Before anything else
None of what follows is a recommendation about whether you should take one of these. It is the set of questions that, answered before you start, prevents most of the avoidable problems we see people run into afterwards. Take the answers to a clinician rather than acting on them alone.
The nine questions
- What am I actually treating?
Weight, blood glucose, and cardiovascular risk are three different reasons to take one of these, and they lead to different drugs, different doses and completely different insurance outcomes. The answer to this question determines most of the others.
- Does my insurance cover weight management?
This is the single largest variable in what a year costs, and it is not close. A covered prescription can run tens of dollars a month; the same medication without coverage can run over a thousand. Coverage for weight management specifically is inconsistent between plans and usually requires prior authorisation. Find out before you choose a route, not after.
- Which compound, and on what basis?
Semaglutide has the longer safety record and a cardiovascular outcomes trial behind it. Tirzepatide produced larger average weight change in trials. That is a real trade and not a ranking.
- Brand or compounded?
Compounded is several times cheaper and more flexible on dose. Brand carries manufacturing assurance that compounded, by definition, does not. Know which one you are buying and why.
- Who sets my dose, and who do I call on a Sunday night?
The routes on this site differ enormously here. On one of them there is no clinician at all. Whatever you decide, know the answer before you need it.
- Do any of the labelled contraindications apply to me?
A personal or family history of medullary thyroid carcinoma, or MEN2, is a contraindication for this whole class. Pregnancy, or planning one, is a reason not to start. A history of pancreatitis or gallbladder disease changes the risk calculation and needs raising explicitly.
- What else am I taking?
Insulin and sulfonylureas raise hypoglycaemia risk in combination and usually need adjusting. Tirzepatide can reduce the effectiveness of oral contraceptives. Slowed gastric emptying can affect anything where absorption timing matters. Bring your full list.
- What is my plan for muscle and protein?
Weight lost on these drugs is not all fat. Adequate protein intake and resistance training are the mitigations with the most support behind them, and the people who plan for this from the start do better than the people who discover it in month six.
- What happens when I stop, and can I afford not to?
The withdrawal data is consistent across the class: stopping is followed by substantial regain. Budget for this as an ongoing treatment rather than a course with an end date, because that is what the evidence says it is.
The honest cost picture
They fall into five kinds. Your own insurance. A telehealth subscription. The manufacturer's own self-pay counter. A concierge practice. And a research-chemical vendor with no clinician attached to it at all. Priced out, the ten routes on this site run from a copay of nothing much up to around two thousand dollars a month for brand pens bought privately.
Insurance is the cheapest of these by a distance and the least predictable, because your plan decides rather than you. After that, the cheapest is the route with nobody clinical on it. That is not a coincidence, and it is the trade sitting underneath most of this page.
Two things distort almost every cost comparison you will read. The first is that quoted prices are usually for the starting dose, and the standard schedule escalates over roughly five months. The second is that membership fees and medication are often billed separately, so two moderate numbers add up to more than one large one.
The ten routes priced side by side · What a year on tirzepatide costs, route by route