Lower cost Novo, Lilly weight-loss pills draw patients from compounded drugs, doctors say

Lower prices for weight-loss pills from Novo Nordisk and Eli Lilly are prompting patients to switch from compounded medications to branded Wegovy and Foundayo, according to Reuters interviews with nine U.S. doctors.

Prices for the lowest doses of both ​Novo’s oral Wegovy and Lilly’s Foundayo tend to be lower than for their injected obesity medicines, and at par with those offered by pharmacies that mix the ingredients themselves and make ‌compounded versions.

As many patients struggle with declining insurance coverage, the lower-priced options have been a boon for the drugmakers, the doctors said.

Denmark’s Novo and Indianapolis-based Lilly began selling the oral medications in the U.S. in January and April, respectively, and have boasted of strong demand from new patients.

Still, they have complained about compounded versions, which are allowed by the U.S. FDA in personalized formulations and doses. The Food and Drug Administration has sought to tighten limits after shortages of the branded drugs that allowed compounding to flourish ended.

Doctors and health experts have ​hoped that lower pricing would turn people toward the branded drugs, which are subject to greater oversight.

“I am seeing people are switching from compounds,” said Dr. Michael Weintraub, assistant clinical professor of endocrinology at ​NYU Langone in New York. He said he does not prescribe the compounded drugs but has seen patients who were already on them.

“I have patients increasingly coming to ⁠me saying, ‘I hear it’s not as expensive to get the pharmaceutical-grade branded version, can we switch over?'”

A Lilly spokesperson said the company was “encouraged by the early momentum, growing prescriber interest and intent to prescribe, and by patients ​choosing authentic, FDA-approved treatments like Foundayo.”

Novo said it has expanded access to its GLP‑1 drugs through its NovoCare Pharmacy and retail partnerships, aimed at steering patients toward FDA‑approved treatments over compounded versions.

WEGOVY, A KNOWN BRAND

While doctors said some ​are switching to injectable GLP-1s, most are turning to the pills because the prices of those medications are more comparable to the compounded versions.

Lower doses of Novo’s Wegovy pills cost around $149 per month, while the injector pens start at $199 per month, according to the company and the White House’s websites.

Lilly’s Foundayo also starts at $149 per month, while vials and pens of its GLP-1 obesity drug Zepbound can cost $299 or more for self-pay patients.

Doctors said Novo’s Wegovy pill benefits from stronger brand recognition, as it is the ​same medicine and name as the injectable. It also has established heart-protective data, making some patients and prescribers more comfortable with it, especially for people at risk of heart disease.

Doctors also said some patients are reluctant to try ​less familiar Foundayo as it is a somewhat different type of medication with no heart-benefit data yet.

“Something about saying it is new creates a little hesitation in at least a handful of patients I’ve spoken about it with,” said Dr. Jorge ‌Moreno, a Yale ⁠Medicine Obesity Specialist. “It’s a small sample, but they’ve opted for the Wegovy (pill).”

Oral Wegovy led to about a 14% reduction in body weight over 64 weeks, and Foundayo about an 11% reduction over 72 weeks, in separate studies. Patients on the GLP-1 injections shed 15%-20% of body weight in trials.

Foundayo’s convenience – it doesn’t need to be taken on an empty stomach like Wegovy – and more time on the market are expected to help Lilly narrow Novo’s advantages for the oral offerings.

Citi analysts said prescribers projected an even split between Foundayo and Wegovy pills based on a survey of 120 doctors who prescribe GLP-1 medicines.

Survey findings also showed that doctors at academic medical centers expect Foundayo to ​eventually account for about 70% of prescriptions between the ​two pills. They cited Foundayo’s lack of a ⁠fasting requirement as a key advantage.

INSURANCE HURDLES

Still, prices are too high for many and all the doctors interviewed said insurance coverage remains a challenge.

“Every day, I get a message from a patient saying ‘my insurance company didn’t approve or denied it again,'” said Yale’s Moreno.

Often, physicians do not code the diagnosis properly for the appropriate prescription, leading to ​rejections, he said. And insurance companies don’t as readily cover preventive care as they do existing conditions.

Lilly’s spokesperson said two of the three largest U.S. pharmacy benefit ​managers have begun covering Foundayo, ⁠and the firm is working to expand coverage further.

Many doctors said they are eager to see the start of the U.S. government’s initial program providing coverage of GLP-1s to Medicare patients, set to begin in July and last through 2027. They say they hope the government program will spur commercial coverage for a larger population.

Some patients already on injectables are switching to the pills, but not en masse, according to most doctors interviewed.

“Right now only a small percentage are switching to the ⁠pill,” said Dr. ​Christina Nguyen, an obesity specialist in Atlanta. “The injectables are working well and people don’t want to mess anything up.”

Doctors also back up ​what the drugmakers’ executives have so far said: The pills are opening up the market to new patients.

“This is expanding the market of GLP-1,” said Sarah Ro, medical director of the University of North Carolina Health’s weight-management program. “Patients who have been offered a GLP-1, but due to ​price, declined… now, they’re wanting to try.”