GLP-1 medication: an honest comparison for 2026

By Bithi H· Last reviewed June 2025 · 9 min read

The four GLP-1 options most people are actually considering right now are brand semaglutide (Ozempic/Wegovy), brand tirzepatide (Mounjaro/Zepbound), compounded semaglutide, and compounded tirzepatide. Brand Wegovy lists at roughly $1,350/month without insurance. Compounded semaglutide from a 503B-licensed pharmacy runs closer to $150-$250/month through a GLP-1 telehealth provider. The drugs work. The question is which path makes sense for your situation in 2026.

I’ve been on compounded semaglutide for six months. I went from 247 to 209 pounds. My first month was miserable with nausea. I’m not a doctor, and none of this is medical advice. But I’ve read the trials, and I’m going to tell you what the data actually says about each option before you make a decision that costs you anywhere from $150 to $16,000 a year.

Does the GLP-1 drug class actually work for weight loss?

Yes, and the effect sizes are large enough that “lifestyle modification” comparisons look embarrassing. The STEP 1 trial (Wilding et al., New England Journal of Medicine, 2021) enrolled 1,961 adults with obesity and showed 14.9% mean body weight loss at 68 weeks on 2.4mg weekly semaglutide versus 2.4% on placebo. That’s not a rounding error.

Tirzepatide outperforms semaglutide head-to-head on weight loss in available data. The SURMOUNT-1 trial (Jastreboff et al., NEJM, 2022) showed that participants on the highest dose of tirzepatide (15mg weekly) lost a mean of 20.9% of body weight at 72 weeks. Sample size: 2,539 adults with obesity or overweight plus at least one comorbidity.

Both drugs work by slowing gastric emptying and suppressing appetite through hormonal signaling. Semaglutide is a GLP-1 receptor agonist. Tirzepatide hits both GLP-1 and GIP receptors, which is the likely explanation for the larger weight loss numbers. Neither drug is magic. Both require dose titration over several months, and both cause GI side effects that make the first four to eight weeks unpleasant for a meaningful percentage of users.

What’s the difference between Ozempic, Wegovy, Mounjaro, and Zepbound?

Same active ingredients, different FDA approvals and different doses.

Ozempic contains semaglutide, approved for type 2 diabetes management, maxes out at 2mg weekly. Wegovy contains semaglutide, approved specifically for chronic weight management, maxes out at 2.4mg weekly. Mounjaro contains tirzepatide, approved for type 2 diabetes. Zepbound contains tirzepatide, approved for weight management and, as of late 2024, also for obstructive sleep apnea. Prescribing Ozempic off-label for weight loss is common and legal. Prescribing Mounjaro off-label for weight loss is also common.

The practical implication: if your doctor writes “Ozempic” for weight loss, your insurance may deny it because the diagnosis doesn’t match the label. Wegovy has the weight-management indication but costs the same as Ozempic and faces its own coverage battles. This is a big reason people end up looking at compounded options or telehealth in the first place.

Brand Active ingredient FDA approval Max dose List price/month (2025) Ozempic Semaglutide Type 2 diabetes 2mg/week ~$935 Wegovy Semaglutide Weight management 2.4mg/week ~$1,350 Mounjaro Tirzepatide Type 2 diabetes 15mg/week ~$1,060 Zepbound Tirzepatide Weight management, sleep apnea 15mg/week ~$1,060 Compounded semaglutide Semaglutide Off-label (prescribed) Varies ~$150-$250 Compounded tirzepatide Tirzepatide Off-label (prescribed) Varies ~$200-$350

List prices sourced from manufacturer websites and GoodRx data, June 2025. Actual cost varies by pharmacy and insurance.

Does the Zepbound savings card actually help?

For commercially insured patients, yes. For everyone else, the math is harder. Eli Lilly’s Zepbound savings card program has offered eligible patients Zepbound for as low as $25/month with commercial insurance, or a discounted self-pay price through Lilly Direct, which has ranged between $349 and $499/month depending on dose. Novo Nordisk runs a similar program for Wegovy.

The catches: you need commercial insurance that covers Zepbound (Medicare and Medicaid patients are generally excluded from manufacturer savings programs due to federal anti-kickback rules), the programs can change terms at any time, and supply shortages have periodically made getting the drug at any price a logistical problem.

If you have employer-sponsored insurance that covers Zepbound and you can actually get the drug, the savings card is genuinely useful. If you’re uninsured, underinsured, or on a government plan, you’re mostly looking at either paying full list price or going a different route.

Is compounded semaglutide legal and is it the same drug?

Compounded semaglutide contains the same active ingredient as Wegovy and Ozempic. It’s not the same product. The FDA does not review compounded drugs for safety, efficacy, or manufacturing consistency the way it reviews brand-name drugs. That’s a real limitation and worth being honest about.

The legal picture has shifted. The FDA declared semaglutide no longer in shortage in early 2024, which triggered restrictions on compounding. After significant legal back-and-forth, including a lawsuit from the Outsourcing Facilities Association, compounding by 503B outsourcing facilities was allowed to continue under certain conditions through mid-2025. The regulatory environment is still evolving. As of this writing, compounded semaglutide remains available through telehealth providers sourcing from 503B-licensed pharmacies, but that could change.

A 503B outsourcing facility is subject to FDA oversight and Current Good Manufacturing Practice (CGMP) standards. That’s meaningfully different from a random compounding pharmacy. If you’re going the compounded route, asking specifically whether your provider sources from a 503B facility isn’t paranoia. It’s basic due diligence.

I get mine through a GLP-1 telehealth service that’s explicit about using a 503B-registered pharmacy. That mattered to me when I was deciding.

How do the side effects compare across options?

The side effect profile is similar across semaglutide and tirzepatide because the GLP-1 mechanism is shared. Nausea, vomiting, diarrhea, and constipation are the most common complaints, particularly during dose escalation. In STEP 1, 44% of semaglutide patients reported nausea versus 16% in the placebo group. In SURMOUNT-1, nausea occurred in 31.5% of the 15mg tirzepatide group.

The clinical consensus is that tirzepatide may cause somewhat less nausea than semaglutide at equivalent weight-loss-producing doses, though comparing across trials is imperfect. A 2023 retrospective analysis by Frias et al. in Diabetes, Obesity and Metabolism found tirzepatide had a lower discontinuation rate due to GI adverse events compared to semaglutide in a real-world population, though this wasn’t a randomized comparison.

The more serious risks include pancreatitis, gallbladder disease, and, in rodent studies, thyroid C-cell tumors (which is why both drugs carry a boxed warning and are contraindicated in patients with a personal or family history of medullary thyroid carcinoma). Muscle loss during rapid weight reduction is a real concern; emerging research suggests prioritizing protein intake and resistance training can reduce lean mass loss, though the GLP-1 trials weren’t designed to test this specifically.

My first month on compounded semaglutide at 0.25mg was rough. Nausea most evenings, no appetite, lost about 8 pounds in four weeks mostly because eating felt unpleasant. Month two at 0.5mg was better. By month three I’d mostly adapted.

Which option makes the most sense for different situations?

There’s no universal answer, but the decision tree is cleaner than the marketing makes it seem.

If you have commercial insurance that covers Wegovy or Zepbound: Start there. The Zepbound savings card can bring your cost down to $25-$499/month depending on coverage. The brand product has the full FDA review behind it, and you’re not navigating the compounding regulatory environment.

If your insurance doesn’t cover weight-management drugs or you’re uninsured: Brand pricing at $1,000-$1,350/month is not realistic for most people. Compounded semaglutide or tirzepatide from a GLP-1 telehealth service in the $150-$350/month range is the realistic option. The clinical evidence for semaglutide is strong enough that the argument for paying five times more for the brand product, without insurance, is mostly about regulatory certainty.

If your primary care doctor won’t prescribe: This is common. Weight management remains stigmatized in primary care, and many PCPs are uncomfortable with GLP-1s or simply unfamiliar with the compounded options. Telehealth changed this. You can get a licensed clinician to review your history and prescribe without an in-person visit.

If you want the best weight loss numbers: The SURMOUNT-1 data on tirzepatide is hard to ignore. 20.9% body weight loss at 72 weeks on 15mg is larger than anything semaglutide has produced in a head-to-head or comparable trial. If maximizing weight loss is the goal and you can access tirzepatide at a reasonable price, the evidence favors it.

If cost is the binding constraint: Compounded semaglutide is typically cheaper than compounded tirzepatide. At $150-$200/month through a reputable GLP-1 telehealth provider, it’s the entry point most people can actually sustain for the 12–24 months these drugs typically need to work.

What does 2026 actually change about this decision?

A few things worth watching. The FDA’s position on compounding continues to evolve following the semaglutide shortage declaration. Oral semaglutide (Rybelsus, already approved for diabetes) is in trials for weight management, which could change the injection-averse calculus. Eli Lilly has also been expanding its Lilly Direct self-pay program, which could make brand tirzepatide more accessible without insurance.

The SCALE maintenance trial (Davies et al., The Lancet, 2021) showed that patients who stopped semaglutide regained two-thirds of their lost weight within a year. That finding isn’t unique to semaglutide; it reflects the chronic nature of obesity. Whatever you start, you’re likely looking at long-term use. That makes cost sustainability a first-order concern, not a secondary one.

The regulatory picture for compounded GLP-1s will likely clarify further in 2025–2026 as FDA guidance and ongoing litigation resolve. That’s worth monitoring if you’re planning to start or continue compounded therapy.