Pill versions of the obesity drugs, now taken only as injections, are in the works. We look at the science behind pills and see if they could be more affordable and accessible than injections.
AYESHA RASCOE, HOST:
Medications like Wegovy and Ozempic have become increasingly popular options for millions of people who want to achieve a healthier weight. But the medications, taken in weekly injections, are not suitable for everyone or every wallet. That’s why experimental pills that might do the same thing are getting so much attention. A Wegovy-like pill is expected to gain approval from the Food and Drug Administration by the end of the year. NPR pharmaceutical correspondent Sydney Lupkin is here to talk with us about that possibility. Good to have you here, Sydney.
SYDNEY LUPKIN, BYLINE: Thanks for having me.
RASCOE: Why hasn’t there been a pill version of these drugs until now? I mean, that seems like something a lot of people would want.
LUPKIN: Yeah. I mean, that’s a good question. And that’s kind of the case. It’s called Rybelsus, but it’s only approved for type 2 diabetes. It’s made by Novo Nordisk, the same company that makes Ozempic for type 2 diabetes and Wegovy for obesity. But it is a lower dose of the active ingredient that these injectable drugs share – semaglutide. The new pill would be higher dose and aimed at patients suffering from obesity, and studies show that its effectiveness is quite close to that of Wegovy. Tracy Zvenyach is director of policy strategy and alliances at the nonprofit Obesity Action Coalition. She says more options would be very important.
TRACY ZVENYACH: The obesity patient community has gone without treatment for so long. New innovations, new treatments to treat this chronic disease are therefore welcome. All are fascinating.
LUPKIN: She says many patients are hopeful about the new pills, especially if they’ve had trouble accessing the shots for one reason or another.
RASCOE: Okay. So how would this new pill work? Is this the same as the injectable versions?
LUPKIN: Semaglutide, this active ingredient, breaks down quite quickly in the stomach – too quickly to actually be absorbed and do its job. This is why it is primarily an injectable. So Novo Nordisk added something to solve this problem. It’s a chemical with a long name, but the abbreviation is SNAC – SNAC. Andrea Traina, one of Novo Nordisk’s obesity directors, explained how it works.
ANDREA TRAINA: If you think about dropping an Alka-Seltzer tablet into a glass of water, this immediate fizzy reaction happens – that’s what happens in your stomach as soon as that tablet hits the base of your stomach, hits that stomach wall.
LUPKIN: It creates this bubbly environment right around the pill, preventing stomach acids from breaking it down too quickly and giving it enough time to be absorbed into the bloodstream. It takes about 30 minutes. The pill must therefore be taken on an empty stomach and you cannot eat or take other medicines until it is absorbed.
RASCOE: Okay. It seems like this might turn off at least some people. What have you heard from patients?
LUPKIN: Yeah. Well, there are other popular medications that people are already taking that need to be taken the same way, so it’s not a problem for everyone. But not everyone is interested. If the injections already work well for them, it would be a daily pill. The injections are weekly. But patients’ big hope is that the pill will be less expensive and have better insurance coverage than the shots. One person told me they just hoped it would be cheaper than their mortgage.
Dr. Richard Siegel is an endocrinologist at Tufts Medical Center.
RICHARD SIEGEL: But one of the big problems with all the drugs in this area has been the cost, and can we equitably provide these drugs to the thousands – you know, millions, actually – of people who could benefit from them?
LUPKIN: He says three-quarters of the messages he gets from patients are about these drugs, and many of them are about refills and insurance companies. His office is staffed to handle this, but not all doctors’ offices are. When some people lose their insurance coverage, they can afford a few hundred dollars a month to buy directly from drug manufacturers. But many people can’t, even with recent company discounts that go down to $200 a month in some cases.
RASCOE: So do you think the pills will actually be cheaper?
LUPKIN: So I’m not sure, but pills are generally cheaper to make than drugs given by injection. Injector pens can also increase the cost. As for Novo Nordisk, it has not yet announced its sticker price. However, as part of an agreement with the Trump administration, it was clarified that patients who did not use their insurance would be offered it for $149 per month. This is a lower direct-to-consumer price than injectable products, which could therefore be an encouraging sign. The company says access is an issue it is working on with others in the drug supply chain.
RASCOE: That was NPR Pharmaceuticals correspondent Sydney Lupkin. Thank you very much, Sydney.
LUPKIN: You bet.
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