Foundayo vs. oral Wegovy: The similarities, the differences and what you need to know

The FDA approval of Eli Lilly’s oral glucagon-like peptide 1 (GLP-1), Foundayo (orforglipron), yesterday set off what is bound to be a fierce fight for market share between Eli Lilly and Novo Nordisk and oral GLP-1, oral Wegovy. J.P. Morgan forecast earlier this year that by 2030, 30.3 million people in the U.S. will be taking on a GLP-1, up from 12.9 million this year. The convenience of the oral formulations, along with falling prices and expanding insurance coverage, are factors fueling prescriptions. Other companies and products are almost certainly going to enter the oral GLP-1 market, but for now it is a head-to-head contest between Foundayo and oral Wegovy. Here are 13 things to know about the two rivals.

Oral Wegovy got a nice headstart

Novo Nordisk announced on Dec. 22, 2025, that the FDA had approved oral Wegovy, which was previously on the market as a subcutaneous injectable formulation, and the Danish company started selling it in the U.S. in January 2026. Partly because of the head start, some Wall Street analysts are predicting a slower initial uptake of Foundayo than oral Wegovy. The pill form of Wegovy also has the advantage of some patients switching from the familiar injectable version to the oral formulation with the same name. There isn’t an injectable version of Foundayo.

Foundayo benefited from a new speedy FDA approval process

Eli Lilly’s drug was approved under the FDA Commissioner Martin Makary’s National Priority Voucher (CNPV) pilot program that is designed to hasten the approval process using a “multidisciplinary ‘tumor board-style’ discussion between review team and senior agency leadership.” According to the FDA, Foundayo is the fifth drug approved in the CNPV program and the first new drug. The approval came 50 days after Eli Lilly filed its application for approval, according to agency.

Foundayo is a small-molecular drug, Wegovy is a peptide. The size difference may give Foundayo an edge

Orforglipron calcium, the active ingredient in Foundayo, is a small-molecule drug, akin to a statin, with a molecular weight of 902 grams per mole (g/mol), according to the package insert for Foundayo. Semaglutide, the active ingredient in Wegovy, is a peptide with a molecular weight of 4,113.58 g/mol, according to the package insert for Wegovy. Lilly executives and drug industry analysts are saying that as a small-molecule drug, Foundayo is much easier to manufacture, giving Eli Lilly a decided advantage over Novo Nordisk. “We can make basically as much as we need,” Lilly’s CEO Dan Ricks said in an interview with Vox.

Oral Wegovy needs to be taken on an empty stomach. Food doesn’t affect Foundayo. Advantage, Foundayo

Food does not affect Foundayo, so it can be taken with or without food. In contrast, oral Wegovy has to be taken on an empty stomach in the morning with up to four ounces of water. The package insert says not to take it with other liquids and to wait 30 minutes before eating.

Foundayo and oral Wegovy reduce weight loss the same way

Both drugs are GLP-1 receptor agonists that bind to the human GLP-1 receptor. GLP-1 regulates appetite, so both drugs reduce appetite and therefore caloric intake. They both delay gastric emptying.

Oral Wegovy shows slight advantage over Foundayo on weight loss — it seems

In the studies used to apply for FDA approval, oral Wegovy seems to have a slight edge when it comes to the weight that people lose on the drugs. In the pivotal OASIS 4 study, 47% of the study participants taking the top dose of oral Wegovy, 25 milligrams (mg) daily, lost 15% or more of their body weight after 64 weeks of taking the drug, and the study participants lost an average of 13.6% from their baseline weight, which was 234 pounds on average.

Foundayo was studied as a capsule in 1 mg, 3 mg, 6 mg, 12 mg, 24 mg and 36 mg doses in the ATTAIN phase 3 trials that are basis for the FDA approval. But FDA approved tablets in dose equivalent formulations at 0.8 mg, 2.5 mg, 5.5 mg, 9 mg, 14.5 mg and 17.2 mg. A Lilly spokesperson said the capsules used in clinical trials and the approved tablets have been shown to deliver equivalent drug exposure.

In the pivotal Attain trial trial, 35.9% of the participants on the top dose of the drug, the 36 mg capsule — the equivalent of the 17.2 mg tablet — lost 15% or more of their bodyweight after 72 weeks of taking the drug, and they lost an average of 11.1% of their starting bodyweight, which was 227 pounds on average.

Comparing results from two separate trials is problematic, so oral Wegovy’s advantage over Foundayo has to be taken with a grain of salt. The ACHIEVE-3 trial is a head-to-head trial of Foundayo and oral Wegovy, but it is a study of people with Type 2 diabetes and the primary end point is hemoglobin A1c (HbA1c). Results reported in The Lancet last month showed Foundayo to be superior on that HbA1c end point.

The two companies are going to be dueling over what trial results and disputing what the data do and do not show. For example,Novo Nordisk announced today that it will be presenting a comparison between oral Wegovy and Foundayo at the Obesity Medicine Association’s annual meeting next week in San Diego that will show the superiority of its oral Wegovy. But the data the company is using is not new. It is pulling data from its OASIS 4 and Lilly’s ATTAIN-1 trial of Foundayo.

Eli Lilly and Novo Nordisk seem to be following similar pricing strategies

There is a lot of “it depends” when it comes to the price of Foundayo and oral Wegovy. Simple statements about which drug is cheaper may be impossible to make. But, at least for now, Lilly and Novo Nordisk seem to be matching each other’s prices in the growing direct-to-consumer market. Lilly is selling the starter 0.8 mg of Foundayo on it’s LillyDirect direct-to-consumer website for $149 a month, the 2.5 mg dose for $199 a month and 5.5 mg doses and higher at $299. LillyDirect also promotes savings cards that the website says may reduce out-of-pockets to as little as $25 per month. And yesterday’s news release says those with Medicare Part D coverage may pay just $50 per month starting in July.

Novo Nordisk’s direct-to-consumer website, called NovoCare, lists a one-month supply of Wegovy 1.5-mg or 4-mg tablets for $149, so it seems like the manufacturers are mirroring each other’s direct-to-consumer price rather than trying to offer a cheaper alternative. That NovoCare price is available only for new patients, and fine print on the website says that price is only good through August for the 4-mg dose. The price for the higher doses (9 mg and 25 mg) is $299. Novo Nordisk, like Lilly, touts saving cards for people with commercial health insurance that the company says can lower the price for the patient down to the same $25 cost price that Lilly highlights on its LillyDirect website.

Foundayo and Wegovy both have the same boxed warnings about a rare form of thyroid cancer

The package insert for Wegovy says semaglutide causes thyroid C-cell tumors in rodents at clinically relevant doses. As a result, the drug is contraindicated in patients with a personal or family history of medullary thyroid cancer, which originates from C cells, or multiple endocrine neoplasia syndrome Type 2. Most thyroid cancers originate from a different kind of thyroid cells; medullary thyroid cancer accounts for just 1% to 2% of thyroid cancers in the United States, according to the American Thyroid Association. The package insert for Foundayo says orforglipron is not pharmacologically active in rodents and did not produce tumors in rodent experiments. Still, the package insert for Foundayo has the same boxed warning about medullary thyroid cancer and multiple endocrine neoplasia syndrome Type 2 as Wegovy.

Foundayo and Wegovy have almost the same set of warnings and precautions

The package inserts for Foundayo and Wegovy (the oral and the injectable formulations have the same package insert) have the same list of warnings and precautions, which includes acute pancreatitis, hypoglycemia, acute gallbladder disease and several other conditions. The Wegovy package insert mentions heart rate increase, which is not listed in the Foundayo package insert. The Wegovy package insert mentions that complications from diabetic retinopathy have been reported for the drug and that patients with the condition should be monitored. The Foundayo package insert says diabetic retinopathy hasn’t been studied but still advises monitoring patients with the condition. The list of adverse reactions for the two drugs is almost identical: a long list of gastrointestinal problems (nausea, constipation, flatulence and so on), plus headache, fatigue and hair loss.

Foundayo interacts with drugs metabolized by the hepatic CYP3A4 enzyme

Foundayo is metabolized in the liver by the CYP3A4 enzyme so it affects drugs that are also metabolized by that enzyme and, in turn, is affected by them. Strong and moderate CYP3A4 inhibitors, such as clarithromycin, a macrolide antibiotic, and verapamil, a calcium channel blocker used to treat high blood pressure and other cardiovascular conditions, increase concentrations of Foundayo and therefore could increase the risk of adverse reactions. In contrast, strong and moderate CYP3A4 inducers, such as carbamazepine, an anticonvulsant used to treat seizure disorders and bipolar disorder, and efavirenz, an antiretroviral used for HIV treatment, may lower Foundayo concentrations. The advice in the package insert is to avoid concomitant use of Foundayo with strong CYP3A4 inhibitors and inducers.

Foundayo also interacts with simvastatin

Simvastatin, one of the statin drugs prescribed to lower LDL cholesterol levels, is also metabolized by the CYP3A4 enzyme. Concomitant use of Foundayo and simvastatin leads to increases in the active metabolite of simvastatin, and the increase happened even when the dosing was staggered by two hours, says the package insert. The advice is not to take more than 20 mg of simvastatin daily when taking Foundayo.

Wegovy may require lowering the insulin or insulin secretagogue doses

Wegovy lowers blood glucose, and the risk of blood glucose levels getting too low (hypoglycemia) increases with concomitant use of insulin or insulin secretagogues, such as sulfonylureas (glyburide, glipizide, glimepiride). The package insert says reducing insulin or insulin secretagogue doses ought to be considered

Foundayo and Wegovy both may affect the absorption of oral medications

Both drugs may affect the absorption of oral medications because they slow down gastric emptying. The Foundayo package insert says the patients taking oral contraceptives should be advised to switch to a nonoral method for 30 days after starting Foundayo and after dose escalation.