Tirzepatide vs Semaglutide Cost: Price Comparison Guide

Cost is a primary factor in choosing between tirzepatide (Mounjaro/Zepbound) and semaglutide (Ozempic/Wegovy) for diabetes and weight loss treatment. While list prices are similar, real-world costs vary dramatically depending on insurance coverage, copay assistance programs, compounded options, and telehealth platforms. This comprehensive guide breaks down all pricing options, insurance considerations, and strategies to minimize costs while maintaining quality and safety.

Understanding List Prices vs Real-World Costs

The starting point for cost comparison is list price—the official manufacturer price before insurance, discounts, or assistance programs. However, list price is rarely what patients actually pay.

List price reality: Both semaglutide and tirzepatide have nearly identical list prices: approximately $1,200-1,500 monthly depending on dose strength and formulation. These list prices are set by manufacturers and published in drug pricing databases. Few patients pay list price; instead, they pay based on their insurance coverage.

Insurance negotiation: Medicare, Medicaid, and private insurance plans negotiate prices down from list prices. The negotiated prices aren't public, but they typically represent 30-50% discounts from list prices. However, patients don't directly benefit from these negotiated prices—instead, they benefit through lower copays or coinsurance based on plan structure.

Transparency gap: A core problem in drug pricing is opacity. List prices don't reflect what patients pay. Actual costs depend on individual insurance coverage, which varies enormously. Two patients with same income and similar insurance plans might pay vastly different amounts depending on plan details. Understanding your specific insurance coverage is crucial—general averages are misleading.

International pricing: Outside the United States, semaglutide and tirzepatide typically cost 40-60% less due to government price negotiations and different pharmaceutical pricing policies. A patient might access these medications at substantially lower costs in Canada, Mexico, or Europe. However, importing medications for personal use has legal and safety complexities worth understanding.

Brand-Name Pricing by Product and Indication

Four main brand-name products exist: Ozempic and Wegovy (both semaglutide), plus Mounjaro and Zepbound (both tirzepatide). While containing the same active ingredients, these products have different pricing due to different indications and marketing strategies.

Ozempic (semaglutide for diabetes): List price approximately $1,400-1,500 monthly depending on dose. Contains 0.5 mg, 1.0 mg, or 2.4 mg semaglutide per dose. FDA-approved for type 2 diabetes management. Insurance coverage varies—some plans cover it readily for diabetes, others require prior authorization or prefer generic alternatives. Medicare Part D coverage is common with standard copays ($35-$150 depending on plan tier).

Wegovy (semaglutide for weight loss): List price approximately $1,300-1,500 monthly depending on dose. Identical semaglutide doses to Ozempic (0.5-2.4 mg). FDA-approved for chronic weight management in obese or overweight patients. Insurance coverage is often less favorable than Ozempic—many plans deny Wegovy coverage, requiring patients to pay out-of-pocket or obtain prior authorization. This creates practical incentive to use Ozempic off-label for weight loss (insurance may cover it better as a diabetes medication).

Mounjaro (tirzepatide for diabetes): List price approximately $1,200-1,400 monthly depending on dose. Contains 2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, or 15 mg tirzepatide. FDA-approved for type 2 diabetes. Insurance coverage is often favorable—many plans readily cover Mounjaro, sometimes with better copay assistance than semaglutide. Manufacturer copay card programs are robust.

Zepbound (tirzepatide for weight loss): List price approximately $1,200-1,400 monthly. Identical tirzepatide doses to Mounjaro. FDA-approved for chronic weight management. Like Wegovy, insurance coverage is often less favorable than Mounjaro for weight loss indication. However, Zepbound was approved more recently (2023) and copay assistance programs may improve as the product matures.

Indication-based pricing implications: The same medication (semaglutide or tirzepatide) costs differently depending on which brand you're prescribed. For cost optimization, asking your doctor to prescribe the diabetes indication (Ozempic or Mounjaro) rather than weight loss indication (Wegovy or Zepbound) may improve insurance coverage, even if using off-label for weight loss. This is legal and common.

Insurance Coverage: What Actually Matters for Your Costs

Insurance coverage and copay structure determine real out-of-pocket costs far more than medication choice between semaglutide and tirzepatide.

Formulary status and tier placement: Insurance companies place drugs on formularies (covered drug lists) and assign tiers (preferred tier 1 is cheapest, tier 2 is more expensive, etc.). Preferred tier drugs have lower copays; less preferred tiers have higher copays or require prior authorization. Some plans place semaglutide on preferred tier, others place tirzepatide preferred. Check YOUR plan's formulary.

Prior authorization requirements: Many plans require prior authorization before covering GLP-1s or tirzepatide—meaning your doctor must justify the medication medically before insurance will cover it. This delay is frustrating but doesn't prevent coverage if criteria are met (documented diabetes or obesity). Authorization typically takes 1-7 business days.

Copay vs coinsurance: Some plans use fixed copays ($50, $100, or $150 per fill). Others use coinsurance (you pay percentage of cost). For expensive medications, coinsurance means higher patient costs—a 20% coinsurance on $1,200 medication is $240 monthly. Fixed copays cap your maximum exposure.

Deductible considerations: Some plans require meeting an annual deductible ($1,000-5,000) before insurance covers brand-name medications. You pay full cost until deductible is met. Once deductible is met, copays apply. For patients starting treatment early in year before deductible is met, initial costs are substantially higher.

Specialty pharmacy requirements: Some insurance plans require using specific specialty pharmacies (not your local pharmacy). Specialty pharmacy networks are limited—you may have only one or two options in your area. Specialty pharmacies specialize in expensive medications and sometimes offer copay assistance programs beyond standard plan copays.

Medicare coverage: Medicare Part D covers semaglutide and tirzepatide through participating plans. Coverage varies—some Medicare plans cover with modest copays ($35-50), others less favorably. Medicare may have specific tier placement or prior authorization requirements. Checking your specific Medicare plan details is important.

Manufacturer Copay Assistance Programs: Dramatically Reducing Costs

Manufacturers of semaglutide and tirzepatide offer robust copay assistance programs that reduce out-of-pocket costs dramatically. Understanding and accessing these programs is crucial for affordability.

Novo Nordisk copay program (semaglutide): Novo Nordisk's copay card program reduces out-of-pocket cost to $0-250 monthly depending on insurance. Eligible patients are those with commercial insurance coverage of semaglutide. The copay card is free to obtain—patients apply online or through healthcare providers. Once approved, the card is used at pharmacies, and Novo Nordisk pays the difference between patient copay and list price.

Novo Nordisk patient assistance (semaglutide): For uninsured or underinsured patients, Novo Nordisk offers patient assistance programs providing free or reduced-cost semaglutide. Income limits apply (typically $75,000-$100,000 for individuals, higher for families). Application requires proof of income and residency. If approved, patients receive medication free. This program is often underutilized—many uninsured patients don't know about it.

Eli Lilly copay program (tirzepatide): Eli Lilly offers similar copay card programs reducing out-of-pocket to $0-250 monthly for insured patients. Eligibility and application processes mirror Novo Nordisk's programs. For commercial insurance holders, the copay card makes tirzepatide affordable.

Eli Lilly patient assistance (tirzepatide): For uninsured/underinsured patients, Eli Lilly provides free or reduced-cost tirzepatide through patient assistance. Income and residency documentation required. If approved, treatment becomes accessible without cost.

Practical implications: Before pursuing compounded alternatives or paying high out-of-pocket costs, all patients should explore manufacturer assistance programs. For insured patients, copay cards reduce costs to $0-250 monthly. For uninsured patients meeting income criteria, free medication is often available. These programs directly compete with compounded alternatives but provide guaranteed product quality.

How to access: Visit Novo Nordisk's website (novo-nordisk.com) or Eli Lilly's website (lilly.com) to find copay card and patient assistance applications. Alternatively, your healthcare provider can help with applications. The application process is usually simple and takes 10-15 minutes online.

Compounded Semaglutide and Tirzepatide Pricing

Compounded versions of both medications offer substantial cost savings for those willing to accept quality uncertainties.

Compounded semaglutide: Typically costs $200-400 monthly depending on dose, pharmacy, and whether 503A or 503B sourcing. This represents 60-75% savings compared to brand-name list prices. For uninsured patients unable to access manufacturer assistance, compounding is dramatically cheaper. However, quality varies—compounded products lack FDA approval guarantees.

Compounded tirzepatide: Similarly costs $300-600 monthly, slightly more than semaglutide compounding due to higher typical doses and slightly less established compounding infrastructure. Still 50-75% cheaper than brand-name tirzepatide. Quality and consistency concerns apply to compounded tirzepatide as with semaglutide.

Cost comparison: Compounded semaglutide is typically $100-200 cheaper monthly than compounded tirzepatide. This cost difference is the primary practical difference between them at compounding level. The choice between semaglutide and tirzepatide becomes more about efficacy (tirzepatide is more potent) versus cost (semaglutide is cheaper compounded).

Quality trade-off: The savings come with risk—compounded products lack FDA potency guarantees, purity verification, or sterility assurance that brand-name products provide. For cost-conscious patients unable to access assistance programs, compounding is a real option, but understanding quality risks is essential.

Telehealth Platform Pricing: Balancing Cost and Medical Oversight

Telehealth platforms partnering with compounding pharmacies offer middle-ground pricing between direct compounding and brand-name products.

Typical pricing: Telehealth platforms offering semaglutide and tirzepatide cost $300-800 monthly, varying by platform and included services. The cost covers the consultation (doctor/provider evaluation), prescription, medication, and ongoing monitoring (check-ins, follow-up communication). Some platforms include additional services like nutritional counseling or exercise coaching, affecting pricing.

Compounding partnership: Most telehealth platforms partner with compounding pharmacies (usually 503B outsourcing facilities) for medication preparation. This ensures better quality control than direct compounding alone, though still lacking full pharmaceutical manufacturing standards. Platform selection of compounder is important—higher-quality partnerships command higher prices.

Medical oversight benefit: Unlike direct compounding, telehealth provides physician oversight ensuring semaglutide or tirzepatide is medically appropriate. This reduces risks and ensures monitoring for side effects. The additional cost ($100-300 more monthly than direct compounding) provides meaningful value for many patients.

Semaglutide vs tirzepatide on telehealth: Pricing is often identical for both medications on same platform ($400-600 monthly), as cost is driven more by provider overhead and compounder partnership than medication type. Some platforms price slightly higher for tirzepatide due to higher typical doses.

Platform comparison: Telehealth platforms vary widely in reputation, provider qualifications, compounder partnerships, and pricing. Research platforms carefully—read reviews, verify provider credentials, check compounder credentials (PCAB certification, 503B status). Cheapest platform isn't always best if provider quality or compounder standards are questionable.

International Purchasing and Importing: Legal and Safety Considerations

Some patients explore international purchasing—buying semaglutide or tirzepatide from Canadian, Mexican, or European pharmacies at lower prices.

Price differences: Identical medications cost 40-60% less in Canada, Mexico, and Europe compared to US list prices due to government price regulation. A $1,500 US medication might cost $600-900 internationally. The cost difference is substantial and tempting.

Legal status: US law permits importing medications for personal use in small quantities if the medication is approved in the US and imported for personal consumption (not resale). Buying semaglutide or tirzepatide from Canadian pharmacy for personal use is technically legal. However, FDA enforcement is inconsistent, and packages could be seized.

Quality assurance: International pharmacies vary in quality. Legitimate Canadian or Mexican pharmacies may provide genuine medications. However, counterfeit or substandard products exist, particularly through online-only operations. Verifying pharmacy legitimacy internationally is difficult. This quality uncertainty partially offsets cost savings.

Medical supervision concerns: Buying internationally bypasses US healthcare system, meaning no medical oversight. Patients self-determine whether semaglutide/tirzepatide is appropriate, self-monitor for side effects, and can't easily access medical guidance. This lack of oversight creates safety concerns.

Practical recommendation: International purchasing remains in legal gray area with quality and safety risks offsetting cost savings. It's a last resort for those unable to access US options (manufacturer assistance, copay cards, compounding) rather than a primary strategy. For most patients, legitimate US options provide adequate cost savings with better safety.

Long-Term Cost Analysis: What to Expect Yearly and Over 5 Years

Understanding projected costs over treatment durations helps inform financial planning and medication choice.

Brand-name uninsured annual cost: Approximately $14,400-18,000 (assuming $1,200-1,500 monthly). Over 5 years: $72,000-90,000. This is prohibitively expensive for most patients without assistance.

Brand-name with copay card annual cost: Approximately $0-3,000 (assuming $0-250 monthly). Over 5 years: $0-15,000. This is affordable for most working individuals and represents the true cost most patients should pay after accessing manufacturer programs.

Brand-name with Medicare annual cost: Approximately $600-1,800 (assuming $50-150 monthly copay). Over 5 years: $3,000-9,000. Senior patients typically have favorable cost access through Medicare.

Compounded semaglutide annual cost: Approximately $2,400-4,800 (assuming $200-400 monthly). Over 5 years: $12,000-24,000. For uninsured patients unable to access assistance, this is typically the cheapest viable option.

Telehealth-supervised compounded annual cost: Approximately $3,600-9,600 (assuming $300-800 monthly). Over 5 years: $18,000-48,000. More expensive than direct compounding but includes medical oversight.

Cost-benefit perspective: Annual GLP-1 therapy costs $0-18,000 depending on approach. Over 5 years, total range is $0-90,000. While substantial, this is often cost-effective compared to treating obesity-related complications (diabetes medications, cardiovascular drugs, surgeries, dialysis for kidney disease). Long-term savings from prevented disease often exceed medication costs.

Practical Cost-Reduction Strategies

Beyond choosing cheaper medications, specific strategies can further reduce costs.

Strategy 1: Explore manufacturer assistance first: Before any other approach, investigate Novo Nordisk and Eli Lilly patient assistance and copay programs. If eligible, these programs often provide lowest costs or free medication with guaranteed quality.

Strategy 2: Call your insurance to verify coverage: Don't assume coverage—contact your insurance plan's customer service and ask specifically: Is semaglutide covered? Is tirzepatide covered? What are copays? Is prior authorization required? This 10-minute call often reveals coverage differences worth $100-300 monthly.

Strategy 3: Discuss indication with your provider: If weight loss is your goal, ask your provider about prescribing Ozempic (diabetes indication) rather than Wegovy (weight loss indication). Insurance often covers diabetes indications better. This off-label prescribing is legal and can reduce costs significantly.

Strategy 4: Compare specialty pharmacies: If your insurance requires specialty pharmacy, check which specialty pharmacies are in-network. Different specialty pharmacies sometimes offer different copay assistance programs or pricing. A call to each may reveal cheaper options.

Strategy 5: Use prescription discount programs: If uninsured or insurance costs are high, programs like GoodRx, Mark Cuban Cost Plus Drugs, or SaveonPharm sometimes offer cheaper prices than pharmacy counter prices. Compare their prices to brand-name pharmacy prices.

Strategy 6: Consider 3-month or 6-month supplies: If using compounding or cash pay through legitimate sources, buying multi-month supplies often receives volume discounts (10-20% cheaper). Only do this with reputable sources and adequate shelf-life products.

Strategy 7: Timing treatment around deductible: If your insurance has an annual deductible, consider when in the year to start treatment. Starting after your deductible is met saves deductible costs. Coordinating with other healthcare needs (surgeries, major procedures) to meet deductible simultaneously optimizes insurance efficiency.

Strategy 8: Verify compounding pharmacy quality before purchasing: If pursuing compounding, verify credentials (state licensing, PCAB certification, 503B status if applicable) and read reviews before committing to a pharmacy. Quality assurance upfront prevents wasting money on unreliable products.

Semaglutide vs Tirzepatide Cost Summary and Decision Framework

For cost purposes, semaglutide and tirzepatide are essentially equivalent at most price points. Brand-name list prices are similar. Insurance coverage varies for both. Copay assistance programs exist for both. Compounded versions of semaglutide are slightly cheaper than compounded tirzepatide.

Cost-based choice factors: Choose semaglutide if compounding cost is your primary concern (slightly cheaper). Choose tirzepatide if superior efficacy (22% weight loss vs 15% for semaglutide) justifies marginally higher costs. For most patients, insurance coverage and copay assistance programs determine actual costs, making medication choice less about price and more about efficacy and individual tolerance.

Recommended approach: Verify your specific insurance coverage first—this determines accessible costs better than general averages. Apply for copay assistance if insured. Investigate patient assistance if uninsured. Only pursue compounding as a last resort after legitimate options are exhausted. Telehealth-supervised compounding offers middle ground for those wanting both cost savings and medical oversight.

Key takeaway: The medication itself (semaglutide vs tirzepatide) matters less for cost than the approach (brand-name, insured, copay card, assistance program, compounded, telehealth). Strategic navigation of these options reduces costs far more than simply choosing one medication over another.