As Told By a Pharmacist

Tag: health

  • The GLP-1 Cold War: Foundayo v. Oral Wegovy

    The GLP-1 Cold War: Foundayo v. Oral Wegovy

    Delphine Adams's avatar

    Written by:

    Delphine Adams

    What’s new in the GLP-1 market? You guessed it: the second oral GLP-1 therapy is here. On April 1, 2026, Fundayo (orforglipron) received FDA approval for weight reduction and maintenance in adults with obesity or overweight adults with one comorbid condition related to their weight. Importantly, the medication is to be used in combination with an increase in physical activity and a reduced calorie diet.[1] This announcement comes just three months after oral Wegovy started to occupy pharmacy shelves. 

    How does Fundayo compare to oral Wegovy?

    With full adherence, oral Wegovy resulted in a 16.6% mean weight loss[2], while Foundayo yielded just a 12.4% mean weight loss reduction.[3] Despite the significant variance in performance, Fundayo does have unique advantages. It can be taken without any dietary restrictions, at any time of the day. Unlike Wegovy, which must be taken in the morning, on an empty stomach, with a full glass of water followed by 30 minutes of fasting. 

    The dosing flexibility Fundayo offers would be beneficial for those who are may not want to use injectables, have less regimented schedules, or struggle with adherence. The added convenience of the oral dosage form, combined with the freedom from special storage requirements is another incentive for consumers. 

    Another advantage is in its chemical structure. Foundayo is a small molecule weighing 902g/mol about 4 times less than that of oral Wegovy.[4] The significance here is that due to the cyclical supply and demand shortage with GLP-1s, it may be cheaper, and easier to manufacture Foundayo which could ensure constant supply. Eli Lilly’s CEO even boasted, “We can make basically as much as we need”, suggesting that the company would be able to meet high demand. For providers, initiating a patient on a readily accessible therapy could provide better outcomes as it would be easier to maintain adherence. 

    What about the Disadvantages?

    Because Foundayo is metabolized by the CYP3A4 enzyme, it is advised to not be used with any strong CYP3A4 inhibitors or inducers due to clinically significant drug-drug interactions. CYP3A4 inhibitors include several commonly prescribed drugs, such as Clarithromycin, Verapamil, and Carbamazepine.

    Foundayo may also interact with certain statin drugs, which would require a thorough risk-benefit analysis. For example, if Foundayo was taken with Simvastatin, it would lead to a 2—2.5-fold increase in drug exposure, which would greatly heighten the chances of rhabdomyolysis (a painful, potentially life-threatening condition where one could experience sever muscle pains, weakness and dark colored urine).[5] Despite this interaction, Simvastatin was not listed as a contraindication. Should a patient be on  both medications, the max Foundayo dose would be 9mg, rather than the regular max dose (17.2mg) that yields the largest weight loss.[6]

    Foundayo also stimulates insulin release, and can cause hypoglycemia in those using insulin and/or insulin secretagogues like sulfonylureas and metaglinides. For these patients, they would need to consistently monitor their blood sugar and understand the manifestations of low blood sugar. 

    How Well is Foundayo Tolerated?

    During the clinical trials, about 7% of participants who received Foundayo had to discontinue the therapy due to adverse events.[7]The most common side effects are consistent with what we’ve observed with the injectable GLP-1s: gastrointestinal effects such as nausea, constipation, diarrhea, and dyspepsia ranging from mild to moderate. 

    Eli Lilly plans to launch Fundayo this Monday April, 6th. Having already anticipated insurance formulary restrictions, Eli Lilly offers a self-pay program, LillyDirect, which mirrors NovoNordisks self-pay program for oral Wegovy. Both programs price the lowest doses at $149 per month and the highest doses at $299 per month. 

    Foundayo was reviewed through the Commissioner’s National Priority Voucher (CNPV) program which is aimed at accelerating the drug approval process in order to provide therapeutic options to Americans in a timely manner. The FDA’s to approval of Foundayo just 50 days after Lilly filed for approval, makes history as the fastest drug approval in the over 2 decades. Yet, in the ever-growing wake of class action suits against GLP-1 medications, one has to wonder if 50 days was adequate to ensure patient safety. 

    [1] https://www.fda.gov/news-events/press-announcements/fda-approves-first-new-molecular-entity-under-national-priority-voucher-program

    [2] https://www.appliedclinicaltrialsonline.com/view/fda-approves-oral-wegovy-positive-oasis-trial-results?utm_source=copilot.com

    [3] https://investor.lilly.com/news-releases/news-release-details/fda-approves-lillys-foundayotm-orforglipron-only-glp-1-pill

    [4] https://www.managedhealthcareexecutive.com/view/foundayo-vs-oral-wegovy-the-similarities-the-differences-and-what-you-need-to-know

    [5] https://www.uptodate.com/contents/rhabdomyolysis-clinical-manifestations-and-diagnosis

    [6] https://pi.lilly.com/us/foundayo-uspi.pdf

    [7] https://www.nejm.org/doi/full/10.1056/NEJMoa2511774

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  • AI Enters Healthcare, This Time, as a Provider

    AI Enters Healthcare, This Time, as a Provider

    Delphine Adams's avatar

    Written by:

    Delphine Adams

    Utah is the first state to automize prescription refills through an artificial intelligence (AI)-driven platform: Doctronic. No active doctor reviewing in real time. No healthcare provider oversight. Just AI. The AI-driven platform originally went live in late 2023, but it was not until December 2025, that the state of Utah partnered with the platform to provide care to the residents of Utah.

    How Does Doctronic actually work?

    The patient completes a questionnaire regarding their symptoms and medication history; subsequently, the interface determines whether a prescription renewal is appropriate. The initial prescription must be written by a doctor, and the program is limited to 190 maintenance drugs that it can refill. Painkillers, injectables, controlled substances and substances for attention disorders are excluded. 

    What Problems Does it Aim to Solve?

    Three in four Americans navigate life trying to manage their chronic conditions.[1] Yet people can wait up to an entire month for a primary care visit in several states. This lapse in care results in delays in therapy. Indeed, it is common for a provider to see the patient for a follow up appointment when starting a new therapy, or before approving refills for a maintenance medication. Those of us working behind the counter see first-hand, the prevalence and complexity of this issue. Medication adherence is far more than a term providers lecture patients about. Medication non-adherence is the single, most preventable healthcare crisis that burdens Americans, and it is responsible for approximately 125,000 deaths and accounts for 10% of hospitalizations annually.[2]

    A common reason for non-adhearance is patients simply not understanding why they are taking the medication and its significance. This is where pharmacists can fill in the gaps and provide adequate counselling at the pharmacy counter. However, automating the prescription renewal process and removing a health care provider completely, does not foster an environment for thorough, personalized counseling. This could potentially lead to unfavorable outcomes when managing chronic conditions. How well can AI communicate the importance of medication adherence when the encounter is not even face-to-face?

    Doctronic also boasts an anonymity feature, and claims that no data is stored in their records. This could present obvious challenges, as there would be no opportunity to follow up between visits, and no access to medication history beyond what the patient provides, which often is inaccurate or incomplete. 

    Can a patient-AI relationship rival a patient-provider relationship?

    There have been legitimate concerns raised by several organizations as to the clinical soundness of this program. The Utah Academy of Family Physicians stated “[w]ithout the involvement of a trained healthcare provider, we risk the possibility of negative drug interactions…lack of clarity around how and when a patient will be referred to their physician, and the risk of misuse or abuse.” 

    The intake survey places a considerable amount of responsibility on the patient to be able to self-identify their symptoms, and to recount which medications they are currently taking as well as the appropriate dose. From my experience, the amount of patients who could independently do so, is few and far between. 

    More importantly, if Doctronic can supply up to 90-day supplies for refills, is it possible for a patient to go extended periods of time without visiting their primary care provider? Does this inclusion of AI come with the tradeoff of valuable patient-provider relationships? Is it a possible answer to the barriers people face to visit providers, or does it reinforce the growing mistrust of healthcare providers? 

    Final Thoughts: Advancing With Caution

    These questions, and several more, should be carefully considered before other states join Utah and fully integrate AI into their healthcare practices as a provider. We will continue to monitor developments and update the community accordingly. 

    [1] https://www.cdc.gov/chronic-disease/about/index.html

    [2] https://psnet.ahrq.gov/issue/hospital-admissions-associated-medication-non-adherence-systematic-review-prospective

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