Many US patients opt for obesity drug injections, defying some expectations

• Injectable Zepbound showed 22% weight loss over 72 weeks versus oral Foundayo's 11% reduction, driving patients to prioritize efficacy over convenience despite industry predictions of 2-to-1 preference for pills
• The Medicare pilot program launched in July for Americans 65+ is processing most authorizations in under 12 hours, with some clinics receiving approvals for 200 patients in the first week
• Access remains uneven as some patients face delays and doctors describe 'cumbersome' processes requiring significant staff hours to navigate approval requirements

Medicare Obesity Drug Program: Injectable Medications Dominate Despite Pill Expectations

Key Developments

The U.S. Centers for Medicare & Medicaid Services launched an 18-month pilot program in July 2024, providing first-time access to GLP-1 obesity medications for Medicare beneficiaries aged 65 and older at $50 monthly. Contrary to pharmaceutical industry predictions, early data shows patients are predominantly choosing injectable forms over oral pills, according to Reuters interviews with doctors and analysts.

Companies and Products

Novo Nordisk: Wegovy (injectable), oral Wegovy

Eli Lilly: Zepbound (injectable), Foundayo (oral pill)

Direct-to-consumer pricing ranges from $149 to $449 monthly without insurance.

Efficacy Data

Clinical trial results demonstrate superior weight loss with injectables:

• Zepbound: 22% weight loss over 72 weeks
• Wegovy injectable: 15% weight loss over 68 weeks
• Oral Wegovy: 14% reduction over 64 weeks
• Foundayo: 11% reduction over 72 weeks

Eight of ten doctors interviewed confirmed patients are selecting injectables, with efficacy being the primary driver. "It's all about efficacy," noted RBC Capital Markets analyst Trung Huynh.

Program Performance

CMS reports most authorizations completed within 12 hours, calling initial weeks "positive." Dr. Christina Nguyen's Knownwell clinic received approximately 200 approvals in the first week. However, challenges persist: some patients face extended wait times, and physicians describe "cumbersome" administrative processes requiring significant staff hours.

Market Implications

Millions qualify for coverage under this program. While IQVIA data shows prescription jumps for Foundayo, injectable therapies remain dominant. Both companies expressed satisfaction with early program results, though neither disclosed specific volume data. The pilot's success could significantly expand market access for these blockbuster obesity treatments.