The Impact of FDA-Approved Oral Wegovy on Sustainable Pharmacy Benefits

The last 5 years have been transformative on the landscape of metabolic health. GLP-1 medications like Ozempic and Wegovy have dominated headlines for their innovative treatment of type 2 diabetes and weight management, respectively. But for many patients, the requirement of a weekly injection remained a hurdle for adoption and adherence.

Enter the oral Wegovy pill. This addition of daily tablets as an option represents a new phase in the evolution of GLP-1s. As this new form hits the market, employers are left wondering: How will this impact our bottom line, and how do we manage this growing demand?

A Shift in Obesity Treatment Options

The FDA’s move toward approving oral versions of semaglutide (the active ingredient in medications like Wegovy, Ozempic, and Rybelsus) for weight management marks a new chapter in clinical obesity care. While oral semaglutide has existed for the management of diabetes (under the brand Rybelsus), the daily oral version specifically indicated for weight management  offers a non-invasive alternative with comparable efficacy to its injectable predecessor.

For many patients, this is a game-changer. It removes the potential barrier of self-injection and simplifies storage and travel. At the same time, there are limitations around its strict administration. The oral product has to be taken on an empty stomach and patients also have to delay eating, drinking, or taking other oral medications for at least 30 minutes, which can be a burden to patients. However, the assumed ease of use has inevitably led to increased demand, which puts further financial pressure on already strained pharmacy benefits plans and employers.

Other FDA-Approved Obesity Treatments

While the increased news and cultural attention to oral Wegovy may spark demand, it’s by no means the only alternative to injectable GLP-1s for obesity as an indication. In some cases, other treatments may be more clinically appropriate for members, and in most cases, are significantly more cost-effective for both the member and plan.

• Qsymia (Phentermine-topiramate) & Contrave (Naltrexone-bupropion): These medications help reduce appetite and cravings. They are recommended by FDA guidelines and are effective; patients can average 5-10% weight loss with these medications. What’s more, they’re much cheaper than GLP-1s (averages ~$150 - $300 per fill) and have different side effects from semaglutides and tirzepatides. 

• Topiramate & Phentermine: These are individual, very low-cost components that can also be used as well and are very low-cost options (less than $25 per fill!) compared to GLP-1s and the branded combination products. 

Looking ahead, the Wegovy pill will not likely be the sole oral GLP-1 for long. Lilly has their own pill in the final stages of trialing and FDA approval. It’s expected that Lilly’s Orforglipron could be approved sometime in 2026. 

Embracing Innovation While Controlling Costs

To understand the current surge of GLP-1 demand, we have to look back at the trends shaping the metabolic health industry. GLP-1s (glucagon-like peptide-1s) have actually been around for nearly 20 years. They were famously inspired by the venom of the Gila monster, a reptile that eats only a few times a year. In humans, the GLP-1 hormone is naturally released after eating, signaling the brain’s appetite centers to promote satiety and slowing digestion.

Today, these drugs are more than a medical breakthrough; they are a cultural phenomenon.

• Usage Surge: The number of American adults taking GLP-1s has increased by 587% over the last five years.

• Powerful Employee Retention Point: 67% of Americans would prefer to stay in a job they dislike just to maintain coverage for these medications.

• Fiscal Impact: Weight management drugs accounted for nearly half of the increase in total drug spend in 2024 alone.

With high prices, employers are caught in a difficult position. Employees view this coverage as an essential benefit, yet skyrocketing costs threaten plan sustainability. Traditional tactics are often not enough to stem the tide. So, how can you deliver on employee expectations without breaking the bank?

The Future of GLP-1s and Sustainable Savings

The pharmaceutical market moves fast, and your PBM should move faster. At SmithRx, we constantly re-evaluate our formulary to seek out low-cost alternatives and direct-to-employer deals. Our approach to sustainability is built on two pillars:

• Robust Clinical Review: We use a risk-based policy that evaluates a member’s entire profile (including co-morbidities and medication history) to ensure the right patient gets the right drug. In addition, we partner with strategic care partners to ensure adherence and appropriate lifestyle modifications to support patient success on treatments like GLP-1s.

• Pathway to Lowest Net Cost: Our system is designed to identify the lowest cost pathway for the plan sponsor. We focus on the net cost rather than deceptive "discounts", leveraging unique partnerships to achieve savings that far outpace the industry average.

We believe employers shouldn’t have to choose between financial health and employee well-being. By implementing strategic plan design, we help you find the middle ground of sustainable care.

The new oral Wegovy medication is a testament to how far science around metabolic health has come, but it also highlights the need for a smarter approach to pharmacy benefits for employers. By combining clinical rigor with transparent cost control and holistic care support, you can offer life-changing treatments in a way that remains fiscally responsible for both your business and your members.