>\n
I\u2019m fortunate to be able to purchase these without a prescription in the country where I live. It\u2019s more affordable that way.<\/p>\n
Other people may need additional options for weight loss. Not everyone gets the same results with GLP-1 drugs or tirzepatide.<\/p>\n
A. You are correct that people have different responses to medicines acting on the GLP-1 pathway. Certain genetic variants make the drugs less effective for 10 percent of the population (Genome Medicine, March 29, 2026<\/a>). On the other hand, certain gene variants make people respond more intensely to these medicines. For them, side effects and weight loss are both more likely (Nature, April 8, 2026<\/a>).<\/p>\n Wegovy tablets need to be taken with four ounces of water at least 30 minutes before eating or drinking anything else. For some people, that is inconvenient. The newest GLP-1 weight loss pill is orforglipron (Foundayo). It was approved by the FDA on April 1, 2026. People taking this pill do not need to wait before eating.<\/p>\n A BIG OOOPS! Correction Below!<\/p>\n Q. In your newspaper column a few weeks ago you stated in reply to a question about oral Wegovy that the tablets \u201cneed to be taken with a big glass of water.\u201d That is not what my Wegovy pill bottle instructions say. In fact, it says to take \u201cwith no more than 4 ounces of water.\u201d<\/p>\n The advice you gave, if incorrect, might lead users to use it ineffectively. Please print a correction.<\/p>\n A. You are absolutely correct. The instructions from the maker of the Wegovy (semaglutide) pill state:<\/p>\n \u201cWake up and take 1 Wegovy pill on an empty stomach with a sip of water (up to 4 ounces).\u201d <\/p>\n Thank you for catching our error.<\/p>\n Which Pill Is Easier? Wegovy or Foundayo? \u201cTake one WEGOVY tablet orally once daily on an empty stomach in the morning with water (up to 4 ounces). Do not take WEGOVY tablets with other liquids besides water. A lot of people don\u2019t have half an hour in the morning to wait around before eating breakfast.<\/p>\n The instructions for Foundayo are a bit easier:<\/p>\n \u201cTake FOUNDAYO orally once daily, with or without food. Which Pill Works Better? Wegovy or Foundayo?<\/p>\n There is no good answer to that question. That\u2019s because there have been\u00a0 no head-to-head clinical trials that maintain identical protocols in a \u201cblinded\u201d setting. By blinded I mean that neither the volunteers nor the clinicians know who is getting the real pills and who is getting placebos.<\/p>\n We will have to wait some time to get that kind of data. Drug companies rarely fund this kind of head-to-head comparison. Their goal is to get FDA approval and hope that their marketing teams can convince doctors and patients that they have a better product.<\/p>\n What we have for now are what I would characterize as preliminary data. One of our favorite insider publications that covers the pharmaceutical industry is FIERCE Pharma.<\/p>\n On April 1, 2026 Fraiser Kansteiner shared these data on weight loss in FIERCE Pharma<\/a>:<\/p>\n \u201cThe FDA based its approval on data from Lilly\u2019s ATTAIN clinical program. In the ATTAIN-1 study, patients on the highest dose of Foundayo and who took the treatment as intended lost an average of 27.3 pounds, or 12.4% of their average body weight, versus 2.2 pounds (0.9%) for those who received placebo, Lilly noted in its approval announcement.<\/p>\n \u201cThough comparisons across trials carry inherent flaws, Novo\u2019s Wegovy pill won a U.S. green light based on data showing an average 16.6% weight loss among patients who adhered to treatment.<\/p>\n \u201cIn Lilly\u2019s program, patients taking Foundayo regardless of trial completion lost an average of 25 pounds or 11.1% of their average body weight versus 5.3 pounds (2.1%) among their counterparts in the control arm.\u201d<\/p>\n Until there is a head-to-head trial, though, I would hesitate to draw any conclusions about effectiveness.<\/p>\n What About the Cost of Wegovy vs. Foundayo? Price is always a hot button issue when it comes to pharmaceuticals. Will insurance pay for the oral medications? That depends upon the insurance company. I can make no predictions.<\/p>\n What I can tell you is that Eli Lilly has implemented something called LillyDirect. It provides online access to pharmacy services. There are \u201ctelehealth\u201d providers, which I interpret as clinicians who may be able to prescribe. I won\u2019t weigh in on the pros or cons of such a service at this time. The word on the street is that people who utilize this online approach (without insurance) will be paying around $149\u00a0a month for the lowest dose of Foundayo.<\/p>\n Keep in mind that the dose of GLP-1 drugs is often started low and gradually increased over the next several months. The Lilly price may increase as the dose is raised. I have seen estimates of around $299 a month if patients continue to take Foundayo at higher doses.<\/p>\n Wegovy:<\/p>\n The cash price for a starting dose of Wegovy has been reported at around $149 a month. I would not be surprised that as the dose is raised, the cost will climb to about\u00a0$299 a month. I suspect that this will be a head-to-head battle of two enormous pharmaceutical companies. They will probably not compete on price but rather through advertising on television and other media. Be prepared for the fight for fat in coming months.<\/p>\n What About Side Effects for Foundayo and Wegovy?<\/p>\n Remember, both these drugs are are GLP-1 receptor agonists. That means they work by mimicking a natural hormone called glucagon-like peptide-1 (GLP-1). You can learn more about how such drugs work at this link<\/a>.<\/p>\n Since both drugs are GLP-1 receptor agonists you might expect the side effects to be somewhat similar. At the highest dose, Foundayo caused the following adverse reactions:<\/p>\n Nausea\u2026\u2026\u2026\u2026\u202635%
\nThe instructions for Wegovy tablets are a bit challenging:<\/p>\n
\n\u201cSwallow tablets whole. Do not split, crush, chew or dissolve in any solution.
\n\u201cAfter taking a WEGOVY tablet, wait at least 30 minutes before eating food, drinking beverages or taking other oral medications.\u201d<\/p>\n
\n\u201cSwallow tablets whole. Do not break, crush, or chew.\u201d<\/p>\n
\nFoundayo:<\/p>\n
\nConstipation\u2026\u202624%
\nDiarrhea\u2026\u2026\u2026\u202625%
\nVomiting\u2026\u2026\u2026\u202624%
\nIndigestion\u2026\u2026\u202613%
\nAbdominal pain..14%<\/p>\n