Semaglutide, a glucagon-like peptide-1 agonist (GLP-1) used for weight loss, was once only available as an injection but is now also prescribed in an oral form. The new semaglutide tablet is making waves as the first of its kind for obesity management in tablet form. But is it as effective as the injectable version?
Called Wegovy, the tablet comes in graded strengths, usually starting at 1.5 milligrams (mg) and increasing up to 25 mg. Unlike the weekly injection, the tablet is taken once a day on an empty stomach with up to 120 ml of water before eating, drinking or taking any other medicines, explains Dr Scott Kipnis.
But how does this new weight loss tablet works and what this milestone could mean for the future of obesity treatment?
How does the Wegovy pill work?
The tablet “uses an absorption enhancer to allow the semaglutide peptide to be absorbed through the stomach lining,” Dr Kipnis says. Because less of the medicine reaches the bloodstream compared to an injection, a higher daily dose is needed to achieve similar levels, he explains. Injectable semaglutide for weight management is usually given in doses up to 2.4 mg once a week.
Used alongside regular movement and a reduced-kilojoule diet, the tablet is intended for adults with overweight or obesity, or those with weight-related health problems. It is also used to help lower the risk of major cardiovascular events such as death, heart attack or stroke in adults with overweight or obesity and established heart disease.
“It does offer an easier means of taking the medication for those worried about needles,” Dr Kipnis notes. “The pill form of the medication works the same way as the injectable GLP-1s. It slows down the movement of food through the stomach, curbing appetite, leading to weight loss.”
Dr Kipnis says the oral medicine is expected to have similar side effects to the injectable version, “typically gastrointestinal issues including nausea and constipation.”
Are Wegovy pills as effective as injections?
A large clinical trial of the oral version found that people who completed 64 weeks of treatment lost an average of about 17% of their body weight, compared to around 3% in the placebo group. In comparison, a key trial of the injectable form reported an average weight loss of about 15% over 68 weeks. Taken together, these data suggest that, when used as directed alongside lifestyle changes, the tablet and injection offer similar weight loss benefits.
“We know there are people who are interested in addressing their weight but have been waiting on the sidelines for a medicine that was right for them,” says Ed Cinca, a senior company representative quoted in a recent announcement about the tablet. “For many of them, that wait is over as we can now offer the powerful efficacy of semaglutide in a once-daily pill.”
How much does the Wegovy pill cost?
According to company information, the out-of-pocket cost starts at about AU$220 per month (roughly AU$7.50 a day) for the 1.5 mg starting dose. Higher doses are priced on a sliding scale, with the top doses reported at about AU$300 per month. Some people with private health insurance may pay less, depending on their cover and any co-payment rules.
Availability and pricing will differ by country, local approval and insurance arrangements, so it is important to speak with a doctor or pharmacist about access, costs and any subsidy options in your own health system.
Wegovy access and PBS subsidies in Australia
In Australia, access to Wegovy is shifting as the government moves to list the medicine on the Pharmaceutical Benefits Scheme (PBS) for a narrow group of patients living with severe obesity and heart disease. The federal Health Minister has committed to subsidising Wegovy for adults with an established cardiovascular condition, such as a previous heart attack or stroke, who also have a body mass index (BMI) of 35 or higher.
Right now many Australians who use GLP-1 medicines for weight management pay full private prices that can reach $4,000 to $5,000 a year, which puts treatment out of reach for a large number of people. Once Wegovy is listed on the PBS, eligible patients will instead pay the standard PBS co-payment (currently $25 per script or $7.70 for concession card holders), slashing their annual out-of-pocket costs and improving access for people at highest medical risk.
The government has flagged that this will be a significant expense for taxpayers, so the criteria have been set deliberately tight and a risk-sharing arrangement with the manufacturer is expected to manage overall cost. Clinicians note that prioritising people with severe obesity and cardiovascular disease is likely to deliver the greatest health benefit, as weight loss in this group can help prevent repeat cardiovascular events and reduce premature deaths.
Regulators are also watching safety closely. Australia’s medicines regulator has warned that GLP-1 drugs may be linked with rare reports of suicidal thoughts, so anyone prescribed Wegovy should be monitored for changes in mood or behaviour and encouraged to seek urgent help if they notice concerning symptoms. Doctors will weigh up these risks against the potential benefits when deciding whether Wegovy is appropriate, and patients should always discuss any side effects before stopping or changing their medicine.
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