Pod Insights Short Wave GLP-1 Pills Are On The Way. Here's What To Know About this episode You may have heard of Ozempic, and other GLP-1 drugs. They’re everywhere. And they typically involve weekly injections — which can have a sticker price of over a thousand dollars a month. And insurance coverage has been tricky to navigate for a lot of people. That’s why there’s a lot of excitement around a new pill form of the drug. NPR Pharmaceuticals Correspondent Sydney Lupkin https://www.npr.org/people/825275572/sydney-lupkinchats about these experimental pills with host Emily Kwong https://www.npr.org/people/767284140/emily-kwong.
Check out more of NPR’s coverage https://www.npr.org/2025/11/25/nx-s1-5619816/obesity-pills-wegovy-semaglutide-orforglipronabout GLP-1s.
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Transcript Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.
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0:12 Speaker 00 You're listening to Short Wave from NPR.
0:17 Emily Kwong? Hey, Short Wavers. I am here with NPR Pharmaceuticals correspondent Sydney Lupkin today to talk about something that has really changed the game when it comes to weight loss, which is injections. When did this all start?
0:29 Speaker 02 I mean, it all started with celebrity weight loss.
0:32 Emily Kwong? One hot topic everyone in Hollywood still seems to be talking about is Ozempic.
0:37 Speaker 02 You're on Ozempic, or one of those things.
0:39 Speaker 03 Or Wegovy, or whatever.
0:40 Speaker 02 Yeah, or you got work done. Like, just stop. Then it wasn't a secret anymore.
0:45 Emily Kwong? Yeah, I remember even Serena Williams came forward as like a spokesperson for the telehealth company Rose GLP-1 injections.
0:55 Speaker 04 I knew my body was missing something it needed. For me, the answer was GLP-1s.
1:02 Speaker 02 Now, these weight loss injections, called GLP-1s, are kind of everywhere. Examples include Ozempic, which is kind of the Kleenex of GLP-1 drugs, but is actually officially for type 2 diabetes, and Wegovy. These are drugs you inject under the skin once a week. And these injectable drugs have become a valuable tool for millions of people trying to get to a healthier weight. We're talking people who've never been able to lose weight and keep it off, finally finding something that works for them.
1:34 Emily Kwong? These are clearly life-changing medications. And also, it seems a big commitment. I mean, not everyone is going to want to inject something weekly for weight loss.
1:42 Speaker 02 For sure. And, you know, they're not for everyone or for every wallet. Injectables do have a sticker price of over $1,000 a month. And insurance coverage has been tricky to navigate for a lot of people. So there's a lot of excitement around a new pill form of the drug. We're going to talk about two types of these pills. The first is a Wegovy pill that's expected to win FDA approval by the end of the year. And then there's another kind of obesity pill that could be right behind it.
2:13 Emily Kwong? Today on the show, a new era of weight loss medications. We talk about the science behind the experimental pills.
2:19 Speaker 02 And what FDA approval would mean for affordability and access.
2:23 Emily Kwong? You're listening to Short Wave, the science podcast from NPR.
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3:59 Emily Kwong? Okay, Sydney, I want to talk about GLP-1s. Am I saying that right?
4:04 Speaker 02 GLP-1.
4:04 Emily Kwong? GLP-1s, how do they work?
4:07 Speaker 02 So yeah, I talked about this with Andrea Trina. Her background is in clinical pharmacy and now she's an obesity director at Novo Nordisk. That's the company that makes Ozempic and Wegovy. And Emily, at my request, she went full Frizzle during our interview.
4:24 Emily Kwong? So like the magic school bus, Miss Frizzle?
4:26 Speaker 02 That is correct.
4:27 Emily Kwong? Our generation's science teacher.
4:28 Speaker 02 100%. Here is her primer on GLP-1s. And GLP-1, by the way, is a hormone your body naturally makes. It stands for glucagon-like peptide 1.
4:40 Speaker 03 As soon as you ingest food, your body is going to start secreting GLP-1 because it immediately triggers that, oh, you've ingested some food. And so it's going to tell your brain you're eating. And so it's going to make sure it triggers that effect so that you start to feel full. But it's very short-acting and only lasts a couple of minutes.
4:59 Emily Kwong? Oh, okay. So in our bodies, the GLP-1 hormone does a good job of making you feel satisfied, but only for a short time. How does GLP-1 medication work differently?
5:10 Speaker 02 It lasts much longer. When Novo Nordisk made its medication version of GLP-1, the company tweaked it. The active ingredient in both blockbuster drugs, Ozempic and Wegovy, is called semaglutide. Andrea explained how they made it.
5:24 Speaker 03 We took out a couple of amino acids and exchanged them for other ones so that the molecule can't immediately be degraded by the enzyme that our body naturally makes to break it down. And then the second thing we did is we added a big fatty acid chain to the end of it so that it binds to protein and hangs out in the body for longer. So semaglutide actually has a half-life of a week instead of just two minutes.
5:51 Emily Kwong? Oh, okay. So this is why the retooling of the GLP-1 hormone is why Ozempic and similar injectables are taken weekly because the chemical at the core of it all, semaglutide, has a half-life of a week.
6:02 Speaker 02 Right. By the way, there are four different blockbuster injectables. Ozempic and Manjaro are for type 2 diabetes. And Wegovy and Zepbound are for obesity. But the latest twist is that now there's a possibility of a pill, two pills, actually. And to be clear, we're not talking about rebelsis, which is a semaglutide pill, but it's approved for type 2 diabetes.
6:23 Emily Kwong? Got it. Okay, these are two new pills, folks. A semaglutide you can swallow and another different pill, which is a new compound. Which pill do you want to talk about first?
6:33 Speaker 02 Let's talk about the pill made by Novo Nordisk, whose active ingredient is semaglutide. It's a peptide, a protein.
6:39 Emily Kwong? OK.
6:40 Speaker 02 The problem is that in your stomach, the drug gets broken down too efficiently and too fast for the semaglutide to get into the bloodstream and do its job all over your body.
6:50 Emily Kwong? Huh.
6:51 Speaker 02 Andrea says to think about how your stomach breaks down some chicken that you've eaten.
6:56 Speaker 03 Our body is trained to release enzymes and to attack those proteins almost immediately to break them down into smaller pieces so that they can be absorbed. So for 100 years, we've been trying to make a protein, a peptide-based molecule, able to be absorbed orally.
7:15 Emily Kwong? This sounds like a tricky design problem.
7:16 Speaker 03 Mm-hmm.
7:17 Emily Kwong? So how did the scientists at Novo Nordisk get around this and make that peptide-based molecule that our bodies wouldn't immediately want to break down?
7:26 Speaker 02 Yeah, they added something to it.
7:28 Speaker 03 It is a very long chemical name, but it is abbreviated as SNAK. S-N-A-C.
7:35 Emily Kwong? Adorable.
7:35 Speaker 03 Isn't that cute?
7:36 Emily Kwong? [laughing]
7:37 Speaker 03 My goodness. No pun intended, but it is just the first letter from each of the chemicals within the structure, and it just worked out to be SNAK, and I love that.
7:45 Emily Kwong? [laughing]
7:45 Speaker 02 And I also love that.
7:47 Emily Kwong? OK, how does the SNAK pill take a ride through your body? Please be my Miss Frizzle.
7:52 Speaker 02 I'll let Andrea explain it, but the gist is that this SNAK thing creates a little protective buffer zone around the pill to keep it from getting broken down too quickly and help it get absorbed into the bloodstream.
8:04 Speaker 03 When you swallow that tablet, it creates a tiny little microenvironment at the base of the stomach, right where that tablet sits. And so it's kind of, if you think about dropping an Alka-Seltzer tablet in a glass of water, that immediate fizzy reaction that occurs, that is what happens in your stomach as soon as this tablet hits the base of your stomach, hits that stomach wall.
8:27 Speaker 02 It creates this little foamy environment directly around the tablet.
8:32 Emily Kwong? Mmm.
8:33 Speaker 02 Then it can do all those other things to make you feel full and regulate blood sugar. The catch is that you have to take this pill on an empty stomach and wait 30 minutes before eating anything else for it to work.
8:48 Emily Kwong? That's very specific. So this pill might not be for everyone.
8:53 Speaker 02 Yeah, I definitely heard from people who were like, "Pass, the injection is working for me, I'm good, I don't want this," but others were curious.
9:02 Emily Kwong? Now, earlier you had mentioned there was another pill that might come onto the scene. Who is making that one?
9:07 Speaker 02 So that one is made by Eli Lilly, which makes the injectables Monjaro and Zepbound. And they both share the same active ingredient called tirzepatide. But unlike Novo Nordisk, which took its injectable active ingredient and made it in pill form with some tweaks.
9:23 Emily Kwong? Yeah.
9:24 Speaker 02 Eli Lilly is doing a whole new active ingredient.
9:27 Emily Kwong? A whole new compound for their pill formation.
9:30 Speaker 02 Mm-hmm.
9:30 Emily Kwong? Okay, how does it work?
9:32 Speaker 02 Eli Lilly isn't saying in detail yet, but I can tell you this: it is not a peptide, so it doesn't have the same restrictions around when you need to take it. You don't have to take it on an empty stomach and wait half an hour before eating anything.
9:45 Emily Kwong? That seems kind of nice.
9:46 Speaker 02 Yeah, but its approval is probably a little ways behind the Novo Nordisk pill. And maybe here is a good place to spell out just how long the development and approval process for these drugs can be. I talked to Dr. Max Denning at Eli Lilly, who's a senior medical director at the company, and worked on studying the new pill.
10:05 Speaker 06 You need a huge number of doctors, you need a huge number of sites to be participating in the clinical trials to get all of that data and make sure that this is a safe and effective medication.
10:18 Emily Kwong? Okay, so Eli Lilly is putting their pill through clinical trials. Does this guy get to meet the patients?
10:23 Speaker 02 Actually, never. His job was to design and oversee clinical trials for the pill and then step back. The trials are double-blind, meaning that neither the patient nor the doctors know who got the drug and who got the placebo.
10:36 Speaker 06 So... You design these trials, you spend maybe six months doing that, you start them up, and then you run the trial. And that process of finding all the participants that come for all of their visits, take the investigational medicine as prescribed, and then get to the end of the study, that whole process takes maybe two, two and a half years. And for me, the anticipation coming up to that first moment when the data card flips over and you see, does this medicine work?
11:08 Emily Kwong? Ooh, well, does it work? Also, what is this pill called, by the way?
11:12 Speaker 02 Oh, it's called Orfaglipron, and it did work. According to one study, patients who took Orfaglipron had 12% average weight loss at its highest dose over 72 weeks.
11:23 Emily Kwong? Cool.
11:23 Speaker 02 And another study showed it was also effective at lowering patients A1C, which is a measure of blood sugar.
11:29 Emily Kwong? Okay, how does this pill's efficacy compare to its competitor, the pill made by Novo Nordisk?
11:34 Speaker 02 Novo Nordisk may have a bit of an edge here. In a study published in September in the New England Journal of Medicine, a 25-milligram semaglutide pill led to a 16%, 17% reduction in weight on average over 64 weeks. And that's about the same as Wegovy.
11:51 Emily Kwong? Oh, so the pill performed about as well as the injectable?
11:53 Speaker 02 Yeah.
11:54 Emily Kwong? So, big picture, as a pharmaceuticals person, I know you've talked to many people over the years about GLP-1 drugs. What do patients think of this?
12:02 Speaker 02 Some just aren't into the idea. They're like, hey, the injections work for me. Why would I switch?
12:08 Emily Kwong? Yeah.
12:08 Speaker 02 But overall, the pill is another option, and that's big, especially when it comes to cost.
12:15 Emily Kwong? Yeah, you said earlier that injectables can be over $1,000 a month, certainly a few hundred dollars a month, depending on your situation.
12:23 Speaker 02 And that's on top of already high insurance premiums. So even if you have insurance coverage, it might be really limited or still require a big out-of-pocket payment.
12:32 Emily Kwong? Yeah. So are the pills going to be cheaper?
12:35 Speaker 02 So we don't officially know what the sticker price for the pills is going to be yet.
12:39 Emily Kwong? Yeah.
12:39 Speaker 02 Novo Nordisk has not said, Eli Lilly has not said. But generally, pills are easier to manufacture. Therefore, they're cheaper to manufacture, which could result in a downstream lower price. We also know that there have been deals with the Trump administration, announced earlier this year, to sell the pills to consumers not using their health insurance for $149 a month.
13:02 Emily Kwong? Wow.
13:02 Speaker 02 Now, that is not a sticker price, but it could mean that a lower sticker price is coming. And that could mean better insurance coverage, more access, basically just more people able to get their hands on these if they need them.
13:15 Emily Kwong? Sidney Lupkin, thank you so much for joining us.
13:18 Speaker 02 Thank you for having me.
13:24 Emily Kwong? This episode was produced by Rachel Carlson and edited by Brent Bachman. Tyler Jones checked the facts. The audio engineer was Kwesi Lee. Beth Donovan is our vice president of podcasting. I'm Emily Kwong. Thank you for listening to Shore Wave from NPR.
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