FAQ: What managed care leaders should know about emerging oral GLP-1 therapies

As GLP-1s continue to reshape treatment for obesity, Type 2 diabetes and other conditions, a new development is drawing increased attention from payers and employers. In December 2025, the FDA approved the first oral version of Wegovy (semaglutide), marking a major shift from injectable therapies to a daily pill option for chronic weight management.

The once-daily pill, developed by Novo Nordisk, offers similar clinical benefits to injectable GLP-1 drugs, including significant weight loss and reduced cardiovascular risk. As oral therapies enter the market and more are expected to follow, managed care leaders are evaluating how these drugs could affect utilization, adherence and long-term costs.

Below are key questions and answers to help guide those decisions.

FAQ 1: What are oral GLP-1 drugs and how do they work?

Oral GLP-1 drugs are medications that mimic a natural hormone in the body that helps regulate blood sugar, appetite and digestion. These drugs slow how quickly the stomach empties, help people feel full longer and improve insulin response.

The newest option, the oral version of Wegovy, is the first GLP-1 pill approved specifically for weight loss. Another oral GLP-1, Rybelsus (semaglutide), has been available since 2019 but is approved for Type 2 diabetes rather than obesity.

FAQ 2: How are oral GLP-1 therapies different from injectable versions?

The main difference is how the medication is taken. Injectable GLP-1 drugs are typically given once a week, while oral versions are taken daily as a pill.

The oral option may appeal to patients who prefer not to use injections or who have needle phobia. However, daily dosing may also introduce adherence challenges, since patients must remember to take the medication each day.

Clinical outcomes and side effects are generally similar between oral and injectable versions, although administration and patient experience differ.

FAQ 3: Why are oral GLP-1 therapies generating so much attention among health plans right now?

The GLP-1 category is one of the largest cost drivers for health plans today, according to Leslie Lotano-Saba, managing director at AArete. She said spending continues to rise as these drugs gain approval for additional conditions beyond type 2 diabetes and obesity, including cardiovascular risk reduction and other chronic diseases.

“The clinical evidence continues to grow in their positive impact on health, but the high cost, need for chronic use and direct consumer purchasing options challenge traditional benefit designs, utilization management and cost structures of health plans,” Lotano-Saba said.

She also noted that the oral version creates a new market of patients who may not have considered injectable therapies, while telehealth platforms and direct-to-consumer advertising are further driving demand.

FAQ 4: What conditions are GLP-1 drugs being used to treat beyond obesity?

While GLP-1 drugs are widely known for treating obesity and type 2 diabetes, their use is expanding.

These therapies are also FDA approved for reducing cardiovascular risk in certain patients, chronic kidney disease, sleep apnea and serious liver disease for metabolic dysfunction-associated steatohepatitis (MASH). Research is also exploring their potential role in other areas, including addiction and metabolic health, according to Lotano-Saba.

This broader set of indications is one reason demand continues to grow across the healthcare system.

FAQ 5: Some experts say oral GLP-1 drugs could weaken traditional formulary controls. Why might that happen?

Lotano-Saba said traditional utilization management strategies may be less effective with oral GLP-1 drugs.

For example, step therapy programs often require patients to try lower-cost oral medications before moving to more expensive injectable options. However, oral and injectable GLP-1 drugs are priced similarly, limiting the effectiveness of that approach.

She added that providers may be more willing to prescribe a pill compared with an injectable therapy, which could further increase utilization even if coverage and cost remain the same.

FAQ 6: Could oral GLP-1 drugs increase utilization compared with injectable therapies?

Yes. Oral GLP-1 drugs could expand access to treatment by lowering barriers to entry.

Patients who were hesitant to use injections could be more willing to start therapy with a pill. At the same time, primary care providers could feel more comfortable prescribing oral medications, which would broaden use beyond specialty care.

Early market trends and reports suggest that oral GLP-1 drugs are attracting new patients rather than simply replacing injectable therapies, contributing to overall growth in utilization.

FAQ 7: What financial implications could these oral drugs create for Medicare and Medicaid plans if utilization continues to rise?

Lotano-Saba said the financial impact could be significant, particularly for government-funded programs.

Medicare and Medicaid populations include a high number of patients with obesity and related chronic conditions, which already drive healthcare costs. Increased use of GLP-1 therapies could add further pressure on budgets, especially for Medicaid programs that rely on state funding.

“States must ensure access while balancing affordability,” she said, noting that plans may face growing challenges as demand increases.

FAQ 8: What other oral GLP-1 therapies are in development?

The approval of oral Wegovy is likely just the beginning.

Eli Lilly and Company is developing an oral GLP-1 drug called orforglipron, which has shown promising results in clinical trials and could receive regulatory decisions in 2026.

Additional candidates are also in development, highlighting a growing pipeline that could further expand treatment options and increase competition in the market.

FAQ 9: What steps can health plans take now to prepare for growing demand for oral GLP-1 drugs?

Lotano-Saba said health plans should begin adjusting their strategies now to manage the expected growth.

She recommended developing more targeted prior authorization criteria focused on metabolic need, setting limits on dosing and refill timing and closely tracking how these therapies impact overall healthcare costs.

Plans may also need to rethink benefit design and consider indication-specific formularies as the market evolves.

“With significant PBM reform coming and changes to rebates, plans will need to consider affordability based on utilization precision, benefit design and outcomes accountability,” she said.

As oral GLP-1 therapies gain traction, they are expected to further reshape how obesity and related chronic conditions are treated. For managed care leaders, the challenge will be balancing expanded access and clinical benefits with the financial realities of long-term use.

Lotano-Saba reviewed and approved this FAQ for accuracy and publishing.