From Pills to Needles: Why Your New Meds Are Now Shots

Sharyl Attkisson

• From weight-loss drugs like Wegovy to cholesterol-lowering Leqvio, injectable drugs are reshaping modern medicine—with new risks and higher costs.

• Injectables are already an $800 billion a year market.

• One popular injectable costs $70,000 a year.

Today, a growing number of new medications are being delivered via injection rather than as oral pills. It’s a trend driven by advancements in biotechnology, the idea that it’s easier for patients, and pharmaceutical industry profits.

But what are the trade-offs when it comes to cost and safety, and what does it mean for patients and the industry?

Read on for details.

Why Injections Over Pills?

The rise of injectable drugs is largely tied to the development of “biologics.”

Biologics are complex medicines derived from living cells, such as monoclonal antibodies and proteins. Unlike “small-molecule drugs,” which can often be formulated as pills, biologics are typically too large or fragile to survive the digestive system. That means they have to be delivered through injections or infusions for direct absorption into the bloodstream.

Advocates say injections offer pharmacokinetic advantages, meaning the way the drug is absorbed, distributed, metabolized, and excreted by the body. All of that influences its effectiveness and how long it lasts.

Long-acting injectables, such as ones given weekly or even twice a year, are said to ensure consistent drug levels in the body, improving their effectiveness. They also make it easier for patients compared to having to remember daily pills. Experts say people with conditions like cancer, and diabetes and other autoimmune diseases, can benefit from the injectable approach.

Consistency of drug levels is possible with long-acting injectables because they are designed to release the drug slowly into the bloodstream over time, often through formulations like microspheres or depot injections. Microspheres are tiny, biodegradable polymer spheres that encapsulate a drug and release it slowly into the body over time. Depot injections are formulations injected into muscle or subcutaneous tissue, forming a reservoir that gradually releases the drug, providing extended therapeutic effects.

Advocates say these processes avoid the peaks and troughs seen with daily pills. The controlled release theoretically maintains a steady therapeutic concentration in the body, preventing rapid spikes or drops.

On the other hand, the idea of consistency is fought by the fact that the drug level does gradually decline as the formulation depletes. The injection is timed to be administered before levels fall below the effectiveness threshold. But concentrations may be higher shortly after injection and lower just before the next dose. It’s unclear what the impact of a higher surge of the drug at first could be.

Side Effect Trap

A bigger concern may be the unique challenges posed when there are negative side effects—as frequently is the case with medicine. When it’s a daily pill, patients can stop taking it quickly if they notice an issue and not compound a side effect. But when it comes to injectables like Leqvio or certain antipsychotics, the drug remains active for its duration, potentially prolonging side effects.

Weight-loss drugs like semaglutide (Wegovy) can cause nausea or gastrointestinal issues in up to 20% or more of patients, and these may persist until the drug clears the system—and even then could be harder or impossible to reverse. Newer research points to potential blindness issues with Wegovy and Ozempic.

When an injectable does cause serious side effects, such as pancreatitis or thyroid issues, the most that may be able to be done while the drug is still in the patient’s system is to try various medical interventions to attempt to manage symptoms, as the drug cannot be easily “turned off.”

Profit-Driven Trend

Big Pharma profits play an undeniable role in boosting the injectable trend.

Future Market Insights estimates the injectable drug market at $597.98 billion in 2024, projected to reach $991.63 billion by 2034.

BioSpace projects the injectable drug delivery market to grow from $757.06 billion in 2024 to $1.63 trillion by 2033.

ResearchAndMarkets forecasts the injectable drug delivery market to reach $2 trillion by 2030.

Compared to pills, injectable drugs often cost significantly more in terms of patients, insurers, and taxpayer funded government programs like Medicare and Medicaid. The expenses are driven by complex manufacturing, specialized delivery systems, and Big Pharma’s ability to maintain patent exclusivity for biologics.

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For example, Humira, an injectable for autoimmune diseases on a dramatic rise in recent decades, costs around $6,000 per month without insurance, totaling over $70,000 annually. A generic oral alternative like methotrexate for similar conditions can cost as little as $100 per year.

Even when insurance “covers” the exorbitant cost, it ultimately costs taxpayers and patients through premiums—it’s just not necessarily out-of-pocket in real time.

Medicare Part D spent $20.5 billion in taxpayer money on injectables like Humira and Keytruda in 2022 alone.

Experts say considering how much of the U.S. population is sick with chronic disease and other disorders targeted by expensive injectables, the U.S. economy cannot survive these costs in the longrun.

The lack of generic competition for injectables, which can take 12-15 years to develop compared to 3-5 years for oral generics, keeps prices elevated, amplifying financial pressures across the healthcare system.

Popular and Lucrative Injectable Drugs

Below is a list of some of the most popular and lucrative injectable drugs. The prices listed are approximate monthly costs.

• Keytruda (pembrolizumab) – Cancer, ~$10,000/month.

• Humira (adalimumab) – Autoimmune diseases, ~$6,000/month.

• Wegovy (semaglutide) – Weight loss, ~$1,300/month.

• Saxenda (liraglutide) – Weight loss, ~$1,300/month.

• Zepbound (tirzepatide) – Weight loss, ~$1,100/month.

• Mounjaro (tirzepatide) – Diabetes, ~$1,000/month.

• Leqvio (inclisiran) – Cholesterol, ~$3,300/dose (twice yearly or $550/month).

• Depo-Provera (medroxyprogesterone) – Contraception, ~$100/shot (every 3 months or $33/month).

Read Sharyl Attkisson’s national bestseller “Follow the $cience: How Big Pharma Misleads, Obscures, and Prevails.”