What Happens to Your Price When You Reach Maintenance

The price you are quoted when you start a GLP-1 is not the price you will pay for most of the time you are on it. That is not a criticism of anyone; it is a structural feature of how this market is built, and it is knowable in advance from published documents.

Maintenance is the product, not the endgame

Read the indications. Wegovy® is indicated "to reduce excess body weight and maintain weight reduction long term".¹ Zepbound® uses the same phrasing.² So does Foundayo™.³

Long term. The plateau is where the label expects you to live, which means the plateau price is the product's real price and the entry price is a sample.

The two clocks are set to expire together

Novo's introductory pen price is worth reading twice. The footnote: "Patients new to Wegovy® Savings Offer & NovoCare® Pharmacy pay $199 for each month of 0.25 mg and 0.5 mg. Offer for 2 monthly fills through December 31, 2026, then $349 per month."⁴

Now the label. Wegovy injection is initiated at 0.25 mg once weekly for four weeks, then follows a dose-escalation schedule titrating every four weeks, with a usual recommended maintenance dosage of 2.4 mg once weekly.¹

Four weeks on the first step. Four weeks on the second. Two fills. The offer covers exactly the two doses the label spends its first eight weeks on, and ends on the fill at which you titrate past them.

The tablet works the same way at a different tempo: $149 covers 1.5 mg and 4 mg, and the label starts at 1.5 mg for 30 days and titrates every 30 days toward a maintenance dosage of 25 mg once daily.¹ Two cheap steps, then the price doubles.

What the bill does between month one and the plateau

Every branded route we priced, entry price against plateau price:

Wegovy pen — $199 → $349. Up 75%.

Wegovy tablet — $149 → $299. Up 101%.

Ozempic® pen, escalated to the top dose — $199 → $499. Up 151%.

Zepbound on LillyDirect — $299 → $449. Up 50%.

Foundayo on LillyDirect — $149 → $299. Up 101%.

Mounjaro® on LillyDirect — $499 → $499. Flat, and the only one.⁵

The plateau price, product by product

What a year at the top actually costs, using each product's own definition of a month:

Wegovy tablet, twelve 30-day bottles at $299 — $3,588.

Foundayo, twelve 30-day fills at $299 — $3,588.

Wegovy pen, thirteen four-weekly boxes at $349 — $4,537. The 7.2 mg high-dose pen at $399 makes it $5,187.⁴

Zepbound, thirteen fills at the label's 5 mg maintenance dosage, $399 — $5,187. At its 10 mg or 15 mg maintenance dosages, $449 — $5,837.⁶

Ozempic pen at 2 mg, thirteen fills at $499 — $6,487.

Mounjaro, thirteen fills at $499 — $6,487.

Zepbound's label names 5, 10 or 15 mg as the maintenance dosages for weight reduction, and 10 or 15 mg for obstructive sleep apnoea.² Which of those a prescriber lands on is a clinical decision that moves the annual bill by $650.

The compounded sellers pull the same lever with a different handle

Flat-priced compounded plans do not have a dose ladder, so nothing changes when you reach maintenance. What they have instead is a first-month discount that expires on the same schedule a titration would have.

Zealthy — $217 first month, then $297. Up 37%.⁷

Found — $169 a month on a twelve-month prepaid plan, $289 month-to-month. A 71% difference between the advertised figure and the one you pay if you do not hand over $2,028 on day one.⁸

Ro, reselling branded Zepbound — $39 membership plus $299 medication in month one, then $149 plus $449. $238 becomes $598. Up 109%.⁹

Different mechanism, identical effect on a budget. Our Ro review and Found review separate the two lines on each of those bills.

On Medicare, the plateau has a different ceiling

If Medicare is paying, none of the ladders above describe your bill.

Novo's Wegovy savings page states: "Starting July 1, eligible Medicare patients pay $50 per month for Wegovy®, through the Medicare GLP-1 Bridge program. This pricing is for adult patients with Medicare prescribed Wegovy® for weight loss only." Its footnote adds that "Eligibility criteria will be determined by the Centers for Medicare and Medicaid Services (CMS)" and that the information "is not a guarantee of coverage".¹⁰

Fifty dollars a month at maintenance is $650 a year against $4,537 at the cash rate. It is also conditional on a determination Novo does not make.

Separately, Medicare.gov puts the 2026 Part D out-of-pocket threshold for catastrophic coverage at $2,100, with plan deductibles capped at $615 and 25% coinsurance in the initial coverage stage.¹¹ A plateau priced through a plan runs into that ceiling; a plateau paid in cash does not, because cash spending does not count toward it.

Budget the plateau, not the entry

Three things follow.

Multiply the plateau price, not the entry price, by the number of fills in a year — and check whether the seller's month is 28 or 30 days before you pick that number.

Check whether an introductory offer is restricted by dose as well as by time. Novo's is restricted by both: it covers only 0.25 and 0.5 mg, so it is unreachable for anyone starting higher up. That trap is worked through in switching from compounded to branded.

And check what happens at the top step specifically. On the Ozempic pen the last step is a 43% increase in one move; on the Wegovy pen it is 14%; on Mounjaro it is nothing.

What we could not price

We could not establish which maintenance dosage any individual reader will reach, and we have not tried — every dosage above is quoted from a label, and choosing among them is a prescriber's job.

We could not price the Wegovy tablet's 9 mg step against its 25 mg maintenance step separately, because Novo prices both at $299 and publishes no further breakdown.

And we could not price a plateau through insurance, because no first-party source publishes plan-level cost sharing per drug.

Related: GLP-1 costs by dose, what NovoCare Pharmacy costs, what LillyDirect costs.

Wegovy® and Ozempic® are registered trademarks of Novo Nordisk A/S. Zepbound®, Mounjaro® and Foundayo™ are trademarks of Eli Lilly and Company.