The short version
The cash-pay GLP-1 market is now big enough that the manufacturers report on it. At its capital markets day in September, Novo Nordisk said half of its US Wegovy business comes through out-of-pocket, self-pay channels and that direct cash purchases make up 90% of demand for the Wegovy pill, according to Reuters as reported by Medical Daily. Novo did not say whether that half is measured in patients, prescriptions or revenue, so treat it as a company statement, not an audited figure.
Third-quarter results since then point the same way. For a brand building its 2027 product list, our conclusion is to carry both pills and both injectables, use a pill as the entry offer for new cash patients, and keep the program fee separate from the drug price because January pricing is still unknown.
What the two reports said
Lilly, October 29. Revenue was $24.4 billion. Zepbound brought in $5.35 billion (up 49%) and Mounjaro $10.72 billion (up 65%). Foundayo, Lilly's oral GLP-1, sold $184 million, below the roughly $229 million analysts expected, but US Foundayo prescriptions and new patients both doubled from the second quarter, and Lilly said about 4 in 10 US patients starting an oral obesity medicine chose Foundayo. Lilly put its share of the US obesity and diabetes market at 63% against Novo's 36.6%. US realized prices fell 7%. Lilly expects a type 2 diabetes approval for Foundayo in the fourth quarter and raised its 2026 revenue guidance to $91 to $92 billion (CNBC).
Novo, November 4. Sales were DKK 79.2 billion, up 4% at constant exchange rates. The Wegovy pill sold DKK 5.39 billion (about $810 million), up 53% from the second quarter, with DKK 4.18 billion of that in the US and about 3.6 million US prescriptions in the quarter. US sales of injectable Wegovy fell 13% at constant exchange rates. Novo raised its full-year outlook to a range of minus 2% to plus 2% (CNBC; Reuters via 93.3 The Drive).
Put next to each other, three things stand out for an operator. The pill is where Novo's US growth is coming from, and Novo says most pill demand is cash. Lilly still sells far more injectable drug than anyone, and Zepbound alone outsold the whole Wegovy pill several times over. And Foundayo is growing fast from a small base and missed estimates, which tells you oral share is still moving.
Demand is not the question anymore
Gallup's 2026 survey (5,065 adults, fielded May 28 to June 5) found 11% of US adults currently take a GLP-1 for weight loss, up from 3% in 2024, and 15% have taken one at some point. About two-thirds of current users take a brand-name product and 18% a compounded one (Gallup).
Coverage is going the other way. WTW found 53% of employers with more than 100 staff cover GLP-1s for weight loss, down from 57% in 2025; 16% cover them but are considering removal; 8% have already moved to steering employees toward direct-to-consumer purchase and 28% are planning or considering it. Gallagher's Seth Friedman estimated that 20% to 30% of the firm's clients dropped coverage for 2027 and are sending employees the direct route (CNBC). Our post on the 14% of employers dropping coverage covers where those patients land in January.
So more people want the drug and fewer plans pay for it. That is the self-pay market, and it is the one a DTC brand serves.
A 2027 formulary, product by product
Cash prices below are the manufacturers' published self-pay prices as of early November. They can change, and the Novo prices in particular are expected to be revisited after December 31.
| Product | Entry cash price | Higher doses | Q3 signal | Who it suits |
|---|---|---|---|---|
| Wegovy pill | $149 (1.5 mg) | $199 (4 mg), $299 (9 and 25 mg) | DKK 5.4B, about 3.6M US scripts, 90% cash per Novo | New cash patients who do not want injections; price-sensitive starts |
| Foundayo | $149 | $199 to $349 by dose | $184M, scripts doubled, about 4 in 10 oral starts | Same patients; Lilly says it can be taken any time without food or water rules |
| Wegovy pen | $199 for first two fills (new patients, 0.25 and 0.5 mg) | $349; Wegovy HD 7.2 mg $399 | US injectable sales down 13% | Patients who want the injection with a known track record |
| Zepbound vial or KwikPen | $299 (2.5 mg) | $399 (5 mg), $449 (7.5 to 15 mg) | $5.35B, up 49% | Patients who want the most weight loss and accept injections |
Sources: NovoCare for Wegovy; LillyDirect prices as compiled in our 2027 pricing post, where Zepbound's lower prices depend on refilling within 45 days.
Four positions we would take from this.
Carry both pills. Patients arrive having seen an ad for one of them, and the Q3 numbers say neither has won. A brand that only offers the Wegovy pill has to talk a Foundayo-curious patient out of their choice. That is a bad first conversation. The pill-curious funnel post covers how to route between them in intake.
Lead acquisition with the pill. A $149 entry price next to your program fee is the easiest offer to explain, and Novo's own data says pill buyers are overwhelmingly cash buyers. Designing a pill-first program has the clinical workflow.
Keep both injectables, and do not apologize for them. In their pivotal trials the top-dose injectables produced more average weight loss than the pills, and Lilly's injectable revenue shows where patients who want maximum effect still go. A patient who plateaus on a pill needs a next step inside your program, not a cancellation.
Do not build a launch around a product that is not approved. CagriSema still had no FDA decision as of early November. If it arrives, adding it should be a formulary change, not a project (our readiness post).
January pricing is the part nobody knows
Here is what is fixed. Novo's $199 offer for the first two 28-day fills of Wegovy 0.25 mg and 0.5 mg applies to new patients whose prescription is written and received by NovoCare Pharmacy by December 31, 2026 and shipped by January 31, 2027 (NovoCare terms). On January 1, Novo's list price for Wegovy, Ozempic and Rybelsus drops to $675 a month, which helps insured patients with deductibles and, Novo says, does not change self-pay prices.
Here is what is not. Medical Daily reports that Novo says its self-pay pricing will be updated after December 31, 2026, without saying how. Lilly has published no 2027 change to LillyDirect prices. Both companies have cut cash prices within the past year, and Lilly's US realized price fell 7% in the third quarter.
What we would do about it:
- Price your program fee on its own line, so a drug price change in January does not force you to reprice your care.
- Tell December Wegovy starts in writing that the $199 price covers two fills and what the third will cost, as of today.
- Build a renewal notice that can carry a price change. If a manufacturer moves, your patients should hear it from you before their card is charged.
- Do not print January prices on ads or landing pages you cannot edit in a day.
We do not know whether January brings lower or higher cash prices. We would plan for either and promise patients neither.
Where Turbopills fits
On Turbopills, a formulary is configuration: each product and dose is its own plan, intake can branch to a pill or an injectable based on answers and provider review, and dose changes move the patient to the right price without re-onboarding. Billing starts only when a provider approves, renewal notices go out before each charge, and the program fee can be billed separately from a drug the patient buys through a manufacturer channel. We are in private beta and quote per program; in a demo, ask us to switch a patient from the Wegovy pill to Zepbound and show you what they are charged and told.
FAQ
How many people take GLP-1s for weight loss in 2026? Gallup's 2026 survey found 11% of US adults currently take a GLP-1 for weight loss, up from 3% in 2024. About two-thirds of current users take a brand-name product.
How much of Wegovy is self-pay? Novo Nordisk said in September 2026 that half of its US Wegovy business comes through self-pay channels and that 90% of Wegovy pill demand is direct cash purchase. Novo did not say how the half is measured.
When does the $199 Wegovy offer end? For new patients on Wegovy 0.25 mg or 0.5 mg, the prescription must be written and received by NovoCare Pharmacy by December 31, 2026 and shipped by January 31, 2027. The price applies to the first two 28-day fills.
Should a telehealth brand offer Foundayo or the Wegovy pill? Both. Lilly said about 4 in 10 US patients starting an oral obesity drug chose Foundayo in Q3, and the Wegovy pill grew 53% quarter over quarter. Patients arrive asking for one or the other, and intake plus provider review should decide.