Changes are coming in 2026 for GLP-1 drugs.

Long defined by high prices, shortages and weekly injections, drugs including Wegovy and Zepbound are expected to be easier to access and afford. And new options for people averse to needles are coming.

“The GLP-1 landscape is expected to broaden significantly,” said Dr. Christopher McGowan, a gastroenterologist who runs a weight loss clinic in Cary, North Carolina. “For the first time, medical obesity treatment will move away from a one-size-fits-all model.”

Weight loss pills

GLP-1 pills for weight loss may mark the most significant shift yet.

Last month, Novo Nordisk won Food and Drug Administration approval for the first GLP-1 pill for weight loss. The medication, marketed as the Wegovy pill, is expected to be widely available this month.

Another GLP-1 pill, from Eli Lilly, is expected to gain approval later this year.

Dr. Shauna Levy, medical director of the Tulane Weight Loss Center, said the pills will be a great option for patients who prefer oral medications or who have struggled to access the injectable versions.

“With so much product in the market, I hope the competition will further reduce prices,” Levy said.

A month’s supply of the pills is expected to be cheaper than a month’s supply of injections.

Novo Nordisk hasn’t announced the list price for the Wegovy pill yet, but it has said that the two lowest doses will cost $149 a month for people paying in cash and not using insurance. The lowest dose of the Wegovy injection, by comparison, is $349 a month for people paying in cash.

Starting Monday, the two higher doses of the pills will be priced at $299 a month for people paying in cash. For those with insurance that covers the drugs, out-of-pocket costs could be as low as $25 a month, according to the company.

Dr. Daniela Hurtado Andrade, an endocrinologist at the Mayo Clinic in Jacksonville, Florida, said the lower prices will most likely expand access. Still, she noted, the most drastic weight loss in the trials came from the highest dose, which means people would likely have to pay more if they want to lose more weight.

Even $149 a month for some is still too expensive, she said.

“It’s something that needs to be discussed with patients,” Andrade said, “because they may have expectations that are not real.”

Levy said that one drawback to the pill is that it must be taken on a strict schedule to get the best results: every morning on an empty stomach. In a late-stage clinical trial, people who adhered to the schedule lost 16.6% of their body weight, on average. That fell to 13.6% when people didn’t take the pill exactly as prescribed.

“I think we need to consider that the efficacy of these medications is decreased if they are not taken consistently, and I am curious to see how they perform in real life,” Levy said. There’s a bit more flexibility around Lilly’s pill, which still must be taken daily but can be taken any time of the day.

Chris Mertens, 35, of Menominee Falls, Wisconsin, said he had no trouble remembering to take the Wegovy pill every morning, which he did as part of a clinical trial in late 2022. Though he didn’t know it at the time, he got the real medication, not a placebo.

When he began the trial, he weighed about 260 pounds, with a body mass index of around 32, and hoped to get closer to 200 pounds. After a year and a half on the medication, Mertens said he lost about 40 pounds, eventually plateauing at around 220. The weight loss, he said, gave him more energy at work and at home and changed his relationship with food.

A stronger injection

Lilly is getting closer to finishing its clinical trials on what could be the most powerful GLP-1 drug yet, called retatrutide.

Like Wegovy and Zepbound, retatrutide is a weekly injection. It targets GLP-1 and GIP, the same two hormones targeted by Lilly’s blockbuster drugs Mounjaro and Zepbound. Retatrutide also targets a third hormone, called glucagon, which may further boost weight loss.

Lilly said in December that in a Phase 3 clinical trial, patients taking the highest dose of the experimental injection lost nearly 29% of their body weight on average after about 16 months — more than has been seen with any GLP-1 drug currently on the market.

The trial included roughly 450 adults with obesity or who were overweight and had knee osteoarthritis.

“These are numbers we simply didn’t think were possible just a few years ago,” McGowan said.

The medication’s high effectiveness, however, may come with a tradeoff of more intense side effects, such as nausea, diarrhea, constipation and vomiting. Lilly reported a dropout rate of 18.2% for patients who got the drug compared with 4% in the placebo group. By comparison, the dropout rate for the highest dose group in a separate trial for Zepbound was just 6.2%.

“More is not always better,” McGowan said. “In real-world practice, those discontinuation rates may be even higher.”

Andrade said the medication could be helpful for people with severe obesity, who may still have trouble losing weight on the existing GLP-1 medications, although she’d like to see more data on the side effects.

A Lilly spokesperson said the company is completing seven additional trials on retatrutide, which are expected to be completed in 2026. It could file for FDA approval as early as this year.

Prices and partnerships

Access to the drugs has also expanded through cash-pay programs.

Lilly first started offering cash discounts for certain doses of Zepbound in 2024, through its LillyDirect program. Novo Nordisk later followed with NovoCare Pharmacy in March, selling Wegovy at a discounted price for cash payers.

In 2025, some major retailers followed. Costco in October announced it would sell Wegovy and Ozempic for $499 a month for customers paying cash, and Walmart has rolled out a comparable arrangement with Lilly for Zepbound.

In 2026, the Trump administration will launch the self-pay platform TrumpRx.gov. The website will not sell prescription drugs directly but will connect people to drugmakers’ discount websites.

The average monthly cost of weight loss injections on TrumpRx is expected to start around $350 and fall to about $250 within the next two years, President Donald Trump said when announcing the arrangements with the drugmakers. Starting doses of GLP-1 pills are expected to cost $149.

Dr. Susan Spratt, professor of medicine at Duke University School of Medicine, said the partnerships will “only improve access.” The question, she added, is whether the discounts will be enough to improve access to everyone who could benefit from the medications. “They are still quite expensive,” Spratt said.

Levy said the self-pay options would make the drugs easier to get, particularly for people whose insurance doesn’t cover them.

Many of the self-pay options connect patients with doctors on telehealth who will determine if they qualify for the drugs and write a prescription.

“I think there is potential for increased access with deals for cheaper products at Walmart and Costco,” Levy said, “but I really want to make sure patients are treated and are followed by obesity medicine specialists or providers who really know what they are doing with anti-obesity medications.”

This article was originally published on NBCNews.com