Most people arrive at this question expecting to compare trial results. In practice the trial numbers decide it far less often than coverage does. Here is the order the decision actually falls in.
1. Does your plan cover one of them? If your formulary covers one and not the other, that is almost always the answer. With a savings card a covered month can run around $25, while self-pay runs in the hundreds. No difference in average results is worth that gap. Call the number on your insurance card and ask which GLP-1s are on formulary for weight management, and what the prior-authorisation criteria are.
2. Do you have established cardiovascular disease? Wegovy carries an FDA indication for reducing major cardiovascular events in adults with known cardiovascular disease who are overweight or have obesity. That indication is frequently what makes a plan approve it, so if this is you, say so explicitly at the appointment.
3. Do you have moderate-to-severe obstructive sleep apnea? Zepbound carries an indication for that in adults with obesity. Same logic in reverse: a documented sleep study can be the thing that unlocks coverage.
4. Do you have type 2 diabetes? Then the conversation is a different one. Mounjaro and Ozempic are the diabetes-labelled versions of the same two molecules, and they are usually covered through a different part of the formulary. Bring your A1c.
5. Paying cash? Now, and only now, the numbers below matter.
| Medication | Manufacturer self-pay | List price, no program |
|---|---|---|
| Zepbound (tirzepatide) | $399 / month | $1,086 |
| Wegovy (semaglutide 2.4 mg) | $299 / month | $1,349 |
| Wegovy pill (oral semaglutide) | $299 / month | $997 |
| Ozempic (semaglutide) | $349 / month | $997 |
| Saxenda (liraglutide) | $449 / month | $1,349 |
Prices last checked August 2026 and they change several times a year. Confirm on the manufacturer page before you decide.
Monthly price is the wrong comparison on its own. Wegovy is the cheaper month, but tirzepatide takes more weight off in the same time, so the cheaper month is not automatically the cheaper pound. The cost calculator works out cost per pound lost for each channel, which is the number that actually ranks them.
SURMOUNT-5 put the two against each other directly. At 72 weeks the tirzepatide group averaged −20.2% of body weight and the semaglutide group −13.7%. That is a real gap and it is the strongest argument for tirzepatide on results alone.
Two things to hold alongside it. These are group averages with a wide individual spread, so plenty of people on semaglutide did better than plenty of people on tirzepatide. And an average advantage of six points is worth very little if the drug that carries it is the one your plan will not pay for. You can see both curves side by side on the drug comparison page.
Brand names. Wegovy and Ozempic are the same molecule, semaglutide, labelled for different conditions. Zepbound and Mounjaro are the same molecule, tirzepatide. Which brand name you end up with is mostly a function of what the prescription is written for, not a difference in what you inject.
Side-effect horror stories. Both are GLP-1s and the common effects are broadly similar: nausea, constipation, reflux, and the ones that mostly arrive during dose escalation. The side-effect page breaks them down by dose. This rarely separates the two drugs at the decision stage.
Needles. A real blocker for some people, and there is now an oral semaglutide option at a similar self-pay price. It does not reach the injection numbers, but it exists and it is worth naming at the appointment if injections are what is stopping you.
Prescribers move faster when the paperwork case is already assembled. Bring your weight history rather than just today's number, any blood pressure, lipid and A1c results you have, a sleep study if one exists, and a short list of what you have already tried and for how long. The eligibility page covers what the labels require and what plans usually ask for on top.
If you do not have a prescriber yet, the telehealth page lists licensed US platforms that prescribe the brand-name versions.
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