Articles / Oral GLP-1
Wegovy pill vs Foundayo: efficacy against convenience in the first oral GLP-1s
Two daily GLP-1 tablets are now approved for obesity. One matches the injection on weight loss; the other removes every dosing constraint. The data on the trade-off.
Published Oct 10, 2026 ยท 6 min read
The oral GLP-1 category went from zero to two approved obesity products in four months. The FDA approved Novo Nordisk's Wegovy pill (oral semaglutide 25 mg) on December 22, 2025 and Eli Lilly's Foundayo (orforglipron) on April 1, 2026. They compete for the same prescription but are built on opposite technical bets.
Summary
The Wegovy pill delivers injection-level weight loss and carries a cardiovascular claim on its label, at the cost of a strict fasting regimen. Foundayo gives up roughly four points of weight loss and has a higher discontinuation rate, but can be taken at any time with no food or water rules. On our GLP-1 Performance Index the Wegovy pill scores 4.6 and Foundayo 3.4, although the pill's figure comes from a small trial of 307 people.
| Wegovy pill | Foundayo | |
|---|---|---|
| Molecule | Semaglutide (peptide) with an absorption enhancer | Orforglipron (non-peptide small molecule) |
| Pivotal trial | OASIS 4, 64 weeks | ATTAIN-1, 72 weeks |
| Weight loss (efficacy estimand) | 16.6% | 12.4% |
| Weight loss (treatment policy) | 13.6% | 11.1% |
| Nausea | 46.6% | 33.7% |
| Discontinued for adverse events | 6.9% | 10.3% |
| Dosing constraints | Fasting, up to 4 oz water, 30-minute wait | None |
| Cardiovascular claim on label | Yes | No |
Top doses. Cross-trial comparison: populations and durations differ.
Two technical bets
Novo's approach keeps the semaglutide peptide and co-formulates it with an absorption enhancer that lets a small fraction cross the stomach wall. The bioavailability is low, which is why the dose is ten times the injection's and why food, drink and other medicines in the stomach must be avoided at dosing.
Lilly's orforglipron is a small molecule that activates the GLP-1 receptor without being a peptide. It survives digestion, so there are no administration rules, and small-molecule manufacturing scales more easily than peptide synthesis. That supply argument matters in a category that has been capacity-constrained since 2022.
Efficacy and tolerability
OASIS 4 produced 16.6% weight loss on the efficacy estimand, in line with the injectable Wegovy result in STEP 1 (16.9%). ATTAIN-1 produced 12.4% at 72 weeks. The gap is about four points on an on-treatment basis and 2.5 points on a treatment-policy basis, where Foundayo's simpler regimen narrows the difference.
The side-effect profiles diverge. Nausea and vomiting were more frequent on the Wegovy pill (46.6% and 30.9% vs 33.7% and 24.0%), but more participants discontinued Foundayo for adverse events (10.3% vs 6.9%). Our burden metric, which adds the discontinuation rate to the average stomach side-effect rate, places the two at 35.7 and 36.9 respectively.
Label and pricing
Semaglutide's cardiovascular outcome data (SELECT) carries over to the Wegovy pill label; orforglipron has no outcome trial readout yet. Both companies sell direct to self-pay patients, with entry doses at about $149 a month and higher doses at roughly $299 to $349 as of autumn 2026. Commercially insured patients can access manufacturer savings cards.
What to watch
The competitive question is whether convenience beats efficacy at the margin. Real-world persistence data, which typically trail trial results, will show whether the Wegovy pill's fasting regimen erodes its efficacy advantage outside a trial setting. See the full numbers in our side-by-side comparison.