We compare Ozempic and Rybelsus for weight loss to help you determine which medication best fits your weight loss plan
You may encounter many different medications on your weight loss journey. The GLP-1 medications may have come across your radar. There are many GLP-1 agonist medications, including Ozempic and Rybelsus. Though these medications share the same component, semaglutide, there are some differences and similarities that you should be aware of before adding one to your weight loss plan.
Ozempic is a GLP-1 agonist medication that has been FDA-approved for treating diabetes. The generic name is semaglutide, the same component used for other GLP-1 agonist medications like Wegovy and Rybelsus. The only difference is the dosage at which it is given. Like other GLP-1 agonist medications, Ozempic mimics the naturally produced hormone GLP-1 to help increase insulin release, slow food movement through the gastrointestinal system, and regulate blood sugar. This leads to increased insulin sensitivity and decreased appetite and food cravings, which leads to the desired weight loss effect.
Rybelsus is FDA-approved for managing type 2 diabetes and can be used off-label for weight loss in patients struggling with obesity. Rybelsus is the same type of medication as Ozempic and even uses the same component, semaglutide. The difference is that Rybelsus is an oral tablet, and Ozempic is a weekly pen injection. Although it is taken differently than Ozempic, Rybelsus uses the exact same mechanism of action to improve insulin sensitivity and decrease appetite and food cravings.
Ozempic has been shown to reduce body weight significantly for patients with diabetes. The SUSTAIN-6 trial published in 2016 showed that participants receiving weekly Ozempic (semaglutide) lost an average of 3-5 kg (8-11 lbs) after a two-year period (1). It is important to note that the participants were not enrolled in a diet and exercise program. Therefore, dieting and exercising regularly may lead to a more substantial weight loss effect when paired with Ozempic.
For Rybelsus, the PIONEER-1 trial was a phase 3 randomized control trial published in 2019 that examined how well Rybelsus managed diabetes in type 2 diabetics compared to a placebo (2). The researchers found a significant difference in body weight in the treatment group receiving a 14 mg dosage of Rybelsus. This group experienced a 2.6 kg (~5lb) difference after just 26 weeks. It should also be noted that the treatment group was not on a diet plan, exercising around 150 minutes per week, nor did a dietician follow them. Therefore, similar to the SUSTAIN-6 trial, implementing diet and regular exercise in combination with Rybelsus may lead to an even greater weight loss effect.
When comparing the trials, participants seemed to have lost more weight when taking Ozempic than Rybelsus; however, it should be noted that the results seen for Rybelsus were in a much shorter time frame than Ozempic (26 weeks vs 102 weeks). Also, the gastrointestinal side effects of GLP-1 medications were less common for people taking Rybelsus when compared to Ozempic (5-16% vs 50-52%)
The dosing and administration of Ozempic is very different from Rybelsus. Ozempic is started as a 0.25mg injection once weekly for four weeks. Based on tolerability and results, the dose is then moved to 0.5mg and gradually increased to 2.0mg per week.
Rybelsus is started at 3.0mg once daily for 30 days, then is increased to 7.0mg once daily. The dose may be increased to 14 mg per day based on tolerability and effectiveness.
Since both medications function similarly, they share common side effects, including multiple gastrointestinal symptoms such as nausea, vomiting, abdominal pain, loss of appetite, and cramps. Typically these symptoms are mild to moderate in severity and go away over time. However, based on the results of the SUSTAIN-6 and PIONEER-1 trials, these symptoms were more common for Ozempic than Rybelsus.
They also have similar contraindications, such as a history of medullary thyroid cancer, pancreatitis, diabetic retinopathy, history of hypoglycemia, or history of gallstones.
Unfortunately, GLP-1 medications can be costly for a month's supply. Ozempic can cost between $900-$950 for a month’s supply. Depending on your insurance plan, you may be eligible for an Ozempic Savings Card, where you can pay as little as $25 for a 1,2, or 3-month prescription. You may also be eligible for the Patient Assistance Program offered by NovoCare, where you may receive Ozempic for free!
Similarly, Rybelsus can cost around the same amount for a month's supply. There is also a Rybelsus savings Card that you can apply for, where you can pay as low as $10 for a 30 - 90 day supply of medication. There is also the option to apply for the Patient Assistance Program through NovoCare.
Around 99% of insurance plans cover Rybelsus, while around 92% cover Ozempic. You should contact your insurance provider to determine which medications are covered under your specific plan. Often times prior authorization is needed before starting these medications. At Mochi Health, our prior authorization team hands over all prior authorization forms and typically hears back from the insurance company in 1-2 weeks. However, response rates due vary.
If you would like to learn more about GLP-1 medications or want to see if you might be eligible for medication-assisted weight loss, check out Mochi Health, where board-certified obesity medicine physicians can offer expertise in this realm!
Vanita R. Aroda, Julio Rosenstock, Yasuo Terauchi, Yuksel Altuntas, Nebojsa M. Lalic, Enrique C. Morales Villegas, Ole K. Jeppesen, Erik Christiansen, Christin L. Hertz, Martin Haluzík, PIONEER 1 Investigators; PIONEER 1: Randomized Clinical Trial of the Efficacy and Safety of Oral Semaglutide Monotherapy in Comparison With Placebo in Patients With Type 2 Diabetes. Diabetes Care 1 September 2019; 42 (9): 1724–1732. https://doi.org/10.2337/dc19-0749
Dr. Constantine Joseph Pella, MD
Boston University Medical Center