Oral semaglutide: the three approved pills and how they differ

For years the only semaglutide pill was Rybelsus, a diabetes drug. Now there are three approved tablets, each with its own name, doses and job, plus a separate GLP-1 pill from Eli Lilly. The names overlap enough to confuse anyone. This guide sorts them out, starting with the one most people searching for “oral semaglutide” want: the Wegovy pill for weight.

Three approved semaglutide pills, three different jobs

The Wegovy pill treats weight and lowers heart-event risk. Rybelsus and its newer version, renamed Ozempic tablets, treat type 2 diabetes. All three contain semaglutide, but the label is blunt that the diabetes tablets “are not substitutable on a mg-to-mg basis” ^[2]. Different doses, different jobs.

What happened to Rybelsus? Novo Nordisk developed a second formulation, called R2, approved in December 2024. FDA approved renaming it “Ozempic tablets” on January 30, 2026 ^[7]. The original Rybelsus tablets are being phased out; FDA’s drug shortage database listed them as “To Be Discontinued” in June 2026 ^[8]. Rybelsus also gained a heart-risk indication in October 2025, based on the SOUL trial ^[6].

How the pill gets absorbed, and why the morning rule matters

Semaglutide tablets only work if you take them on an empty stomach with a small sip of water, then wait. Food and drink cut how much gets absorbed. The Wegovy label says to take the tablet “once-daily on an empty stomach in the morning with water (up to 4 ounces),” and to “wait at least 30 minutes before eating food, drinking beverages or taking other oral medications” ^[1]. Rybelsus and Ozempic tablets carry the same rule ^[2].

The reason is chemistry. Semaglutide is a peptide, and the stomach normally breaks peptides down. The tablets are “co-formulated with SNAC which facilitates the absorption of semaglutide,” and absorption happens mostly in the stomach ^[1]. Even so, the label estimates absolute bioavailability at only about 1% to 2%. That’s why the pill doses (up to 25 mg a day) look so much larger than the injection doses (up to 2.4 mg a week, or 7.2 mg for Wegovy HD).

What the Wegovy pill did in trials: 13.6% weight loss at 64 weeks

The approved 25 mg Wegovy pill was tested in OASIS 4. In 307 adults without diabetes, average weight fell 13.6% over 64 weeks, against 2.2% on placebo ^[13]. People on the pill were also more likely to reach 5%, 10%, 15% and 20% weight-loss milestones.

An earlier trial, OASIS 1, used a 50 mg daily tablet and reached 15.1% weight loss at 68 weeks, against 2.4% on placebo ^[14]. That 50 mg dose is not the one FDA approved, so don’t read OASIS 1 as the Wegovy pill’s result.

How does the pill compare with the shot? No trial has tested them head to head. In separate trials, the 25 mg pill reached 13.6% at 64 weeks and the 2.4 mg injection reached 14.9% at 68 weeks ^[19]. Those are close, but different people, lengths and sites mean you can’t subtract one from the other. All of these trials were funded by Novo Nordisk.

Heart and diabetes evidence for the tablets

For people with type 2 diabetes, the heart data are direct. SOUL followed 9,650 adults aged 50 and older with diabetes and heart or kidney disease for about four years. Oral semaglutide cut major heart events by 14% against placebo (hazard ratio 0.86) ^[15]. The earlier PIONEER 6 trial was built only to show the pill didn’t raise heart risk, and it met that goal ^[16].

The Wegovy pill’s heart indication is different. It covers adults with established heart disease and obesity or overweight ^[1], the population studied for the Wegovy injection in SELECT. A separate heart-outcome trial of the 25 mg pill in people without diabetes hasn’t been published. Keep that in mind if heart protection is your main reason for choosing a pill over the shot.

Label doses, as the labels state them

Each pill starts low and steps up, to ease stomach side effects. The Wegovy pill label starts at 1.5 mg daily, then moves to 4 mg from day 31, 9 mg from day 61 and the 25 mg maintenance dose from day 91 ^[1]. Rybelsus steps through 3, 7 and 14 mg, and Ozempic tablets through 1.5, 4 and 9 mg ^[2]. Foundayo starts at 0.8 mg and steps up at least 30 days apart, to a maximum of 17.2 mg ^[3].

The labels include tables for switching between these products. Switching is your prescriber’s call, not a conversion you should do at home. The mg numbers don’t line up across products, which is the whole point of the “not substitutable” warning.

Side effects: mostly stomach, plus a boxed warning

Stomach side effects are the main story. In OASIS 4, 74.0% of people on the 25 mg pill reported a gastrointestinal adverse event, against 42.2% on placebo ^[13]. Most were mild to moderate. The combined Wegovy label lists nausea, diarrhea, vomiting, constipation and stomach pain among the most common reactions ^[1].

The Wegovy label, which covers both the injection and the tablets, carries a boxed warning: semaglutide caused thyroid C-cell tumors in rodents, and “it is unknown whether WEGOVY causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans” ^[1]. The pills aren’t for anyone with a personal or family history of medullary thyroid cancer or MEN 2. Rybelsus, Ozempic tablets and Foundayo carry the same contraindication ^{[2] [3]}.

Pill or injection? The trade-offs that decide it

• Schedule. The pill is daily; the injection is weekly.
• Routine. The semaglutide pill needs an empty stomach and a 30-minute wait every morning. Foundayo can be taken “with or without food” ^[3].
• Needles. The pill has none. For some people that settles it.
• Trial results. 13.6% (pill, 64 weeks) and 14.9% (injection, 68 weeks) in separate trials ^{[13] [19]}.
• Cost. NovoCare prices the pill from $149 a month and the pen at $199 for the first two fills, then $349 ^[11].
• Long run. Either one works only while you take it. Pick the one you can keep doing in year three, not just month one.

The pill-versus-shot question gets its own comparison in Wegovy pill vs Wegovy injection.

What it costs: $149 to $299 a month self-pay, before a program fee

NovoCare sells the Wegovy pill for cash at $149 a month for 1.5 mg, $199 for 4 mg and $299 for 9 mg or 25 mg, with one month defined as a 30-tablet bottle as of this update ^[11]. NovoCare says pricing will be updated after December 31, 2026. Foundayo through LillyDirect starts at $149 a month for 0.8 mg ^[12]. The 2.5 mg dose is also $149 and 5.5 mg is $199, prices Lilly calls temporarily reduced through December 31, 2026. Doses from 9 mg to 17.2 mg are $299. The 14.5 mg and 17.2 mg prices apply when you refill within 45 days. Self-pay prices for Rybelsus and Ozempic tablets aren’t quoted here.

Telehealth programs add a visit or membership fee on top of the medication, or bundle the two. The table shows what each program’s monthly total comes to as of this update.

Also offered by (no standing monthly price published): Sesame, Found, ShedRxPartner, Sesame.

Programs that offer the Wegovy pill side by side are on the GLP-1 pill programs scorecard. AgelessRx also lists Wegovy pill access but doesn’t publish its pill pricing. If you’re comparing a brand pill with compounded options, what compounded semaglutide costs lays out the other side, and how to get compounded semaglutide covers both routes.

The other GLP-1 pill: Foundayo (orforglipron)

Foundayo is Eli Lilly’s once-daily GLP-1 pill, approved on April 1, 2026 for weight reduction and long-term maintenance in adults with obesity, or overweight plus a weight-related condition ^{[9] [3]}. It isn’t approved for type 2 diabetes. Unlike semaglutide, orforglipron is a small molecule rather than a peptide, so it doesn’t need the fasting routine: the label says to take it “with or without food.”

In the main trial described in its label, the top dose lowered weight 11.1% at 72 weeks against 2.1% on placebo ^[3]. The trial used an earlier formulation, which the label maps to equivalent Foundayo doses, and it was published as ATTAIN-1 ^[17]. In people with type 2 diabetes, orforglipron lowered A1C more than oral semaglutide over 52 weeks in ACHIEVE-3, a Lilly-funded trial with several Lilly employees among its authors ^[18]. Foundayo has its own page at orforglipron.

“Oral semaglutide” from compounding pharmacies is a different product

Compounded semaglutide drops, lozenges, dissolving tablets and capsules are not FDA-approved and have not been tested in trials. The Wegovy pill’s results don’t transfer to them. They don’t contain Novo Nordisk’s SNAC formulation, and nobody has published how much semaglutide they deliver.

FDA’s general warning about compounded GLP-1s applies to every form: compounded drugs “are not FDA approved,” and FDA does not review them “for safety, effectiveness or quality before they are marketed” ^[10]. If a program offers “oral semaglutide” for less than the Wegovy pill, ask whether it’s the Novo Nordisk tablet or a compounded product. More on what compounded semaglutide is, and isn’t, is in compounded semaglutide. Questions about low or stretched-out doses are covered in microdosing GLP-1s.