What semaglutide is
Semaglutide is a once-weekly injectable (and, in two products, once-daily oral) GLP-1 receptor agonist developed by Novo Nordisk. It is approved as Ozempic for type 2 diabetes (2017), Rybelsus as an oral tablet for type 2 diabetes (2019), and Wegovy for chronic weight management (June 2021), with additional Wegovy indications for cardiovascular risk reduction (March 2024) and, in August 2025, for metabolic dysfunction-associated steatohepatitis (MASH). An oral Wegovy tablet at 25 mg was approved for weight management in December 2025.
Semaglutide is also the molecule in most compounded semaglutide sold through telehealth, which is not FDA-approved. This page covers the evidence, which applies to the approved products, and then what changes when the product is compounded.
How it works
Semaglutide is a modified version of human GLP-1 with a fatty-acid side chain that binds albumin and two amino-acid substitutions that resist degradation, extending its half-life to about a week. It activates GLP-1 receptors in the pancreas (glucose-dependent insulin release and glucagon suppression), the gut (slower gastric emptying) and the brain (reduced hunger, increased satiety, and reduced reward-driven eating). Unlike tirzepatide it does not act on GIP receptors, and its maximum weight-loss effect is smaller.
The evidence: STEP, SELECT and beyond
STEP 1 (NEJM, 2021), the pivotal weight-management trial, randomized 1,961 adults with obesity or overweight plus a comorbidity, without diabetes, to semaglutide 2.4 mg or placebo for 68 weeks with lifestyle intervention. Mean weight change was −14.9% versus −2.4%. Some 86% of semaglutide participants lost at least 5%, 69% at least 10%, 50% at least 15% and 32% at least 20%. A one-year off-treatment extension found participants regained about two-thirds of lost weight.
STEP 2 (Lancet, 2021) in adults with type 2 diabetes produced −9.6% on 2.4 mg versus −3.4% on placebo, the familiar pattern of smaller loss in diabetes. STEP 3 added intensive behavioral therapy (−16.0%). STEP 4 was a withdrawal study: after 20 weeks on treatment, switching to placebo led to a 6.9% regain over 48 weeks while continuers lost a further 7.9%. STEP 5 extended treatment to 104 weeks (−15.2%). STEP 8 compared semaglutide 2.4 mg with liraglutide 3.0 mg (−15.8% versus −6.4%). STEP UP (2025) tested a 7.2 mg dose and reported about −20.7% at 72 weeks, closing part of the gap with tirzepatide at the cost of more gastrointestinal events; the higher dose is under regulatory review.
SELECT (NEJM, 2023) is the largest outcome trial in obesity pharmacotherapy: 17,604 adults with overweight or obesity and established cardiovascular disease, without diabetes, followed for a mean of 40 months. Semaglutide 2.4 mg reduced the composite of cardiovascular death, non-fatal heart attack and non-fatal stroke by 20% (6.5% versus 8.0%). The benefit appeared early, before most of the weight loss, suggesting mechanisms beyond weight alone. This is the basis of Wegovy's cardiovascular indication and the strongest argument for choosing semaglutide over tirzepatide in patients with existing cardiovascular disease, since tirzepatide's obesity outcome trial has not yet reported.
OASIS 1 (Lancet, 2023) tested oral semaglutide 50 mg for weight management (−15.1% at 68 weeks); the approved oral Wegovy dose is 25 mg, supported by the OASIS 4 trial (about −13.6%). SUSTAIN-6 and PIONEER 6 in type 2 diabetes established cardiovascular safety and, in SUSTAIN-6, a signal for diabetic retinopathy complications that appears in the labeling.
Dosing and titration
Wegovy is started at 0.25 mg once weekly for four weeks, then 0.5 mg for four weeks, 1 mg for four weeks, 1.7 mg for four weeks, and then the 2.4 mg maintenance dose from week 17. The 1.7 mg dose is an acceptable maintenance dose if 2.4 mg is not tolerated. For a dose-based telehealth provider, this means the top-tier price applies from month five; our 12-month model uses three months at the starting price, which favors the provider.
Rybelsus is taken once daily on an empty stomach with no more than 4 ounces of water, 30 minutes before food, at 3 mg for 30 days then 7 mg, with an option to increase to 14 mg. The oral Wegovy tablet follows a similar escalation to 25 mg. These administration rules exist because oral semaglutide's absorption depends on the SNAC enhancer and is destroyed by food; they are the clearest demonstration that oral peptide delivery is difficult, which is relevant to compounded sublingual claims.
Side effects
In STEP 1, gastrointestinal events were the most common: nausea 44.2% versus 17.4% on placebo, diarrhea 31.5% versus 15.9%, vomiting 24.8% versus 6.4%, constipation 23.9% versus 9.7%. Most were transient and mild to moderate. Discontinuation for adverse events was 7.0% versus 3.1%. Gallbladder-related disorders occurred in 2.6% versus 1.2%. The class boxed warning for thyroid C-cell tumors applies, along with warnings for pancreatitis, hypoglycemia with insulin or sulfonylureas, acute kidney injury, hypersensitivity, diabetic retinopathy complications, severe gastrointestinal disease and aspiration under anesthesia. An FDA review completed in January 2024 found no evidence that GLP-1 medications cause suicidal thoughts, though the labeling advises monitoring. See the important safety information.
Body composition
The STEP 1 DXA substudy reported that about 39% of lost weight was lean mass, a somewhat higher proportion than in the tirzepatide substudy, though the absolute lean-mass loss was modest and the ratio of fat to lean loss was within the range seen with dietary restriction. Protein of 1.2 to 1.6 g/kg/day and resistance training are the standard mitigation.
Compounded semaglutide: what changes
Semaglutide was on the FDA shortage list from 2022 until February 21, 2025, when the FDA declared the shortage resolved and set April 22, 2025 (503A) and May 22, 2025 (503B) deadlines for ending compounding of copies. Compounding for an individual patient with a documented need for a different formulation remains permitted, which is the basis for the compounded semaglutide, "microdose" and sublingual products telehealth providers sell in 2026.
Compounded semaglutide has a longer history of quality problems than compounded tirzepatide. The FDA has warned about products made with semaglutide sodium or semaglutide acetate, which are not the base peptide in the approved products, and about dosing errors from vials and from confusion between milligrams and units; it has received adverse-event reports including hospitalizations. Novo Nordisk ended a 2025 partnership with Hims & Hers within months over what it described as mass promotion of compounded semaglutide. As with tirzepatide, a patient's practical protections are to confirm the pharmacy's state license, to insist on knowing the concentration on the vial label, and to treat sublingual products as unproven: the approved oral form needed a 25 mg dose and an absorption enhancer to achieve about 1% bioavailability, and a compounded sublingual product with no pharmacokinetic data offers no assurance of any particular exposure.
Brand-name semaglutide: prices and access
Wegovy pens are sold through pharmacies and, for self-pay patients, through Novo Nordisk's NovoCare Pharmacy at a flat price across doses that was cut substantially in late 2025, with an introductory offer for new patients and a lower launch price for the oral tablet. Insurance coverage for weight management remains inconsistent, while coverage for the cardiovascular indication is broader. See the NovoCare benchmark row for the brand self-pay price and its verification status, and Ro for an insurance-first program.
Choosing between semaglutide and tirzepatide
On weight loss, tirzepatide is more effective (SURMOUNT-5). On cardiovascular outcomes in people with existing cardiovascular disease, semaglutide has the completed trial and the approved indication. On tolerability the two are similar. On price, compounded semaglutide is typically $20 to $40 per month cheaper than compounded tirzepatide at the same provider; at NexLife the difference is $20 per month on the 12-month plan. Patients who cannot tolerate one sometimes tolerate the other. The tirzepatide reference covers the dual agonist in the same depth.
What it costs at each telehealth provider
The ranked list below is computed from our pricing database and ordered by 12-month all-in total. Providers offering semaglutide whose prices we have not yet verified are listed after it.
Providers offering semaglutide, ranked by 12-month all-in cost
Sunlight
Patients comparing mid-to-upper market flat prices
Trimi
Patients able to prepay a year who have confirmed the refund terms
NexLife
People who want to know the exact all-in monthly cost before they start and who expect to titrate to a higher dose, where dose-based pricing would otherwise raise the bill
Ozari Health
Patients comparing starter offers who will confirm the continuing price before enrolling
Orderly Meds
Patients comparing all-in compounded plans who want oral and injectable options from one provider
Mochi Health
Patients who value frequent clinician contact and dietitian support and who expect to stay on lower doses, where Mochi's starting price is most competitive
Ivím Health
Patients who want coaching and app tracking bundled with a moderately priced compounded tirzepatide plan
Henry Meds
Patients who want a simple all-in monthly price with no membership and no commitment, and who may switch providers as prices move
Fifty 410
Price-focused patients comparing low-cost compounded plans
Noom Med
Patients who already use Noom and want medication added to a behavioral program
Remedy Meds
Patients who want a low first-month price and are prepared for a higher recurring rate
Sprout Health
Patients outside the five excluded states comparing mid-market prices
Also offering semaglutide, pricing pending verification: Fella Health, Ro, Hims, Hers, Shed (ShedRx), Found, WeightWatchers Clinic, Calibrate, Eden, Willow, Lavender Sky Health, LifeMD, Strut Health, Raeliva (formerly onlinesemaglutide.org), TrimRx, ReflexMD, MyStartHealth.
Frequently asked questions
How much weight do people lose on semaglutide?
In STEP 1, adults with obesity without diabetes lost a mean of 14.9% of body weight on semaglutide 2.4 mg over 68 weeks versus 2.4% on placebo; 32% lost at least 20%. In the SURMOUNT-5 head-to-head, semaglutide produced 13.7% mean loss versus 20.2% for tirzepatide.
How much does compounded semaglutide cost in 2026?
The lowest verified all-in price in our database is $119 per month on NexLife's 12-month plan ($1,428 per year), with the month-to-month plan at $139. Several other providers offer compounded semaglutide at prices we are still verifying; they are listed but not ranked.
Is there a semaglutide pill?
Yes. Rybelsus (oral semaglutide, 3-14 mg) has been approved for type 2 diabetes since 2019, and an oral Wegovy tablet (semaglutide 25 mg) was approved for chronic weight management in December 2025. Both use an absorption enhancer (SNAC) to achieve about 1% bioavailability. Compounded sublingual or ODT semaglutide has no published pharmacokinetic data.
Does semaglutide reduce heart attacks and strokes?
In SELECT, semaglutide 2.4 mg reduced major adverse cardiovascular events by 20% over a mean of 40 months in adults with overweight or obesity and established cardiovascular disease but without diabetes. Wegovy carries an FDA-approved cardiovascular indication on that basis.