Episode #158: Let's Talk About The Wegovy Pill

In this episode of the Conquer Your Weight podcast, you’re going to learn everything you need to know about the new Wegovy pill. 

We’ll talk about:

• What is the Wegovy pill and how does it compare to the injection
• What are the expected benefits and side effects of the Wegovy pill
• Who is a good fit for this medication
• What can you expect in terms of cost and coverage

Ready to get started on your weight loss journey? We’re now enrolling patients for in-person visits in Charlottesville, Virginia and for telemedicine throughout the states of Illinois, Tennessee, and Virginia. Learn more and get started today at https://www.sarahstombaughmd.com

Are you taking a GLP medication? We are thrilled to share we are offering an online course, The GLP Guide, to answer the most common questions people have while taking GLP medications.

To sign up, please visit: www.sarahstombaughmd.com/glp

Transcript

Dr. Sarah Stombaugh:

This is Dr. Sarah Stombaugh, and you are listening to the Conquer Your Weight Podcast.

Announcer:

Welcome to the Conquer Your Weight Podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh.

Dr. Sarah Stombaugh:

Everybody has been talking about the brand new Wegovy pill that just came available in the market over the last week. It is January 2026, and everybody is excited for the new oral GLP option that is available. Let's talk about what is the Wegovy pill, who is a good fit for it, is it actually effective? What are the side effects? What are the costs? Because there are a lot of people who are getting started or thinking about getting started on this medication. And I want you to know if you are going to be a good fit for this medication. So the oral Wegovy pill, this is an oral semaglutide product. And what's exciting is we now have it available for the weight indication in a pill form. So I think this will be really exciting for people who have not been interested in taking an injection. These medications, it's a little bit more cost effective to take it in a pill form. So really exciting to have this available. Now the semaglutide medications, we can now almost think about this as a class of medications. It is one of the GLP medications. The semaglutide medication, which is just really a single medication, has been available now for a while. It was first FDA approved in the end of 2017 for the treatment of type 2 diabetes as Ozempic, the big Ozempic that we all know and love. It actually a couple of years later became FDA approved as Rybelsus as oral semaglutide for the treatment of type 2 diabetes. We then saw it a couple of years later for Wegovy, and that was the traditional once-a-week injection, and now most recently as the Wegovy pill. 

It's interesting, we never saw the popularity of Rybelsus. So really the exact same medication as the Wegovy pill that we're seeing now. We never saw the popularity of that medication take off. And that's really for a couple of different reasons. So when we look at the Rybelsus formulation, what's interesting is that there's actually the old formulation of Rybelsus. It's actually the one that's still available on the market, but the R1 formulation, there's been a newer formulation that we anticipate to be available over the course of the next year or so. And the Wegovy pill is more similar to that newer formulation of Rybelsus. The Rybelsus for the treatment of type 2 diabetes was studied at lower doses of medication. The absorption of it was pretty low. And so, from a weight perspective, we didn't see as significant of weight loss. It was also only studied in patients with type 2 diabetes. And we know there are some differences when we look at patients who do versus do not have diabetes when we look at the effectiveness of medication from a weight standpoint. We're not going to get too much into that as part of today's conversation, but simply put, people who have more significant metabolic disease, people who have diabetes, on average, lose less weight compared to people who do not have type 2 diabetes. So when we looked at the studies for Rybelsus, the weight data was pretty minimal. We also know with the older formulation, which is the one that's currently being used for Rybelsus in the states, that it wasn't as well absorbed compared to the newer formulations of medication. And it was available at lower doses. But as you can imagine, the semaglutide medication, whether we're talking about Ozempic, whether we're talking about Wegovy, it's been wildly popular for the treatment of weight. And so studying it in this oral form has been going on now for a while, and it's really exciting to see it now available. When we look at the doses of this medication that are available, it comes in four doses. The starting dose is a 1.5 milligram dose. There's then a 4 milligram dose, a 9 milligram dose, and a 25 milligram dose. 

I think what's really interesting is when they very first started studying this medication, they actually studied up to the 50 milligram dose of medication. And I think a lot of us anticipated that it would require that higher dosing in order for the medication to be effective. But what we found, or what the clinical researchers found in those trials, was that there were quite a bit more side effects at the higher dose without much more significant weight loss. And so we've seen it just available to that 25 milligram dose. When we look at this newest approval, it's the 1.5 milligram, the 4 milligram, the 9 milligram, and the 25 milligram pill. And these are designed as once daily pills. So there's a lot of, you know, asterisk, make sure you're really paying attention here. If you're taking the medication, there are some stipulations that you want to make sure to follow in order to improve the absorption of this medication. So we know that these medications, the GLPs in general, are medications that are not very well absorbed when taken orally. They're rapidly broken down in the stomach. And so the absorption can be quite variable. When they're taken as an injection, however, we're able to absorb them incredibly well. And so you'll notice if you're familiar with the doses of the injections, those are orders of magnitude lower for injections compared to what we're talking about for the oral version of medication. So these medications are designed to be taken first thing in the morning. They're designed to be taken on an empty stomach. So no food, no other medications, no beverages except for water. You can take it with water, but even the water, you want to make sure to take not a huge amount, so less than four ounces of water, in order to create an environment where nothing else is going to interfere with the absorption. Now, the medication is paired with something called the SNAC, SNAC, SNAC, I keep wanting to like add the K in there, but SNAC technology. And the snack technology that is paired with the semaglutide medication is going to create a neutralizing environment in the stomach to improve the absorption of this medication. 

Because of that SNAC technology, this cannot be, the medication cannot be split in half. So splitting the medication in half will impair the absorption. It's even recommended not to take two Wegovy pills together. It's not that that can also impair the absorption. So you think these morning requirements and no other food, no other beverages, just some sips of water are going to be the part of this medication that is the most challenging, but I think really pretty doable for most people. After 30 minutes after taking it, you can have other food, you can have other beverages, you can have other medications. Now, certainly there are people who take other medications that are recommended to be taken first thing on an empty stomach in the morning. And even those you cannot take at the same time. So maybe thyroid medications, there are certain PPIs like omeprazole, for example, medications for the treatment of acid reflux. These medications are also typically recommended to be taken first thing in the morning. And what I would recommend for anyone who's taking other medications, just make sure you have a plan with your physician about what that looks like. Typically, we're thinking about the Wegovy as the very first thing to enter the stomach, then wait 30 minutes, then you would take, let's say, if you had a thyroid medication, then you would take that, and then waiting the 30 or 60 minutes as you've been advised by your physician. If you also had another medication, it could become a pretty complicated morning routine, in which case you may be more interested in the injection options. 

But certainly it's possible to work around that if you want to. There are some people who actually take their thyroid medication at nighttime. And so you do want to have a period of time where the thyroid's taken on an empty stomach, typically about at least three hours after eating. So if you're in that position, you might decide to make adjustments there with a Synthroid or levothyroxine dosing. However, you will have a conversation with your one-on-one physician with what that looks like. Now, when we look at the clinical trials and we look at the effectiveness of the medication, one of the pieces that I want to point out is the effectiveness is going to be most significant for people who take the medication consistently. And I know that sounds like maybe the most obvious thing in the entire world, but the reality is we want to make sure that we're consistently taking these medications so that they're effectively absorbed into our body. If we miss a dose, they actually recommend just skipping that dose and waiting till the following day because later taking it later in the day, especially if you've had anything to eat, anything to drink, is really going to impair absorption. And so it's kind of silly to take a medication if it's not going to be properly absorbed into your body. But the people who did take it consistently every morning had better effectiveness compared to those who did not. Additionally, the bioavailability and absorption of this medication is pretty variable. This is true even for the injection medications. That's a much more narrow window where we see some people are what we would call super responders or hyper-responders on the medication, even at very low doses. And this is true regardless of whether we're talking about Wegovy, whether we're talking about Zepbound, whatever, that there are people for whom, even at very low doses of medication, they feel it very potently in their body. That can be a good thing in terms of effectiveness. It can also mean sometimes that they experience more side effects. And that can come up with the injection. It comes up a little bit more significantly with the oral version, that there are some people who feel the effect more potently and some people who may be less well absorbing the medication. So there will be some time in starting the medication, feeling how it feels in your body from an effectiveness, from a side effect standpoint, to see what this looks like in terms of are you feeling it really significantly versus are you someone who more quickly may need to go to the next dose of medication? 

Now, the way that this was studied in terms of titrating was that everybody started on the 1.5 milligram dose of medication, they were on that for 30 days, then they moved to the 4 milligram dose of medication, they were on that for 30 days, then they moved to the 9 milligram dose of medication, they were on that for 30 days, and then they moved to the 25 milligram dose of medication, which is designed as the long-term maintenance dose of this medication. Now, what we know is especially for people who have insurance coverage of these medications, that a lot of times the insurance will mimic what the FDA approval is for. So when something was studied for, okay, every month we're titrating to the next dose, sometimes there will be limits where it says, hey, you can do one month or two months at a titration dose before being required to move to the treatment dose of medication, which in this case is that top dose, the 25 milligram dose of medication. But we know in practicality that especially if you're someone who is a super responder to this medication, maybe you're someone who is absorbing the medication a little bit more significantly compared to someone else, that you may do well at a lower dose of medication. You may have to work with your prescriber and with your insurance company if that is creating any problems, like they're like, hey, you need to move to the next dose. And you're like, I don't know that I need to work with your doctor or your prescriber about that. But if you are a cash pay patient, the good news is you get a little bit of flexibility in dosing. 

So for anybody, as with any of these medications, we start at the lowest dose. And then depending on how you're responding, what is the effectiveness of the medication, both in terms of how does it feel in the body, as well as movement that we're seeing on the scale, as well as from a side effects perspective, are you having side effects? If they are, do you feel that they're well managed before we move to the next dose of medication? Those are the questions that we're addressing before we're moving up on dosing. So I think what may be an option for people is that they will be working one-on-one with their prescriber to see, hey, how is this feeling in my body? Am I doing well at a lower or an intermediate dose of medication, or do I need additional support from medication? And then you can titrate from there. So that will certainly be an option. But when they looked at what was the average weight loss, that was for people who did month over month titrate up to the next dose of medication, continued on at the 25 milligram dose. So when we look at the effectiveness of this medication, on average, during the uh course of the trial, the average weight loss for people taking the medication was in the range of 13.6 to 16.6. Now, the reason for these two different numbers is that there's this idea of intention to treat. So there's a group of people who started the clinical trial, they were randomized to take the medication, but maybe they were having really significant side effects or dropped out for a different reason. And so they didn't actually continue the medication throughout the entire study. 

So for people who did continue the semaglutide 25 milligram dose, so the Wegovy pill at the top treatment dose of medication for the entirety of the clinical trial, on average, those patients lost 16.6 of their total body weight compared to patients who uh did not take the medication, they took the placebo. Those were patients who lost, I believe it was 2.7% of total body weight, which is pretty average. Typically, we see about a 3% 3% response rate in the placebo arm. And so this mirrors that actually almost exactly. And then people who were assigned to take that top dose of medication, but may or may not have actually finished the trial, on average, that number was 13.6%. So you'll see some different numbers. You'll see people saying 13, 14%, you might people saying 16 or 17% if they're rounding up from the 16.6%, but that's the reason for the difference between those two numbers. But for people who did continue the treatment dose of medication, seeing that 16.6% total body weight loss over the course of the study period. Now, when we compare that to the Wegovy injection, it's actually very similar. You may remember that the top dose of Wegovy is 2.4 milligrams taken in an injection once per week. And the average weight loss on that medication over the course of the clinical trial, which I believe was 64 weeks, but don't quote me on it, was 15.6% total body weight loss. So what we're seeing is actually pretty similar effectiveness between the 2.4 Wegovy dose taken once per week as an injection and the 25 milligram pill taken every single morning. And what we know is when we think about converting from the pill to the injection or vice versa, these doses, even recommended by the manufacturer, are considered equivalent doses. 

So let's say that someone is taking the Wegovy 2.4 injection, they desire to do a trial on the pill, maybe they like the idea of the convenience on it. It is a little bit more affordable, and we'll talk about price here in just a moment. And so it is appropriate to convert that person from the injection to the pill version of medication. When you're making a conversion from injection to pill, you're taking that injection every single week. Let's say you take it every Monday. So you'll take it on this Monday, then you'll wait a full seven days. So next Monday, when you're do just take your next injection, instead of taking the injection, now you would start taking the pills daily. Let's say you're switching from the pills to the injection, you'll just take your pills up, you know, let's say you're taking it Monday, Tuesday, Wednesday, Thursday, Friday, and then on Saturday you're going to take the injection. Great, you took the injection on Saturday, and then every Saturday, then moving forward, you would continue to take that injection. But we do consider these two doses to be equivalent to one another. And the reality is when we look at the dosing options that are available, generally we'll think about the Wegovy 1.5 milligram pill being pretty similar to the 0.25 injection, those two starting doses of medication. The Wegovy 4 milligram pill will be fairly similar to the 0.5 milliliter injection, the 9 milligram pill I would consider very similar to the 1militer injection, uh or milligram, excuse me, injection. So we compare these two things. I would look at that 0.25 with the uh 1.5, the 0.5 with the four, the one milligram with the 9 milligram, then there's going to be a gap. There is a Wegovy 1.7 milligram dose for the injection. There is no equivalent dose of that for people who are going to be taking the pill, and then that Wegovy 2.4 injection will be equivalent to the 25 milligram pill.

So if you are looking to switch from one of these to the others, that will be the easiest way to do that. If you are taking another medication, you may have a conversation with your physician about what makes the most sense if you're considering switching to this medication. Now we are starting to see in terms of insurance formulary, because this is the same Wegovy medication, that uh companies that were already covering the Wegovy injection are going to be covering the Wegovy pill. We do know that lots of people have already been able to pick up the Wegovy pill. And we're starting to see on prior authorizations that language is included that both of these medications will be covered. Now, certainly that's not guaranteed to be the case. So make sure to check with your individual insurance company, look at prior authorizations to see, but we do anticipate that for people who have coverage of the Wegovy injection, that they would also have coverage for the Wegovy pill. Now, in terms of coverage, the Wegovy pill is covered for the weight reduction indication. It is covered for the cardiovascular indication. So we know that Wegovy is approved for secondary cardiovascular risk reduction. So meaning that people who've had a heart attack, people who've had stroke, people who've had a history of cardiovascular disease and are at risk for having another event, Wegovy is approved for those patients who also have a BMI of 27 or higher for that treatment of cardiovascular risk reduction. So the pill also carries these two indications for weight reduction as well as cardiovascular risk reduction. The pill does not carry an indication for the treatment of liver disease. So it does have approval for the treatment of metabolic liver disease or NAFOLD, non-alcoholic liver disease, which is the old terminology, but still very commonly used. More colloquially, fatty liver, which maybe not the favorite terminology, but a terminology that is often used as well. So it has that approval for liver disease as well. Excuse me, the Wegovy injection has approval for liver disease. The Wegovy pill does not have approval for liver disease. 

And then similarly, the Wegovy injection does have approval for adolescents. So for 12 to 17 year olds, where the Wegovy pill at this time is only approved for adults 18 or older. So a little bit difference in terms of who this medication is covered for. Now, cost-wise, as I mentioned, insurance coverage looks very similar to insurance coverage of the Wegovy injection. So I would default to that. The best way to find out is to call the number on the back of your insurance card or to check your drug formulary online. But if you are a cash pay patient, there are cash pay options available. The starting dose of medication, so the 1.5 milligram dose right now is $149 per month. The four milligram dose is also $149 per month through April of this year, 2026. Then it's listed that the higher doses of medication, the 9 milligram and the 25 milligram of medication will be $299 per month. So that is as of right now, January 2026. I think one of the most exciting things about being in this space is that I feel like as soon as I say a price, that information is out of date. So if you're listening to this at any point in the future and you're like, well, it's actually quite a bit cheaper right now, or just wondering, is that still the same price, you can always look these up online because the prices are changing every day, which has been really exciting. We're still seeing these medications are expensive, but when we compare them to especially like two years ago, where everything was in the range of $1,200 to $1,500 per month, seeing them now in this $200 to $300 range, or even $150 for that starting dose of medication, really, really exciting to be continuously seeing these numbers move down. So those are the prices. January 2026, again, $149 for the starting dose, the $1.5 and 4 milligram. 

After April of 2026, that low price for the four milligram. Go away and that will become $199. Then the nine milligram and 25 milligram will be $299 per month. So a little bit of savings right now over what is available for the injection. So maybe a good option for people who are in that situation. So we think about well, who who's really a good fit for these medications? I think it could look like a handful of different people. The idea of giving yourself an injection, I think a lot of people don't love the idea of that. I do win a lot of people over when I show them the size of the needle is teeny teeny tiny. And then we like when we look at people who are doing like Wegovy or Zepbound and you look at the mechanism of the pen where you don't even have to see the needle. It's pretty appealing to do that. But I do know I have a handful of patients in my practice for whom we have just been waiting for this pill version to come available because they are like, Dr. Stombaugh, no way am I taking an injection of medication. And so for those people, here it is. The first pill is available. We do anticipate another pill called Orforglipron, a GLP medication from Eli Lilly. Will be out later this year. So that's really exciting. But the first one is here, it's available, and the price is reasonable for some. And so that will be an option. I do think too, I see this a little bit less with the Ozempic and Wegovy medication compared to Zepbound. But when you're taking that once per week injection, I sometimes experience patients who feel the effect of the medication wearing off towards the end of the week. So let's say they're injecting it every Saturday. They might feel that by Thursday or Friday, noticing that they're quite a bit more hungry, noticing that they're having more cravings for food. Like I said, this is a little bit more common on the Zepbound medication because it does have a shorter half-life compared to Wegovy medication. But that being said, excuse me, even people on the Wegovy medication may notice a little bit of that wearing off effect towards the end of the week. So taking the pill every single day can help to combat that somewhat. And so this can absolutely decrease that effect where you're noticing, hey, the medication's wearing off. So there's a little bit more consistency in dosing. Traveling with this medication is certainly easier. Um, while the pens can be taken out of the refrigerator for 28 days for Wegovy, 21 days for Zepbound, it is not ideal. You know, it's a clunky thing. A lot of people are nervous, like, hey, what will TSA say? Maybe just the logistics of it. You know, I've had patients who've left it like in the car, for example, and then the medication gets really hot, and that's just really incredibly disappointing if you have a pen that goes bad.

So the nice thing about the pills, there's nothing in terms of storage regulations. You can keep it on the bathroom counter, you can travel with it, nothing that's going to be problematic there. So I think there are people who may be traveling that may be really excited about this as an option. And certainly I'm sure other people who are more cost conscious looking for a way that they can save money, this will be a little bit more affordable. We may see that it becomes even more affordable over the next couple months. You know, fingers only can be crossed on that. But it's exciting. So we've got the first Wegovy pill here for the treatment of obesity. If you have been thinking about taking a medication like this and you're wondering, hey, am I a good fit for this? Right now it is uh approved for that weight reduction indication. It can be prescribed off-label though, so you can have a conversation with your physician, like, hey, BMI of 30 or BMI of 27 or higher with a weight-related comorbidity. But what happens for the person who's in the BMI of 26 range? It may make sense to consider a medication like this, but only you and your doctor can decide what's right for you. If you are looking for a doctor, I see patients in person in Charlottesville, Virginia. I also see patients by telemedicine throughout the states of Illinois, Tennessee, and Virginia. I would love to support you in your weight journey. If you're like, shoot, Dr. Stombaugh, I am not in one of those states, but I would love to get additional help. I have two things that I recommend for you. I do have an online program called The GLP Guide, which is a great resource for people who are starting these GLP medications to understand what are some of the side effects, how do I travel with my medicine? How much protein do I need? What kind of exercise should I do? How do I respond when someone asks me about my weight loss? All these different things that can come up. I've got the answer to your questions and I would love to support you with that. You can learn more at www.sarahstombaughmd.com/glp. You can also look for a board-certified obesity medicine physician to support you in your journey. You can go to the ABOM, the American Board of Obesity Medicine, to find a physician near you who can help support you in your journey. Thank you so much for joining us in today's episode. We'll see you all next time.