Oral Semaglutide (Wegovy Pill)

Oral semaglutide for weight management received FDA approval on December 22, 2025, with US commercial launch in January 2026 -- the first oral GLP-1 receptor agonist approved for chronic weight management, preceding orforglipron by approximately three months. The mechanism is identical to injectable Wegovy: semaglutide activates GLP-1 receptors in the hypothalamus and gut, suppressing appetite, slowing gastric emptying, and stimulating glucose-dependent insulin secretion. The oral format uses SNAC as an absorption enhancer, requiring strict administration: empty stomach, no more than four ounces of water, no food for 30 minutes after ingestion. The OASIS 4 Phase 3 trial (N=307, 64 weeks) demonstrated 16.6% body weight loss in the adherent population. 34.4% of adherent participants lost 20% or more body weight versus 2.9% placebo. The trial was smaller (N=307) than STEP or SURMOUNT programs; broader cardiovascular outcomes trials (SELECT-O) are ongoing. Side effects mirror injectable semaglutide: nausea, diarrhea, vomiting, constipation, headache, fatigue. Black box warning for thyroid C-cell tumors. Cost: Novo Nordisk self-pay $149/month. Commercial savings card: as low as $25/month. Medicare Part D: $50/month from July 2026. Eligibility: adults with BMI 30+ or BMI 27+ with weight-related comorbidity.