Semaglutide vs Orforglipron: Weight Loss, Side Effects
Semaglutide and orforglipron are both GLP-1 medicines, weekly injection or daily tablet versus daily tablet. In their own trials, average weight loss was 14.9% and 11.1%. Self-pay starts at $149 per month for Semaglutide and $149 per month for Orforglipron.
Foundayo and Wegovy at a glance
Semaglutide and Orforglipron compared
| Semaglutide | Orforglipron | |
|---|---|---|
| Medicine | semaglutide |  orforglipron |
| Active ingredient | semaglutide | orforglipron |
| Manufacturer | Novo Nordisk | Eli Lilly |
| How it is taken | Weekly injection or daily tablet | Daily tablet |
| Approved for | Approval covers weight loss, heart risk, and MASH liver disease. For people with type 2 diabetes, it also covers type 2 diabetes and kidney disease | Weight loss |
| First FDA approval | 2017 | 2026 |
| Average weight loss in trials | 14.9% (STEP 1, 68 weeks) | 11.1% (ATTAIN-1, 72 weeks) |
| Most common side effect | Nausea 20.3% vs 6.1% on placebo | Nausea 35% vs 10% on placebo |
| List price | $1,027.51 per pen | $649 per month |
| Self-pay from | $149 per month | $149 per month |
| Medicare GLP-1 Bridge | $50 per month, eligible Part D | $50 per month, eligible Part D |
| FDA shortage | Resolved February 21, 2025 | Not listed |
Sources: FDA label, FDA label (DailyMed), Novo Nordisk pricing, pricinginfo.lilly.com.
A comparison of weight loss
No trial has directly compared the two, so the figures shown come from separate trials with different participants and different lengths.
| Trial | Who took part | Length | Group | Average weight loss | Placebo |
|---|---|---|---|---|---|
| OASIS 4 | Adults with obesity or overweight, without diabetes | 64 weeks | Wegovy pill 25 mg daily | 13.6% | 2.4% |
| STEP 1 | Adults with obesity or overweight, without diabetes | 68 weeks | Semaglutide 2.4 mg weekly | 14.9% | 2.4% |
| STEP 2 | Adults with obesity or overweight who also have type 2 diabetes | 68 weeks | Semaglutide 2.4 mg weekly | 9.6% | 3.4% |
| ATTAIN-1 | Adults with obesity or overweight, without diabetes | 72 weeks | Foundayo 5.5 mg daily | 7.4% | 2.1% |
| ATTAIN-1 | Adults with obesity or overweight, without diabetes | 72 weeks | Foundayo 9 mg daily | 8.3% | 2.1% |
| ATTAIN-1 | Adults with obesity or overweight, without diabetes | 72 weeks | Foundayo 17.2 mg daily | 11.1% | 2.1% |
| ATTAIN-2 | Adults with obesity or overweight who also have type 2 diabetes | 72 weeks | Foundayo 5.5 mg daily | 5.1% | 2.5% |
| ATTAIN-2 | Adults with obesity or overweight who also have type 2 diabetes | 72 weeks | Foundayo 9 mg daily | 7% | 2.5% |
| ATTAIN-2 | Adults with obesity or overweight who also have type 2 diabetes | 72 weeks | Foundayo 17.2 mg daily | 9.6% | 2.5% |
Trial sources: OASIS 4 (FDA label (DailyMed)), STEP 2 (PubMed), STEP TEENS (PubMed), ATTAIN-1 (FDA label (DailyMed)).
A comparison of side effects
For each label, a separate group of people was tested against that label's own placebo group.
| Side effect | Ozempic | Placebo (Ozempic trials) | Foundayo | Placebo (Foundayo trials) |
|---|---|---|---|---|
| Nausea | 20.3% | 6.1% | 35% | 10% |
| Vomiting | 9.2% | 2.3% | 24% | 4% |
| Diarrhea | 8.8% | 1.9% | 25% | 11% |
| Abdominal pain | 7.3% | 4.6% | 14% | 7% |
| Constipation | 5% | 1.5% | 27% | 9% |
| Dyspepsia | Not listed | Not listed | 16% | 4% |
| Headache | Not listed | Not listed | 9% | 7% |
| Abdominal distension | Not listed | Not listed | 9% | 3% |
How price and coverage compare
| Medicine | How you pay | Price |
|---|---|---|
 Ozempic | List price before insurance | $1,027.51 per pen |
| Ozempic | Ozempic Savings Offer (insured) | for up to 3 months, starting as low as $25 each month |
| Ozempic | Self-pay: Ozempic pill (from 1.5 mg) | $149 per month |
 Wegovy | List price before insurance | $1,349.02 per month |
| Wegovy | Wegovy Savings Offer (insured) | from $25 per month |
| Wegovy | Self-pay: Wegovy pill 1.5 mg | $149 per month |
| Wegovy | Medicare GLP-1 Bridge (Wegovy, eligible Part D) | $50 per month |
 Rybelsus | List price before insurance | $1,027.51 per 30 tablets |
| Rybelsus | RYBELSUS Savings Offer (insured) | starting at $25; each fill covers 1 month or 2 months or 3 months |
| Foundayo | List price before insurance | $649 per month |
| Foundayo | Foundayo Savings Card (insured) | from $25 per month |
| Foundayo | Self-pay: LillyDirect 0.8 mg and 2.5 mg | $149 per month |
| Foundayo | Medicare GLP-1 Bridge (Foundayo, eligible Part D) | $50 per month |
Prices checked November 2026 (10)
Sources: Novo Nordisk pricing 1 2, NovoCare 1 2, TrumpRx, CMS, rybelsus.com, pricinginfo.lilly.com, foundayo.lilly.com, Eli Lilly.
Who should pick which?
- No needles needed: Orforglipron comes as a tablet, while Semaglutide is given by weekly injection or taken daily as a tablet.
- When you have type 2 diabetes, Semaglutide alone is approved to treat it.
- Kidney disease with type 2 diabetes: Semaglutide holds that approval.
- MASH liver disease: Semaglutide has approval for this use.
- Heart risk: Semaglutide is approved to lower the risk of heart attack and stroke.
- Children under 18: Semaglutide is approved for some of them.
Your prescriber considers your health history, other medicines, and coverage. Whether you switch between them is their decision.