Novo Nordisk announced on August 11 that Awiqli (insulin icodec-abae), the first once-weekly basal insulin approved in the United States, is now available at pharmacies nationwide for adults with type 2 diabetes.
Awiqli was approved by the U.S. Food and Drug Administration in March 2026 as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes. Unlike currently available daily basal insulins, Awiqli is administered once each week using a prefilled FlexTouch pen, reducing the number of scheduled basal insulin injections from seven per week to one.
The FDA approval was supported by Novo Nordisk's ONWARDS phase 3a clinical trial program. Across the pivotal trials in adults with type 2 diabetes, once-weekly Awiqli demonstrated noninferior reductions in HbA1c compared with daily basal insulin.
The reduced dosing frequency could be particularly useful for people who find daily insulin injections difficult to maintain consistently. Diabetes specialists Diana Isaacs, PharmD, and Natalie Bellini, DNP, recently discussed potential uses for once-weekly insulin among people who struggle with daily medication routines, as well as older adults and people who rely on caregivers for insulin administration.
Awiqli is a concentrated U-700 insulin, and its once-weekly dosing and titration differ from those of traditional daily basal insulins. This makes patient education and careful dosing particularly important when starting treatment or switching from another basal insulin.
Novo Nordisk says Awiqli will be distributed through more than 70,000 pharmacies across the United States. The company is also offering affordability programs through NovoCare, with eligible patients potentially paying as little as $35 per month.
Another Once-Weekly Insulin May Follow
Awiqli may not remain the only once-weekly basal insulin available in the United States for long.
Eli Lilly's insulin efsitora alfa, known as Onswik, is currently under regulatory review for adults with type 2 diabetes. Lilly's QWINT phase 3 program found that once-weekly efsitora produced HbA1c reductions that were noninferior to daily basal insulin across multiple studies.
Lilly submitted insulin efsitora alfa for U.S. regulatory review in 2025, and the company's current development pipeline continues to list it under regulatory review. Lilly has indicated that an FDA decision is expected later in 2026, with company materials identifying November 2026 as the anticipated U.S. regulatory action date.
If approved, insulin efsitora alfa would give people with type 2 diabetes and their healthcare providers a second once-weekly basal insulin option. The arrival of Awiqli, and the possible approval of efsitora later this year, could mark an important change in insulin treatment by making weekly rather than daily basal insulin dosing an established option.
Sources
Novo Nordisk US: "Novo Nordisk's Awiqli®, the first once-weekly basal insulin for adults with type 2 diabetes, now available in the US"
Diabetes Dialogue: "Weekly Insulin Icodec Now Available for Type 2 Diabetes" (Article)
Diabetes Dialogue: "Weekly Insulin Icodec Now Available for Type 2 Diabetes" (Video)
HCPLive: "Insulin Icodec Now Available for Type 2 Diabetes in US"