I have always worked to keep you informed on pricing of GLP-1 medications—and to keep my rates below the lowest standard published prices for both semaglutide and tirzepatide.

You have probably noticed the surge of advertising from companies like Lilly, Novo Nordisk, ReflexMD, Hims/Hers, and Ro Body (Super Bowl, the Oscars, print media, Internet, etc).

These campaigns often feature “special offers” (for example, I recently received a ReflexMD St Patrick’s Day promo for 20% off with the code LUCKY20).

While these promotions can be appealing, but they don’t always reflect the true long-term cost.

It seems like everything about GLP-1 medications is confusing—two medications, multiple brand names, and different injection formats (pens vs. syringes vs oral). My goal here is to simplify it for you.

THE MEDICATIONS - SEMAGLUTIDE AND TIRZEPATIDE

When it comes to medical weight loss, there are essentially two options: semaglutide and tirzepatide.

Semaglutide is the original GLP-1 medication for weight loss. It’s been used since 2017 (as Ozempic for diabetes) and was approved for weight loss in 2021 (as Wegovy). It’s available as brand-name products or compounded versions. The compounded versions are typically combined with B12 and/or glycine.

At equivalent doses:

Ozempic = Wegovy = compounded semaglutide

Efficacy is the same.

Tirzepatide is newer and works on both GLP-1 and GIP receptors, which may improve results. It was approved in 2022 (Mounjaro for diabetes) and 2023 (Zepbound for weight loss). It’s also available in brand and compounded forms. However,  compounded versions of tirzepatide from reputable reputable, licensed compounding pharmacies are not currently available in California.

At equivalent doses:

Mounjaro = Zepbound = compounded tirzepatide

Again, efficacy is the same.

How do semaglutide and tirzepatide compare?

Tirzepatide is typically ~40% more expensive and produces greater weight loss in a year. But in my opinion, it does not result in much higher weight loss in the early phases of weight loss. Most of my patients can easily get at or near their target weight with semaglutide. I typically will switch patients to tirzepatide if they stall completely on the higher doses of semaglutide (1.5 - 2.0 mg) or if they seem to be “resistant” to semaglutide.

Contrary to popular belief, there are no significant differences in the side effect profiles of semaglutide and tirzepatide. I am well aware that many people contend that tirzepatide has lower side effects, but these are usually people who have gone “through” the early GI side effects of semaglutide and then switched to tirzepatide. It is well-known that early GI side effects go away with time. In fact, I find that patients who are “treatment naïve” with GLP-1 medications have more significant side effects with tirzepatide than with semaglutide. I also strongly recommend those individuals with irritable bowel syndrome or “sensitive tummies” start on a half a typical starting dose of semaglutide because it has fewer side effects.

Bottom line: tirzepatide is somewhat more effective, but often not “worth it” particularly if you don’t have much weight to lose (10-20 pounds) or are in maintenance. I typically use it in harder cases or for those last five pounds.

COMPOUNDED VS BRAND NAME MEDICATIONS

The companies that make the brand name medications (Lilly and NovoNordisk) would like you to believe that compounded medications are dangerous and unregulated. This is far from reality. In fact, the compounding pharmacies often have a greater degree of regulation and, unlike the Big Pharma companies, are required to have state-specific licenses to provide their products. Because the compounding pharmacies do not have huge marketing budgets nor developmental costs, they can offer lower prices.

I have two criteria for the compounding pharmacies which I use (typically Strive or APS/Bel-Mar)

1. Medication must be "legal" in the state you reside. The pharmacy must have a state-specific license. I don't provide advice or scrips to suppliers or pharmacies that are not licensed or provide "research grade" peptides. These state-level approvals (particularly in California) require sterility, stability, and potency compliance.

2. Pharmacies must have a long track record. I have long relationships with the pharmacies I use. They are not "fly by night" operations. Your safety is paramount.

THE COSTS

So what is taking a GLP-1 actually going to cost you per month? Because most of my patients are in California and compounded tirzepatide is not an option.

You have basically three sources for GLP-1 medications. (I exclude local pharmacies like CVS here because the cost is typically two to four times greater than the sources listed below).

1. Purchase brand name medications direct from the manufacturer (Wegovy from Novo Nordisk, Zepbound from Lilly). You need a prescription for these. Depending on where you get the prescription, you will likely need to pay a clinical fee. You are likely to get minimal guidance on proper dosing, monitoring and side effect mitigation.

2. Join a telehealth program like ReflexMD, HimHers, Henry Meds, etc. These programs are hybrid membership and dosage based. That is low dose programs have lower membership fees and higher dose ones have higher monthly fees. They often come with some degree of clinical support, but you are unlikely to have the same provider each time you check in.

3. Purchase medication through an independent provider like me. Different providers have different models and different levels of clinical support. I have three programs currently.

   • Semaglutide (compounded). California, Georgia, and South Carolina

   • Tirzepatide (compound). South Carolina and Georgia only

   • Tirzepatide (brand name). California

Cost for semaglutide (based on using average of 1.5 mg per week)

Cost for tirzepatide (dose range 2.5 - 15 mg per week)

Zepbound      tirzepatide branded             $449 / mo doses 10 mg a week or more

ReflexMD        tirzepatide compounded    $347 first mo, then $547/mo

Dr Jeff             tirzepatide compounded      SC only