By Dr. Asnat Raziel, bariatric surgeon specializing in obesity treatment, metabolic health and healthy longevity; Director of the Multidisciplinary Center for Obesity Treatment, Assia Medical, Assuta Ramat HaChayal, Tel Aviv
Foundayo in Israel: a new option for people who dread injections
Foundayo in Israel is already available, and it brings a once-daily pill to people who are wary of injections. It may also suit people who struggle with constant hunger or worry about their heart. A large study in people with diabetes found weight loss, better blood sugar and a met cardiac safety goal. Here is how to turn that news into a personal plan.
You try to eat sensibly, but in the evening the hunger comes back. The extra weight weighs on your knees, and your blood sugar results are worrying. On top of that, the thought of an injection makes you put off seeking treatment yet again. For many people, the challenge is not only finding an effective drug. They need a treatment that fits into daily life and that they can stick with.
Foundayo in Israel: when and at what price
Foundayo contains the active ingredient orforglipron. According to Israeli press reports, it went on sale in Israeli pharmacies on September 15, 2026. The published launch prices ranged from 691 to 1,146 shekels a month, depending on the dose. In addition, the reports noted that it is available by prescription only. I trace the Foundayo approval path from the FDA to Israel in a separate article.
So it is worth checking the current cost and your eligibility before you start. Ease of use matters, but so does the ability to pay for treatment over the long term. I discuss this further in my article on insurance coverage for obesity drugs.
A daily pill that fits into your routine
Foundayo activates the receptor for GLP-1, a hormone involved in regulating appetite and blood sugar. You can read more about the mechanism in my article on GLP-1 drugs and the brain. Unlike peptide-based drugs, it works through a small molecule. That is why it can be taken as a pill.
You take it once a day, at any time. According to Lilly’s announcement, there are no food or drink restrictions around the dose. For people who struggle with needles, this option may remove a major barrier. Even so, a pill is not free of side effects. It still has to be matched to your health status and your other medications. For a comparison with other options, see my guide to choosing between a pill or injection for obesity.
The study that looked at the heart: ACHIEVE-4
The ACHIEVE-4 trial was published in The Lancet and presented in September 2026. It included 2,749 people with type 2 diabetes and overweight or obesity. Their average age was 63.1. In addition, 85.9% had established cardiovascular disease, and 37.6% had chronic kidney disease. Some had both conditions.
The researchers randomly assigned participants to two groups. One group received orforglipron, and the other received insulin glargine. The trial was open-label, meaning that participants and clinicians knew which treatment was given. Median follow-up was about two years.
The researchers tracked four serious events: death from cardiovascular causes, nonfatal heart attack, nonfatal stroke and hospitalization for unstable angina. Such an event occurred in 57 of 1,358 patients on orforglipron (4.2%). By contrast, it occurred in 67 of 1,343 patients on insulin (5.0%). The trial was funded by Lilly, the drug’s manufacturer. For a more detailed analysis, see my article on Foundayo heart safety.
What cardiac safety means
The trial met its prespecified cardiac safety goal. In research terms, Foundayo showed “non-inferiority” to insulin. In other words, the risk stayed within the safety margin the researchers had defined.
For the four-event outcome, the estimated risk was 16% lower with Foundayo. The hazard ratio was 0.84, and the range of statistical uncertainty was 0.59-1.20. For the outcome that included only cardiovascular death, heart attack and stroke, the estimate was 23% lower: a hazard ratio of 0.77, with a range of 0.52-1.13.
Why do these ranges matter? In both cases, they also include the possibility that there is no difference between the treatments. Therefore, the trial supports cardiac safety. However, it does not prove that Foundayo prevents more heart attacks and strokes than insulin.
The prespecified limit required the upper end of the range to be below 1.8. In practice, it was 1.20. Keep in mind that meeting this limit does not guarantee zero risk for every person.
Fewer deaths: a hopeful finding
According to the company’s announcement of the results, additional prespecified analyses showed a 53% lower estimated risk of cardiovascular death. The hazard ratio was 0.47, with a range of 0.25-0.90. In addition, the estimated risk of death from any cause was 57% lower: a hazard ratio of 0.43, with a range of 0.25-0.75. During the trial, 19 participants (1.4%) died in the orforglipron group, compared with 43 (3.2%) in the insulin group.
These findings are encouraging, but they should be read with caution. The researchers examined many outcomes. For these analyses, they did not apply a statistical correction that reduces the chance of a random result. So it is too early to promise that the pill lowers mortality to this extent. Still, the data justify further research.
Foundayo in Israel: what happened to weight and blood sugar
After 52 weeks, glycated hemoglobin fell by about 1.6 percentage points with Foundayo, compared with 1.0 with insulin. HbA1c, or glycated hemoglobin, is a blood test that reflects blood sugar control over the past few months. At the start of the trial, the average was 8.22%.
Weight fell by an average of 8.8%, about 8.1 kilograms, with Foundayo. By contrast, weight rose by 1.7%, about 1.4 kilograms, in the insulin group. The average starting weight was 90.9 kilograms.
After 104 weeks, 54.6% of the Foundayo group reached an HbA1c of 6.5% or lower, compared with 23.8% on insulin. A weight loss of at least 10% was achieved by 35.9%, compared with 3.4% in the insulin group.
The blood sugar and weight data come from a specific type of analysis. It estimates what the effect of treatment would have been if participants had stayed on it without adding other glucose-lowering drugs. As a result, individual results can vary with adherence and tolerability.
Waist size, blood pressure and blood fats improved too
After one year, waist circumference fell by 7 centimeters in the Foundayo group. Systolic blood pressure dropped by 4.4 mmHg. In addition, triglycerides fell by 18.9%, and non-HDL cholesterol fell by 6.6%. The inflammation marker hsCRP fell by 38.9%. hsCRP, or high-sensitivity C-reactive protein, is a blood marker of chronic inflammation in the body.
Compared with insulin, there was also a smaller decline in kidney filtration, a difference of 2.8 mL/min/1.73 m². Urinary albumin excretion fell by 27.1% more. However, these were also additional analyses without correction for multiple comparisons. So on their own, they do not prove protection of the heart or kidneys.
And what about side effects?
Digestive side effects occurred in 62.1% of the orforglipron group, compared with 14.2% on insulin. They mainly included nausea, vomiting, diarrhea, constipation and decreased appetite. During the minimum treatment period of 52 weeks, 10.6% stopped Foundayo because of side effects. How can you cope with them? I cover this in my guide to GLP-1 side effects.
On the other hand, significant or severe low blood sugar was less common: 6.8% versus 19.2%. Anyone taking insulin or other drugs that can lower blood sugar should have their medication combination reviewed. They also need appropriate monitoring.
Foundayo in Israel: turning the news into a practical step
You can start with an appointment with your family doctor or a physician who treats obesity. Bring a list of your medications and recent test results. Explain your main difficulty: hunger, weight regain, blood sugar, fear of injections or the cost of treatment. The first steps are laid out in my guide to starting weight loss medication.
Together, set goals you can track: weight, waist circumference, blood sugar and daily function. Then increase the dose gradually, according to the product instructions and how well you tolerate it. Also, build in regular meals, a protein source at every meal and strength training that matches your ability. Finally, schedule regular follow-up to catch side effects and assess your progress.
What the study does not tell us yet
The trial involved people with diabetes at increased cardiac risk. Therefore, it does not prove the same benefit in people without diabetes. Moreover, it did not compare Foundayo with Mounjaro or Wegovy. For a different comparison, with oral semaglutide, see my article on Foundayo versus oral semaglutide.
The ongoing ATTAIN-Outcomes trial is examining the drug’s effect on cardiac events. It is being conducted in adults with atherosclerotic cardiovascular disease or chronic kidney disease.
The bottom line on Foundayo in Israel
Foundayo in Israel widens the range of treatment options. For people whom the injection held back, the pill can open a way to get started. The goal is a treatment you can stay with, alongside habits and support that help you protect your health over time.
The information in this article is general and is not a substitute for personal medical advice.
References
Foundayo (orforglipron), Lilly’s new oral GLP-1 pill for weight loss, now available in the U.S.
The ACHIEVE-4 trial was funded by Lilly, the drug’s manufacturer.
