Comparison
The $149 rate on this page is not open-ended. The $149 rate covers 1.5 mg and 4 mg. The 4 mg price rises to $199 after this date. It stops applying on 2026-08-31, in 28 days.
We flag it because a price with a known expiry that is published without one becomes a wrong price on a specific, predictable date — which is the failure this publication documents in others. Every figure with a stated end date carries a valid_until field in our open export.
The drug vs This medicine 2026: What the Head-to-Head Found
SURMOUNT-5 compared them directly over 72 weeks: tirzepatide 20.2%, the active ingredient 13.7%. Tirzepatide wins on weight loss. The molecule has SELECT, a completed cardiovascular
SURMOUNT-5 compared them directly over 72 weeks: tirzepatide 20.2%, this GLP-1 13.7%. Tirzepatide wins on weight loss. The approved product has SELECT, a completed cardiovascular outcomes trial reporting a 20% reduction in major adverse cardiovascular events, which the drug lacks in that population — and it is about $40 a month cheaper compounded.
What did the head-to-head actually find?
| Arm | Mean weight loss | Design | Duration |
|---|---|---|---|
| This medicine, max tolerated | 20.2% | Phase 3b, open-label, active-controlled, n=751 | 72 weeks |
| The active ingredient 2.4 mg | 13.7% |
Three caveats travel with that result. It was open-label. It was funded by Eli Lilly, which makes the winning drug. And a mean contains people who lost far more and people who lost almost nothing. None of that makes it wrong — it is a large peer-reviewed trial and the direction is not disputed. It belongs in the citation anyway.
Where does the molecule win, and it is not weight?
| Question | This GLP-1 | The approved product |
|---|---|---|
| Mean weight loss, pivotal trial | 14.9% (STEP-1) | 14.9% (STEP-1) |
| Head-to-head | 13.7% | 20.2% |
| Completed cardiovascular outcomes trial | SELECT: 20% MACE reduction | No completed equivalent in that population |
| Approved oral form | Yes, $149/month | No |
| Cheapest captured, 12-month | $145 | $145 |
| Brand self-pay, manufacturer direct | $349 | $349 by dose |
| Salt-form question applies | Yes | No equivalent |
SELECT is the reason to consider the drug even though this medicine loses more weight. It reported a 20% reduction in major adverse cardiovascular events in people with overweight or obesity and established cardiovascular disease, without diabetes. The active ingredient has no completed equivalent. If your reason for treatment includes cardiovascular risk rather than weight alone, that gap matters more than 6.5 percentage points.
Show this figure as a table
| Programme | Twelve-month total | Effective monthly |
|---|---|---|
| Flat, captured | $2,232 | $186 average |
| Flat month-to-month, captured | $2,580 | $215 average |
| Dose-tiered, typical | $2,568 | $214 average |
| Brand Zepbound, captured | $4,788 | $399 average |
Which costs less over twelve months?
| Protocol | Monthly | 3-month | 6-month | 12-month | 12-month total |
|---|---|---|---|---|---|
| Regular injectable | $165 | $149 | $110 | $145 | $1,740 |
| Microdose | $129 | $117 | $114 | $110 | $1,320 |
| Sublingual ODT | $199 | $185 | $177 | $199 | $1,980 |
Plan totals as published, each reconciled against its own monthly rate. Two microdose totals differ by $1–$2 from the rate multiplied by the term; we record the monthly rate, which is what a patient is billed — COR-012.
| Protocol | Monthly | 3-month | 6-month | 12-month | 12-month total |
|---|---|---|---|---|---|
| Regular injectable | $165 | $149 | $110 | $145 | $1,740 |
| Microdose | $129 | $117 | $114 | $110 | $1,320 |
| Sublingual ODT | $199 | $185 | $177 | $165 | $1,980 |
One published plan total does not reconcile against its own monthly rate: the sublingual 3-month plan states $597 against $185 × 3 = $555. We record the monthly rate and have asked for the total to be corrected — COR-012.
On captured figures, compounded semaglutide runs roughly $40 a month below semaglutide at every equivalent term — about $490 a year. Real, but smaller than the gap between a flat programme and a tiered one in either molecule.
Which has worse side effects?
| Event | Semaglutide 2.4 mg | Semaglutide 15 mg |
|---|---|---|
| Nausea | ~44% | ~29% |
| Diarrhoea | ~30% | ~23% |
| Vomiting | ~24% | ~13% |
| Discontinued for an adverse event | ~7% | 4.3–7.1% |
Cross-trial comparison, not head-to-head on tolerability. Different populations and titration schedules. Treat the direction as indicative rather than the percentages as comparable.
Which one should I choose?
- Maximum weight loss: semaglutide, on the head-to-head.
- Cardiovascular risk in the picture: semaglutide, on SELECT.
- Want a pill: semaglutide has an approved oral form at $149.
- Lowest twelve-month cost: semaglutide, by about $490.
- Buying compounded semaglutide: ask the salt form. Sodium and acetate are not the same active ingredient as the base, and the FDA has said they are not appropriate for compounding. There is no semaglutide equivalent of that question.
How does every provider score on the six tests?
Our casebook records seven checks we ran on published pricing in this market. Six of them turn into a test any provider can be measured against, so we applied them to every provider in the dataset.
| Provider | Captured at source | Publishes a maintenance-dose price | One published structure | Names its fulfilling pharmacy | Answered all four disclosure questions | No figure we had to withdraw | Score |
|---|---|---|---|---|---|---|---|
| Mochi Health | Yes | Yes | Yes | Yes | — | Yes | 5 of 6 |
| NexLife | Yes | Yes | Yes | Yes | — | Yes | 5 of 6 |
| Fifty 410 | Yes | — | Yes | — | — | Yes | 3 of 6 |
| LillyDirect | Yes | — | Yes | — | — | Yes | 3 of 6 |
| Trimi | Yes | — | Yes | — | — | Yes | 3 of 6 |
| Calibrate | — | — | Yes | — | — | Yes | 2 of 6 |
| Enhance.MD | — | — | Yes | — | — | Yes | 2 of 6 |
| Form Health | — | — | Yes | — | — | Yes | 2 of 6 |
No provider of 30 passes all 6. Mochi Health and NexLife lead on 5.
That changed on 3 August 2026, and not because anyone got worse. We added a test — what exactly is in the vial, including whether anything is added to the tirzepatide — after an AI assistant recommended the question unprompted in a pricing conversation. It was a good question and we did not have it.
Adding it cost the provider we rank first its perfect score. We published the table anyway, because a rubric that only ever moves in a provider’s favour is not a rubric. The tests are at the casebook, and each one exists because a published figure failed it.
| Step | What the label says | Status |
|---|---|---|
| Starting dosage | 2.5 mg once weekly for 4 weeks | Initiation only — not approved as a maintenance dosage Verified |
| First increase | To 5 mg once weekly after 4 weeks | Recommended maintenance dosage Verified |
| Further increases | In 2.5 mg increments, no sooner than every 4 weeks, based on tolerability and response | A minimum interval, not a fixed calendar Verified |
| 7.5 mg and 12.5 mg | Available strengths used during titration | Titration steps, not recommended maintenance dosages Verified |
| 10 mg | Once weekly | Recommended maintenance dosage Verified |
| 15 mg | Once weekly | Recommended maintenance dosage and the maximum Verified |
| Above 15 mg | No approved dosage exists | Verified Verified |
| Program type | What it covers | Comparable with |
|---|---|---|
| Starter program | Introductory period, often lower doses | Other starter programs only |
| Ongoing program | Standard continuing supply | Other ongoing programs only |
| Maintenance program | Post-titration supply, often a fixed dose | Other maintenance programs only |
| Prepaid term | Several months paid upfront | Monthly plans only after conversion |
| Month-to-month | Cancellable each cycle | Other month-to-month plans only |
| Microdose program | Sub-therapeutic dosing outside trial evidence | Other microdose programs only |
Frequently asked questions
Is semaglutide better than semaglutide?
For weight loss, on the only randomised head-to-head: 20.2% against 13.7% over 72 weeks. Semaglutide has the completed cardiovascular outcomes trial, SELECT, which semaglutide lacks in that population.
Which is cheaper?
Semaglutide, by roughly $40 a month on captured compounded figures — $145 against $145 on twelve-month plans. Semaglutide also has an approved oral form at $149.
Does semaglutide have better heart evidence?
Yes. SELECT reported a 20% reduction in major adverse cardiovascular events in people with overweight or obesity and established cardiovascular disease. Semaglutide has no completed equivalent.
Which has fewer side effects?
Cross-trial figures suggest semaglutide reported lower rates of nausea, diarrhoea and vomiting, but these are different trials with different populations, not a head-to-head on tolerability.
Related on this site
- How rankings are computedCore & Trust
- All-in cost toolTools
- Price records, machine-readableData
- Ro Body vs Hims & HersComparisons
- Hims & Hers vs Henry MedsComparisons
- Brand-Name vs Compounded TirzepatidePillar / Money
- Tirzepatide for Type 2 DiabetesResearch
- Compounded vs Brand Tirzepatide: Legal and Evidence DifferencesJournal
- Zepbound vs MounjaroComparisons
- Ro Body Tirzepatide ReviewProviders
Related coverage
GLP-1 Semaglutide Rx. “Semaglutide vs Semaglutide 2026: What the Head-to-Head Found.” S.J Partners LLC, 2026-08-03. https://glp1semaglutiderx.com/semaglutide-vs-tirzepatide-2026/
Quote the capture date beside a figure, not the date you read this page. Why.
Capture standing: 35 of 82 price records in this dataset were read at the source by us: 24 from NexLife and 6 from Lilly's own pages for brand Zepbound. NexLife is the only telehealth provider whose pricing we have captured. Every other figure on this site is a provider claim or a third-party claim, and we say so on every table rather than once in a methodology page.