The Brief

Millions of people use injectable drugs like Wegovy to reach a healthier weight. But the weekly injections aren't for everybody — or every wallet.

That's why experimental pills that could achieve similar results are drawing so much attention.

The medicines haven't yet won approval from the Food and Drug Administration, but the first one could get the green light by the end of the year.

"The patient community in the obesity space has … gone without treatment for so long," says Tracy Zvenyach, director of policy strategy and alliances at the nonprofit Obesity Action Coalition. "So new innovations, new treatments to treat this chronic disease — all are welcome. All are exciting." The coalition receives financial support from multiple drugmakers, including Novo Nordisk, Eli Lilly and Pfizer.

Here's what you need to know — from how much the pills might cost to how they work.

1. Two new pills are (probably) coming

Novo Nordisk's obesity pill is expected to be approved first. It has the same ingredient — semaglutide — that's in Wegovy, Ozempic and also in Rybelsus, the company's Type 2 diabetes pill that was approved in 2019.

The difference between this new pill and Rybelsus is the dose. There's more semaglutide in the new pill.

Novo Nordisk's main competitor is Eli Lilly, which makes Zepbound and Mounjaro. And it's working on an obesity pill, too. But instead of using the same ingredient that is in its blockbuster injectables, tirzepatide, the company is working on a new one for its obesity pill that is called orforglipron.

2. Patients will take the pills daily, not weekly

The pills need to be taken every day, but the injectables are once a week.

For Novo Nordisk, it was a challenge making a semaglutide pill that wasn't immediately broken down in the stomach before the medicine could be absorbed. So the scientists there added an ingredient that would protect the pill for 30 minutes while it is being absorbed. It's a mouthful: sodium N-(8-[2-hydroxybenzoyl]amino)caprylate, or SNAC for short.

"If you think about dropping an Alka-Seltzer tablet in a glass of water, that immediate fizzy reaction that occurs, that is what happens in your stomach," says Andrea Traina, one of Novo Nordisk's obesity directors. "It creates this little foamy environment directly around the tablet."

That foam prevents a stomach enzyme from breaking the tablet down, lowers the stomach's acidity ever so slightly, and makes the cells under the pill a little bit more permeable so the semaglutide can get absorbed into the bloodstream more easily. The process takes about 30 minutes. It has to be taken on an empty stomach.

Eli Lilly's orforglipron is a little different. It's not as vulnerable to being broken down in the stomach.

"It has no food or water restrictions," says Dr. Max Denning, one of Eli Lilly's senior medical directors. "You can take it orally, and it's very effectively absorbed without any additional absorption enhancers or administration restrictions."

3. They both work, but one appears to have an edge

In a study published in September in the New England Journal of Medicine, a 25 mg semaglutide pill led to a 16.6% reduction in weight on average over 64 weeks. That's about the same as Wegovy.

Eli Lilly's obesity pill, orforglipron, had a 12.4% average weight loss at its highest dose over 72 weeks, which means it's less effective than injections on the market.

The drugs have similar side effects to the injectables, including nausea and diarrhea.

4. These pills should cost less than the injectables

Pills tend to be cheaper than injectables, so patients are hoping they'll be more affordable than the brand-name injected medicines with list prices of over $1,000 a month — and that insurance companies will be more likely to cover them.

"It's easier to manufacture and the cost ultimately should be lower," says Dr. Richard Siegel, co-director of the Diabetes and Lipid Center at Tufts Medical Center. "One of the big problems with all of the medicines in this arena has been the cost. And can we equitably get these medicines to the millions, really, of people who might benefit from them?"

According to a recent poll by KFF, a nonprofit health policy research organization, 1 in 8 people is currently taking an injectable drug in this class. While most of them have at least some insurance coverage, more than half said they had difficulty affording the drugs.

Since early 2025, the drugmakers have made these medicines available at a discount to patients not using their health insurance, and the prices have come down a bit over time. As of early November, when Novo Nordisk and Eli Lilly announced deals with the Trump administration, the starting dose of Zepbound will be available for $299 a month for people buying without using insurance. And Wegovy will now be available for $349 a month.

While neither company has announced an official list price for the experimental pills, their Trump administration deals say that if their oral obesity medicines are approved, they'll sell them directly to consumers for $149 a month. That means patients can get this price if they don't use their health insurance.

Still, if the pills get better insurance coverage, copays could be significantly lower than that.

5. The FDA could act soon on the first two, and more new drugs are in the works

Novo Nordisk's obesity pill is expected to win approval before the end of the year.

Eli Lilly, on the other hand, has said it will submit orforglipron for FDA approval this year. The drug won a priority review voucher from the agency, which could mean the agency will make a decision "within months."

Novo Nordisk and Eli Lilly are also working on the next generation of these drugs, which could prove to be even more effective than the ones already on the market.

Novo Nordisk is studying another compound called cagrilintide and a combination of cagrilintide and semaglutide. And Eli Lilly is studying retatrutide. Both are in Phase 3 clinical trials.

Meanwhile, another company, Metsera, has several obesity drugs in its pipeline, though none is in late-stage clinical trials yet. Novo Nordisk tried to acquire the company, but it ultimately lost out to Pfizer, which completed the acquisition that could ultimately be worth more than $10 billion.

Copyright 2025 NPR

With California electric rates stuck at nearly the highest in the nation, the state’s utility regulator is poised to lower the payout shareholders can receive from California’s three large investor-owned power companies.

In a proposed decision, the California Public Utilities Commission recommended dropping the “return on equity” by 0.35% each for Pacific Gas & Electric, Southern California Edison and San Diego Gas & Electric. If approved, shareholders of all three companies would see a potential return next year of just under 10%. Such returns for PG&E and Edison haven’t dipped below double digits in at least 20 years.

Utilities said the decline would affect their ability to bring in needed investment for their work. Critics of the decision said that the decline is too small to meaningfully impact ratepayers’ bills, even if it’s a step in the right direction.

“California and other [public utility commissions] authorize rates of return that are far in excess of the statutory requirement,” said Mark Ellis, former chief economist at Sempra, which owns San Diego Gas & Electric.

The California Public Utility Commission is expected to vote on the decision in December.

Californians pay the second-highest electric rates in the U.S. after Hawaii, according to the most recent figures from the U.S. Energy Information Administration. A number of factors go into those rates, including wildfire mitigation costs. PG&E in particular has attracted the ire of California customers for its frequent rate hikes within the last year.

Baked into those bills is the return on equity, money meant to compensate shareholders for the risk of doing business. These shareholder return rates are set by each state’s utility regulators and hover nationally around 10%. If approved, PG&E’s rate would be 9.93% (down from 10.28%), Edison would be 9.98% (down from 10.33%), and San Diego Gas & Electric would be 9.88% (down from 10.23%). These rates are not automatically guaranteed – utilities can fall short of this return if they don’t keep down costs, such as project overruns or unexpected lawsuit fees.

A small change in this rate can be a difference of millions of dollars for ratepayers. The return is a percentage of the rate base, the total value of a utility’s assets it can earn a return on; this includes projects such as building a new power plant, for example. The rate bases for California’s three large investor-owned utilities have steadily grown each year as they add new customers and projects, increasing the amount that shareholders can receive.

PG&E, for example, had a 10% shareholder return in 2023, a possible return of about $125 million. Had it been 1% lower, the potential return would have been $12.5 million less.

“The proposed cost of capital decision needs refinement to better reflect California’s unique risks and market realities,” said Edison spokesperson Jeff Monford. “Making those refinements in the final decision will enhance SCE’s ability to finance essential infrastructure projects for a more reliable, resilient and ready electric grid.”

PG&E spokesperson Jennifer Robison echoed this sentiment, saying the decision “fails to acknowledge current elevated risks to help attract the needed investment for California’s energy systems.”

Anthony Wagner, spokesperson at San Diego Gas & Electric, said, “A decision that accurately reflects these realities is essential to enabling investments that reduce wildfire risk, strengthen reliability, replace aging infrastructure and advance California’s clean energy transition for the benefit of the communities we serve.”

Utilities routinely request these rates be pushed higher because they are a key part of what goes into utilities’ credit rating, affecting the interest they pay on loans for infrastructure investments. But in recent years, experts and consumer advocates point to a mismatch – the utility industry is typically considered low-risk, but critics say the shareholder return rates don’t reflect that. Rates for U.S. 10-year treasury bonds, which are considered the benchmark for a risk-free investment, are about half of the national average for approved utility shareholder return rates. And it’s costing utility ratepayers across the country as much as $7 billion annually, according to academics.

Ellis, the former Sempra economist, said there is a way to lower shareholder returns while keeping customer bills in check and maintaining credit ratings that the commission has not yet explored – changing the balance of debt and equity each utility has.

“You really need to understand credit,” he said. “This is where they’re going to get you.”

The commission is allowed to set the debt-equity balance when it determines shareholder returns, but it left this unchanged for all three utilities in its proposed decision for 2026. Keeping shareholder return rates high as the main means for keeping credit ratings up, Ellis said, unnecessarily burdens ratepayers.

A little-noticed provision in the sweeping "One Big Beautiful" legislation enacted by the GOP over the summer sharply limits the amount of federal student loans that students earning professional degrees — including medical school — can borrow.

It also imposes even stricter borrowing caps for other health fields including nursing and public health. The Education Department does not consider graduate education in those fields "professional" education, though officials described that as a technical and regulatory decision, rather than a value judgment.

The loan changes will hit next July when an open-ended federal loan program known as Grad PLUS will stop making new loans. From that point on, med students won't be able to borrow more than $50,000 a year — or more than $200,000 over the four years. Many private med schools already cost north of $300,000, including living expenses.

"That will automatically give a lot of people some pause to think about where they're accepted and what their finances are," said Vineet Arora, vice dean of education, at the University of Chicago's Pritzker School of Medicine.

Given that most medical students already come from the upper 40% of family income, Arora added, "we already have fewer medical students coming from sort of middle class and lower income families." Lack of access to loans, she said, may well skew it even more.

On top of those new restrictions, a federal regulation posted October 30 — already facing a court challenge — adds new conditions to the Public Service Loan Forgiveness program, which enables health workers who work in high needs areas and make payments for 10 years to erase debt.

The new Trump administration policy said loan forgiveness won't be an option for people working for an entity engaging in, among other things, illegal activities involving immigration, gender-affirming care, or "terrorism" aimed at "obstructing or influencing" federal policy. It will be up to the Education Secretary to decide which organizations will be ineligible.

These limits on how aspiring doctors or other health providers — nurses, occupational therapists, social workers, dentists and more — can finance their education likely foretell a more affluent, and less diverse, health care work force in the future, said Atul Grover, who recently stepped down from his long-time policy post at the Association of American Medical Colleges. He is now a visiting scholar at Stanford and a health sector consultant.

But champions of the legislation, including Senate HELP Committee chairman Sen. Bill Cassidy, who put forth a version of this legislation earlier this year, have argued that it will bring about changes in higher ed financing that will push down tuition costs and protect people beginning careers from "from drowning in debt."

These new loan changes come on top of a slew of recent court rulings and administration policies that crack down on diversity, equity and inclusion initiatives in higher ed.

Grover said the new policies will "disproportionately discourage and decrease the likelihood" that students from lower income families attend — or even apply — to med school.

"Once you tell them, 'Oh, you're going to have to borrow $300,000 to go to med school,' they're like, well, that's out, right?'" Grover said.

Narrowing who can afford medical education

Since the landmark June 2023 Supreme Court ruling banning consideration of race in admissions, Black and Latino enrollment to medical school has dropped.

That trend, and the new Trump administration policies, could mean fewer young doctors practicing in underserved communities, both rural and urban. Some new doctors will of course still choose to practice there, including some who themselves grew up in such communities. But many may feel like they have to choose high-paying specialties over primary care to get out from piles of loans.

The Association of American Medical Colleges said the new loan limits will likely worsen the physician shortage, already forecast to hit up to 86,000 doctors by 2036 — on top of existing shortfalls in underserved communities.

"If future medical students face greater financial barriers — especially those from low-income, rural, or first-generation backgrounds — we risk shrinking the supply of qualified applicants. Fewer students entering medical school now means fewer residents and practicing physicians later," the AAMC said in an emailed statement.

The AAMC declined further comment, as did several administrators and spokespeople for med schools.

Along with physicians, the changes will affect students in dentistry, and various advanced pharmacy and psychology degrees considered professionals, along with chiropractors and podiatrists, according to an Education Department memo.

But advanced nursing degrees, along with health practitioners like occupational and physical therapists, are not on that list. And for these "nonprofessional" graduate school tracks, the annual loan limits would be $20,500. Organizations representing those practices hope to win some changes in policy before the regulations are finalized but they have not been successful during months of debate.

"Misinformation on TikTok has caused confusion about the Trump Administration's ongoing actions to implement student loan caps for graduate students," The Department of Education's Press Secretary for Higher Education Elle Keast said in a statement Monday. "The Trump Administration is implementing long-needed loan limits on graduate loans to drive down the cost of programs."

Nurses disagree.

"At a time when health care in our country faces a historic nurse shortage and rising demands, limiting nurses' access to funding for graduate education threatens the very foundation of patient care," American Nurses Association president Jennifer Menik Kennedy said in a statement. "In many communities across the country, particularly in rural and underserved areas, advanced practice registered nurses ensure access to essential, high-quality care."

Benefits of a diverse health care workforce

Making graduate training in the health professions less attainable could change the makeup of the health care work force.

That runs counter to mounting evidence, outlined in a major National Academies of Science, Engineering and Medicine report last year called Ending Unequal Treatment , that a health care work force that looks like America is actually good for America's health.

It's not that a white doctor or nurse can't provide excellent care to a Black or Latino or Asian patient — or vice versa. That happens each and every day. But shared experience, the racial, linguistic and cultural matches between patient and provider known as "concordance," can improve doctor-patient communication. Some data show it improves patients' ability to manage chronic conditions like diabetes or hypertension.

"What the data says is that when we have a diverse and inclusive workforce that is representative of the populations that are served, that we actually see improved health outcomes," said Vincent Guilamo-Ramos, executive director of the Institute for Policy Solutions at the Johns Hopkins School of Nursing, who served on the National Academies panel.

"Across all the health professions," he said, "we see that there's underrepresentation in terms of the people that need providers who can bring to their practice their sort of lived experience." That can include speaking languages in addition to English to enhance communication with patients.

According to data from the AAMC and its osteopathic medicine counterpart reported in JAMA Network Open, since the 2023 Supreme Court ruling incoming Black or African American student enrollment fell 11.6% and Latino by 10.8%. Asian and White student enrollment rose.

A number of universities run assorted "pipeline" enrichment programs to help high school students, or even younger kids, explore and prepare for careers in science and medicine. Some of those are still ongoing, and structured to avoiding running afoul of the DEI rules.

But an approach that med schools used after the Supreme Court, sometimes called "holistic admissions," ran into opposition from the Trump administration. The idea was to look broadly at med school applicants -- at those who may have overcome adversity for instance, not just those with the highest MCAT scores.

That was encouraged under the Biden administration. But President Donald Trump in August issued a "presidential memoranda" outlining how the Department of Education should crack down on "overt and hidden racial proxies."

"Greater transparency is essential to exposing unlawful practices and ultimately ridding society of shameful, dangerous racial hierarchies," Trump wrote.

Many health educators say the primary problem though, is the high cost of education for health fields.

Champions of the changes, including Cassidy and the Department of Education, argue that as borrowing is limited, the pressure will mount on schools to cut tuition.

But some in the education field say that while they too would like to see education become more affordable, they don't think these policies will achieve that. With NIH support under threat, taxes rising on endowments on some large prestigious universities,, and feuds between the administration and elite institutions relief is not likely, Guilamo-Ramos noted

But more affordable education, he said, would be good for students – and good for patients.

"One way that we can optimize health for everyone and save money is by ensuring that we have the best workforce, which means it being representative and then motivating people, all different kinds of people, to pursue careers in health and not only ones that would be the most lucrative."

Copyright 2025 NPR

The century-old partnership between the U.S. military and Scouting could be coming to an end.

U.S. Defense Secretary Pete Hegseth is planning for the military to sever all ties with Scouting America, saying the group once known as the Boy Scouts is no longer a meritocracy and has become an organization designed to "attack boy-friendly spaces," according to documents reviewed by NPR.

In a draft memo to Congress, which sources shared with NPR but which has not yet been sent, Hegseth criticizes Scouting for being "genderless" and for promoting diversity, equity and inclusion.

The military has provided support to the Scouts for more than 100 years, assistance that was formalized in 1937. But in one memo, Hegseth says, "The organization once endorsed by President Theodore Roosevelt no longer supports the future of American boys."

The proposal calls for the Pentagon to no longer provide medical and logistical aid to the National Jamboree, which brings in as many as 20,000 scouts to a remote site in West Virginia. It also states that the military will no longer allow Scout troops to meet at military installations in the U.S. and abroad, where many bases have active Scout programs.

A source told NPR the documents were being prepared at the Pentagon to communicate Hegseth's decision to Congress, but that they had not been sent yet. The source requested anonymity because they were not authorized to discuss the documents.

In response to an inquiry from NPR, the Pentagon sent a statement attributed to "a War Department official" saying they wouldn't comment on "leaked documents that we cannot authenticate and that may be pre-decisional."

Scouting America released a statement saying the organization is proud of its long affiliation with the military and will work to continue it.

"Scouting is and has always been a nonpartisan organization," the statement read. "Over more than a century, we've worked constructively with every U.S. presidential administration — Democratic and Republican — focusing on our common goal of building future leaders grounded in integrity, responsibility, and community service."

Congress requires the Pentagon to support the scouting program's Jamboree, a gathering of thousands of young scouts held every three or four years. The U.S. military lends trucks, ambulances and medical teams, and puts on aviation and skydiving demonstrations, all at no cost to the Scouts. For the military, it's both a training exercise and an opportunity to recruit highly motivated, civic-minded kids.

But the law includes an exemption: the Secretary of Defense can withhold support  if he determines providing it would be "detrimental to national security."

Drafts of a report to Congress obtained by NPR show Hegseth invoking that clause — accusing Scouting America of fostering "gender confusion."

His memo to the House and Senate Armed Services committees argues the Scouts have strayed from their mission to "cultivate masculine values." It also claims that with international conflicts and a tight budget, sending troops, doctors and vehicles to a 10-day youth event would harm national security by diverting resources from border operations and protecting U.S. territory.

President Trump waves to the crowd after his speech during the National Boy Scout Jamboree in 2017.

(

Saul Loeb

/

AFP/Getty Images

)

President Trump, the honorary leader of Scouting America by nature of his elected office, praised the crowd at the Jamboree in West Virginia in 2017. "The United States has no better citizens than its Boy Scouts. No better," the president told the crowd. He pointed out that 10 of his cabinet members were former Scouts.

Hegseth was never a Boy Scout, and has said he grew up in a church-based youth group that focuses on memorizing Bible verses. Last year, as a Fox News host, he complained about the Scouts changing their name and admitting girls back in 2018.

"The Boy Scouts has been cratering itself for quite some time," Hegseth said. "This is an institution the left didn't control. They didn't want to improve it. They wanted to destroy it or dilute it into something that stood for nothing."

What Hegseth says about the Scouts echoes his moves at the Pentagon, cutting DEI programs and firing some senior female and African-American officers, while suggesting diversity hires weaken the organization.

A draft memo to top Pentagon leaders about Scouting America, which was also shared with NPR, picked up on that theme. "Scouting America has undergone a significant transformation," the memo states. "It is no longer a meritocracy which holds its members accountable to meet high standards."

NBC first reported in April that the Pentagon was considering breaking with Scouting America, citing sources familiar with the move. In a statement to NBC, Sean Parnell, the Pentagon's chief spokesman, said, "Secretary Hegseth and his Public Affairs team thoroughly review partnerships and engagements to ensure they align with the President's agenda and advance our mission."

Banning Scout troops from meeting on military bases in the U.S. and overseas troubles Kenny Green. He's a retired Army Staff Sergeant who served as a sniper in Iraq and is the parent of three Scouts — two girls and a boy. Because of his military service, his family has moved frequently.

"We went from Louisiana to Alaska. From Alaska to Germany. From Germany to Texas," he said. But at every military base there was a Scout troop that could help ease the transition to a new home. "We don't have to say a word to them, let them go see the other kids, and they'll be immediately integrated in."

Green was surprised by the proposal to cut all Pentagon ties with the Scouts.

"It's gonna be kind of harsh the way I say this… It's kind of like they don't care about us more than they care about their perceived message. Scouting… It probably is not a perfect organization, but … I can't even say how vast their benefits are, especially for military families."

Scouting has long been a part of military recruiting efforts. As many as 20 percent of cadets and midshipmen at the service academies are Eagle Scouts, according to statistics from Scouting America. Moreover, enlistees who've earned Eagle get advanced military rank and better pay. That practice would end.

The potential impact is causing friction at the Pentagon. In one memo sent to the department's Undersecretary for Policy Elbridge Colby, Navy Secretary John Phelan warns the proposed new policy might be "too restrictive." Up to a third of the Navy's officers in training, he writes, have some scouting background.

"Passive support to Scouting America through access to military installations and educational opportunities aboard said installations serve as a crucial recruiting and community engagement tool for the [Navy]," Phelan wrote in the memo, which NPR also viewed. "Prohibition of access could be detrimental to recruitment and accession efforts across the department."

Whether Hegseth's argument — that supporting the Jamboree and allowing Scout troops on military bases harms national security — will pass muster with Congress is unclear. But the statute also requires the report be submitted "in a timely manner." Planning for next summer's Jamboree is already well underway.

Included in the documents NPR reviewed is a draft letter to the head of Scouting America, informing him that the Secretary has disapproved the use of DoD personnel and equipment for the Jamboree - detailing what will not be available. It concludes, "You have our best wishes for a safe and successful National Scout Jamboree."

Copyright 2025 NPR