Key takeaways
- On verified 12-month plans at the same provider, tirzepatide costs $1,668 a year and semaglutide $1,428, a difference of $240.
- Using SURMOUNT-5's 20.2% and 13.7% averages, a year of tirzepatide costs about $83 per percentage point of weight lost versus about $104 for semaglutide, so the more expensive drug is cheaper per unit of result.
- For a 250-pound patient the average difference is about 16 pounds over 72 weeks, which prices the extra $240 to $360 a year at roughly $15 to $23 per additional pound.
- Semaglutide remains the better buy for patients with established cardiovascular disease, patients who have already reached their goal on it, and patients for whom the monthly difference is decisive.
- The arithmetic only holds if the compounded product is what its label says and the patient reaches an effective dose; sub-potent product or microdose protocols break it.
The question
Telehealth patients choosing between compounded tirzepatide and compounded semaglutide face a small price difference and a large evidence difference, and most comparison pages present only the price. This article puts the two together using the verified 2026 prices in our pricing database and the results of the SURMOUNT-5 head-to-head trial, and shows the arithmetic so you can substitute your own weight, your own provider's prices and your own expectations.
The inputs
Prices. At NexLife, the provider with verified pricing for both drugs on identical terms, compounded tirzepatide is $139 per month on a 12-month plan and $169 month-to-month, and compounded semaglutide is $119 and $139. The annual difference is $240 on the 12-month plans and $360 month-to-month. At providers with reported or pending pricing the gap is generally similar, $20 to $40 per month, because semaglutide's active ingredient is cheaper and its doses are smaller.
Results. In SURMOUNT-5, mean weight loss at 72 weeks was 20.2% on tirzepatide and 13.7% on semaglutide 2.4 mg. Because telehealth pricing is annual and the trial is 72 weeks, we scale the trial results to 52 weeks using the published curves, which puts the one-year averages at about 18% for tirzepatide and about 12.5% for semaglutide. The ratio is what matters, and it is stable.
Weight. We show a 200-pound, a 250-pound and a 300-pound patient. Multiply by your own weight to get your own numbers.
Cost per percentage point
Over one year on the 12-month plans, tirzepatide costs $1,668 for about 18 percentage points of average loss, or about $93 per point. Semaglutide costs $1,428 for about 12.5 points, or about $114 per point. Using the full 72-week figures scales both numbers but keeps the ordering: about $83 per point for tirzepatide and $104 for semaglutide. On either basis the more expensive drug is about 20% cheaper per unit of result.
Month-to-month, tirzepatide is $2,028 a year, or about $113 per point, and semaglutide $1,668, or about $133 per point. Same ordering.
Cost per pound
A 200-pound patient loses about 36 pounds on tirzepatide and 25 on semaglutide in a year at the trial averages: about $46 per pound versus $57 per pound on the 12-month plans. A 250-pound patient loses about 45 and 31 pounds: $37 versus $46 per pound. A 300-pound patient loses about 54 and 38 pounds: $31 versus $38 per pound. The additional loss on tirzepatide is about 11 pounds at 200 pounds, 14 at 250 and 16 at 300, and the additional cost is $240, which prices the extra pounds at roughly $15 to $22 each on the 12-month plans and $22 to $33 month-to-month.
Those are averages. The responder distribution in SURMOUNT-5 matters as much: 31.6% of tirzepatide participants lost at least 25% of body weight versus 16.1% on semaglutide, and about 82% versus 61% lost at least 10%. A patient's chance of a sub-10% result is roughly halved on tirzepatide. For a patient who has a specific target, the probability of reaching it is a better way to think about value than the average.
When the arithmetic changes
Cardiovascular disease. The SELECT trial showed a 20% reduction in major adverse cardiovascular events with semaglutide 2.4 mg in people with obesity and established cardiovascular disease. Tirzepatide's outcome trial has not read out. For a patient with a prior heart attack, stroke or peripheral arterial disease, that evidence has a value the weight-loss arithmetic does not capture, and semaglutide is the reasonable first choice pending tirzepatide's data.
Already at goal. A patient who has lost what they intended on semaglutide and is maintaining does not need 6.5 more percentage points. Staying on the cheaper drug is rational.
Tolerability. The trials found similar gastrointestinal side-effect rates, but individuals differ. A patient who tolerates semaglutide and not tirzepatide has an easy choice.
Affordability. If $20 to $30 per month is the difference between staying on treatment and stopping, semaglutide wins, because stopping either drug leads to substantial regain (SURMOUNT-4 and STEP 4) and the cheapest effective drug that a patient can sustain beats the more effective drug they cannot.
Diabetes. Both drugs produce less weight loss in type 2 diabetes, and the head-to-head at obesity doses has not been done in that population. Tirzepatide's glycemic advantage in SURPASS-2 favors it for a patient whose HbA1c matters as much as weight.
What breaks the arithmetic entirely
The trial results apply to the molecule at the doses the trials used. Two things common in telehealth break the link between price and result.
Sub-potent or wrong product. A compounded vial that contains less tirzepatide than its label states, or a salt form the FDA has warned about, delivers less than the trial dose. The price per percentage point of a product that does not work is infinite. The compounding pharmacy guide explains how to check the pharmacy; it is the most important five minutes in this decision.
Microdose protocols. Providers selling doses below the approved starting dose are selling something the trials did not test. The dose-response in SURMOUNT-1 was clear: 15.0% at 5 mg, 19.5% at 10 mg, 20.9% at 15 mg. A "microdose" plan that is $10 cheaper per month and holds the patient at a fraction of 5 mg is not cheaper per unit of result; it may produce no result at all. The microdosing article reviews what evidence exists.
Dose-based pricing changes the comparison too
The prices above are flat-rate. At providers whose medication price rises with dose, the cost per percentage point rises with dose as well, because the dose that produces the result is the expensive one. Mochi Health's verified tirzepatide price is $90 for the first month and $199 a month thereafter for medication, plus a $39-then-$79 membership; from month two that is $278 per month, and the same SURMOUNT-5 arithmetic gives about $158 per percentage point on a 12-month basis ($3,187 ÷ 20.2), roughly double the flat-rate figure. At LillyDirect's published dose ladder ($299/$399/$449) the year is about $4,938, or $236 per point. The dose-based pricing article works through the curves.
Running your own numbers
Take your weight. Multiply by 0.18 for a one-year tirzepatide average and 0.125 for semaglutide, or by 0.202 and 0.137 for the 72-week trial averages. Take your provider's 12-month all-in cost for each drug from the true-cost calculator. Divide. If the tirzepatide figure per pound is lower, and it usually is, the more expensive drug is the better buy for weight loss. Then check the exceptions above with a clinician who knows your history, because a spreadsheet does not know whether you had a heart attack in 2021.
Frequently asked questions
Is tirzepatide worth the extra cost over semaglutide?
For most patients whose goal is weight loss, yes. On verified prices the difference is $240 to $360 a year, and SURMOUNT-5 showed 6.5 percentage points more average weight loss, which works out cheaper per percentage point on tirzepatide.
How much does each pound of weight loss cost on a GLP-1?
On the cheapest verified 12-month plans, a 250-pound patient losing the trial-average amount pays roughly $33 per pound on tirzepatide and $42 per pound on semaglutide over the first year. Individual results vary widely.
When is semaglutide the better value?
When you have established cardiovascular disease (semaglutide has the SELECT outcome trial), when you are already at goal on semaglutide and maintaining, when you tolerate semaglutide and not tirzepatide, or when $20 to $30 a month decides whether you can stay on treatment at all.
Sources
- Aronne LJ et al. Tirzepatide as Compared with Semaglutide for the Treatment of Obesity. N Engl J Med 2025 (SURMOUNT-5).
- NexLife tirzepatide and semaglutide plan pages, nexlife.us, accessed August 25, 2026.
- Jastreboff AM et al. SURMOUNT-1. N Engl J Med 2022;387:205-216.
- Wilding JPH et al. STEP 1. N Engl J Med 2021;384:989-1002.
- Lincoff AM et al. SELECT. N Engl J Med 2023;389:2221-2232.
- Institute for Clinical and Economic Review. Medications for Obesity Management: Effectiveness and Value. 2022 and 2025 updates.
Citations are to primary sources (peer-reviewed trials, FDA labeling and announcements, and provider pricing pages). See our sources policy and corrections log.