Tirzepatide vs Semaglutide: What a Year of Each Costs

Tirzepatide costs more than semaglutide on every channel we price. Compounded, the typical year runs $3,228 for tirzepatide against $2,388 for semaglutide, a gap of about $840. Branded and bought direct from the manufacturer, a steady-state year of Zepbound® is $5,837 and a year of Wegovy® pens is $4,537, a gap of $1,300.

Those are the headline answers. The rest of this page shows where each number comes from, which one climbs as the dose goes up, and why the advertised monthly price is rarely the one to budget on.

The annual gap, compounded and branded

The compounded figures below are medians across every no-commitment price we have read on a company's own page: 88 companies for compounded semaglutide and 78 for compounded tirzepatide. Each row is annualized at its own billing cycle, so a four-weekly plan counts thirteen charges, not twelve. The branded figures are each manufacturer's own cash price.

Two things stand out. The compounded gap is smaller than the branded one at the median, and far smaller at the low end, because the cheapest compounded tirzepatide plans are priced close to the cheapest semaglutide ones. And branded semaglutide bought direct from Novo costs more per year than the typical compounded tirzepatide plan, so the molecule matters less to the bill than whether the product is branded.

Compounded drugs are not FDA-approved, so a compounded plan and a branded pen are different products even when the molecule is the same. We set them side by side because readers compare them, not because they are equivalent. For what separates a compounding pharmacy from an outsourcing facility, see our explainer.

The branded price ladders

Eli Lilly prices Zepbound in steps through LillyDirect: $299 a fill at 2.5 mg, $399 at 5 mg, and $449 at 7.5 mg and every dose above it, as long as you refill within 45 days.² Miss that window and the same fill costs $499 at 7.5 mg and $699 at 10, 12.5 and 15 mg. Lilly defines a month as 28 days.

Novo Nordisk prices Wegovy pens almost flat through NovoCare Pharmacy: $349 a month at 0.25, 0.5, 1, 1.7 and 2.4 mg, and $399 for the 7.2 mg Wegovy HD pen. Patients new to the offer pay $199 for each of their first two fills at 0.25 and 0.5 mg, through December 31, 2026. Novo's month is one box of four pens, which is also 28 days.¹

The late-refill line is the one to watch. On Zepbound at 10 mg, the difference between refilling on day 44 and day 46 is $250 a fill. Across a year of late refills that turns $5,837 into $9,087. For the full LillyDirect terms, see what LillyDirect costs; for Novo's, see what NovoCare Pharmacy costs.

Which one gets pricier as you titrate

Branded tirzepatide does. Zepbound's price rises $150 a fill between the starting dose and 7.5 mg, then flattens. Wegovy's pen price does not rise with dose at all between 0.25 and 2.4 mg. The only step is to the 7.2 mg HD pen, and the only discount is the introductory one.

That shape matters more than the sticker. A Wegovy patient knows the maintenance price from the first fill. A Zepbound patient pays $299 in month one and $449 from month three onward, so a budget built on the first bill will be short within eight weeks.

Compounded sellers split both ways. Some hold one price at every dose, and some charge more as the dose climbs, which is the most common hidden escalation in this market. The medians above are each company's no-commitment price as published, so a company that tiers by dose is counted at the tier it advertises. Check the dose table on any plan before comparing it with a flat one. GLP-1 costs by dose walks through every ladder.

Prepay vs month-to-month

Most compounded headlines are not the price you pay if you stop after one cycle. Of the 107 compounded semaglutide prices we track, 73 (68%) advertise a figure below the no-commitment rate. For compounded tirzepatide it is 64 of 91 (70%).

Prepaying can be worth it if you are confident you will stay on the drug for the full term and at a dose the plan covers. It is a poor bet in the first months, when side effects or a dose change are most likely to end the plan early. What a prepay plan really costs shows the break-even arithmetic.

The manufacturers do not sell prepay at all. Their discounts are the introductory Wegovy fills and Lilly's on-time refill price.

Why we don't compute cost per pound lost

It is tempting to divide each year's price by the weight each drug takes off. The best head-to-head data make that look easy. In SURMOUNT-5, a 72-week open-label trial of 751 adults with obesity but without type 2 diabetes, tirzepatide at 10 or 15 mg lowered body weight by 20.2% and semaglutide at 1.7 or 2.4 mg by 13.7%.³⁴

We don't do the division, for three reasons. The trial tested the branded products at their maximum tolerated doses, not compounded preparations, so its results say nothing about what a compounded plan delivers. Individual response varies widely around those averages, so a per-pound figure would be precise and wrong for most readers. And the trial was funded by Eli Lilly, which makes one of the two drugs. The honest comparison here is price, and the clinical choice belongs with a prescriber.

How to use these numbers

If you are paying cash for a branded drug, compare the manufacturer's own channel before any reseller. The typical telehealth year for branded Zepbound, $6,057, sits above LillyDirect's own $5,837, because a reseller adds its fee to the same product.

If you are comparing compounded plans, compare no-commitment prices at the dose you expect to reach, annualized at the plan's real billing cycle. The cost pages for compounded semaglutide, compounded tirzepatide, Wegovy and Zepbound show the full spread, and Zepbound vs Wegovy compares the two branded products channel by channel.

Wegovy® is a registered trademark of Novo Nordisk A/S. Zepbound® is a registered trademark of Eli Lilly and Company. Doseworth is not affiliated with either.