GLP-1 Comparison Guide: Semaglutide vs Tirzepatide, Brand vs Compounded (2026)
⚡ The Short Answer
Tirzepatide is slightly more effective (~20-22% weight loss vs ~15-17% for semaglutide). Semaglutide is more affordable and accessible through telehealth ($129-300/mo). Brand-name and compounded versions contain the same active ingredients — the difference is price and packaging. For most people, semaglutide via telehealth is the best starting point.
If you’re researching GLP-1 medications, you’ve probably encountered a confusing web of drug names, brand names, and pricing options. This guide cuts through all of it.
Semaglutide vs Tirzepatide: The Two Main GLP-1s
These are the two GLP-1 medications dominating the weight loss conversation. Here’s how they differ:
💊 Semaglutide
Single GLP-1 agonist
- Targets GLP-1 receptors only
- 15-17% average weight loss
- Weekly injection
- More affordable via telehealth
Brands: Ozempic, Wegovy, Rybelsus
💚 Tirzepatide
Dual GLP-1 + GIP agonist
- Targets GLP-1 and GIP receptors
- 20-22% average weight loss
- Weekly injection
- Generally more expensive
Brands: Mounjaro, Zepbound
Effectiveness: Head-to-Head #
| Semaglutide | Tirzepatide | |
|---|---|---|
| Average weight loss | 15-17% | 20-22% |
| % losing 10%+ body weight | ~70% | ~85% |
| % losing 20%+ body weight | ~30-35% | ~55-60% |
In real numbers (starting at 200 lbs):
- Semaglutide: ~30-34 lbs lost → ~166-170 lbs
- Tirzepatide: ~40-44 lbs lost → ~156-160 lbs
That’s about 10 extra pounds on average with tirzepatide — meaningful, but not dramatic.
Side Effects: Nearly Identical #
Both medications have similar side effect profiles:
- Nausea — Most common, especially when starting or increasing dose
- Decreased appetite — That’s the point
- Diarrhea or constipation — GI effects are common
- Fatigue — Usually temporary
- Injection site reactions — Minor
Tirzepatide may cause slightly more GI side effects at higher doses, but individual responses vary. Some people tolerate one better than the other.
Brand Names Explained: Same Drugs, Different Labels
This is where it gets confusing. The same medications have different brand names depending on what they’re FDA-approved for.
Semaglutide Brands #
| Brand | FDA Approved For | Form | Max Dose |
|---|---|---|---|
| Ozempic | Type 2 diabetes | Weekly injection | 2.0mg |
| Wegovy | Weight loss | Weekly injection | 2.4mg |
| Rybelsus | Type 2 diabetes | Daily pill | 14mg |
Tirzepatide Brands #
| Brand | FDA Approved For | Form | Max Dose |
|---|---|---|---|
| Mounjaro | Type 2 diabetes | Weekly injection | 15mg |
| Zepbound | Weight loss | Weekly injection | 15mg |
Why Does This Matter? #
Insurance treats them differently:
- Ozempic/Mounjaro (diabetes drugs) — More likely to be covered IF you have diabetes
- Wegovy/Zepbound (weight loss drugs) — Rarely covered because most plans exclude “weight loss medications”
The Insurance Reality
- Have diabetes? → Ozempic or Mounjaro may be covered
- Want weight loss only? → Wegovy/Zepbound rarely covered
- Using Ozempic "off-label" for weight loss? → Insurance may deny it
Ozempic vs Wegovy: What’s Actually Different? #
Nothing, really. They’re the same molecule (semaglutide) made by the same company (Novo Nordisk).
| Ozempic | Wegovy | |
|---|---|---|
| Active ingredient | Semaglutide | Semaglutide |
| Manufacturer | Novo Nordisk | Novo Nordisk |
| Maximum dose | 2.0mg | 2.4mg |
| Pen type | Multi-dose (dial your dose) | Single-dose (one pen = one shot) |
Wegovy goes slightly higher (2.4mg vs 2.0mg), which may produce marginally more weight loss. But at equivalent doses, they’re identical.
The same applies to Mounjaro vs Zepbound — same tirzepatide, different FDA approval and packaging.
Compounded vs Brand-Name: The Price Gap Explained
You’ve probably noticed telehealth platforms offering “semaglutide” for $129-300/month when brand-name Wegovy costs $1,000+. What’s the difference?
Same Active Ingredient, Different Source #
| Brand-Name (Wegovy/Zepbound) | Compounded | |
|---|---|---|
| Active ingredient | Semaglutide or tirzepatide | Semaglutide or tirzepatide |
| Manufacturer | Novo Nordisk / Eli Lilly | Compounding pharmacies |
| FDA approved | Yes | No (but FDA-regulated) |
| Format | Pre-filled auto-injector pens | Vials (you draw with syringe) |
| Quality control | Pharmaceutical-grade | Varies by pharmacy |
| Price | $1,000+/month | $129-400/month |
Think of it like brand-name Tylenol vs generic acetaminophen. Same active ingredient, different manufacturers, different packaging, different prices.
Is Compounded Safe? #
Yes, when sourced from legitimate pharmacies.
✓ Signs of a Legit Compounding Pharmacy
- 503A or 503B FDA registration
- State board of pharmacy license
- Third-party testing certificates available
- Named on the telehealth platform's website
- US-based (not overseas)
🚩 Red Flags
- Won't disclose which pharmacy compounds it
- Prices suspiciously low ($50/month = suspicious)
- Ships from overseas
- No verifiable pharmacy information
Does Compounded Work as Well? #
For most people, yes. The active ingredient is identical. If the compounding pharmacy is legitimate, it should work the same as brand-name.
I’ve used both. Started on brand-name, now maintain on compounded semaglutide through telehealth. The effects are comparable — and I’m saving hundreds per month.
Complete Cost Breakdown (2026)
Here’s what you’ll actually pay for each option:
Semaglutide Options #
| Option | Monthly Cost | Notes |
|---|---|---|
| Wegovy (list price) | $1,000-1,350 | No insurance |
| Wegovy (with savings card) | ~$500-900 | Commercially insured only |
| Wegovy (good insurance) | $0-150 | Rare for weight loss |
| Ozempic (with diabetes) | $0-150 | Often covered |
| Compounded (telehealth) | $129-300 | Most common path |
Tirzepatide Options #
| Option | Monthly Cost | Notes |
|---|---|---|
| Zepbound (list price) | $1,000-1,200 | No insurance |
| LillyDirect (self-pay) | $299-449 | Brand-name, no insurance needed |
| Mounjaro (with diabetes) | $0-150 | Often covered |
| Compounded (telehealth) | $200-400 | Available at some platforms |
💰 The Math Over 12 Months
Brand Wegovy: $1,000/mo × 12 = $12,000/year
LillyDirect Zepbound: $449/mo × 12 = $5,388/year
Compounded tirzepatide: $300/mo × 12 = $3,600/year
Compounded semaglutide: $196/mo × 12 = $2,352/year
Which Should You Choose?
Decision Flowchart #
Question 1: Do you have Type 2 diabetes?
YES → Ask your doctor about Ozempic or Mounjaro. Insurance often covers them for diabetes, and you'll lose weight as a "side effect."
NO → Continue to Question 2
Question 2: Is budget a major factor?
YES → Go with compounded semaglutide via telehealth ($129-300/mo). It's effective, affordable, and accessible.
NO → Continue to Question 3
Question 3: Do you want maximum weight loss results?
YES → Consider tirzepatide — either LillyDirect ($299-449/mo) for brand-name Zepbound, or compounded through telehealth ($200-400/mo).
NOT NECESSARILY → Semaglutide works great for most people. Start there.
Quick Recommendations #
Choose Semaglutide If:
- Budget matters
- You're new to GLP-1s
- 15-17% weight loss meets your goals
- You want easy telehealth access
- You're looking for a maintenance option
Choose Tirzepatide If:
- You want maximum results
- You've tried semaglutide and plateaued
- You have 50+ lbs to lose
- Budget is flexible
- You want brand-name (LillyDirect)
My Path #
I used tirzepatide (Zepbound via LillyDirect) for active weight loss — I wanted maximum results. Once I hit my goal, I switched to compounded semaglutide through telehealth for maintenance. Same effectiveness for keeping weight off, lower monthly cost.
Where to Get GLP-1s
Telehealth Platforms (Compounded) #
These platforms offer compounded semaglutide and/or tirzepatide with medical oversight:
Brand-Name Options #
LillyDirect (Tirzepatide/Zepbound): $299-449/month for brand-name, FDA-approved tirzepatide. No insurance needed, ships direct from Lilly. → LillyDirect Review
Through your doctor: Ask about Ozempic, Wegovy, Mounjaro, or Zepbound. Check insurance coverage first — call the number on your card.
Frequently Asked Questions #
What’s the difference between Ozempic and Wegovy?
Same drug (semaglutide), same manufacturer (Novo Nordisk). Ozempic is FDA-approved for diabetes; Wegovy is approved for weight loss. Wegovy has a slightly higher max dose (2.4mg vs 2.0mg). Otherwise identical.
Is tirzepatide better than semaglutide?
Tirzepatide produces about 5% more weight loss on average (20-22% vs 15-17%). Whether that’s “better” depends on your goals and budget. Semaglutide works great for most people and costs less.
Is compounded semaglutide safe?
Yes, when sourced from legitimate 503A/503B compounding pharmacies. The active ingredient is the same as brand-name. Quality depends on the pharmacy — stick with reputable telehealth platforms.
Can I switch from semaglutide to tirzepatide?
Yes. Many people start with semaglutide and switch to tirzepatide if they plateau. Your provider will help with the transition.
Can I switch from brand-name to compounded?
Yes. Same active ingredient. You may notice slight differences in how it feels (different formulation), but the mechanism is identical.
Which has fewer side effects?
They’re similar. Some people tolerate one better than the other, but there’s no consistent winner. If you have bad side effects on one, it’s worth trying the other.
Will insurance cover any of these?
Maybe for diabetes (Ozempic, Mounjaro). Rarely for weight loss (Wegovy, Zepbound). Most plans exclude weight loss medications. That’s why telehealth is so popular.
What about the oral pill (Rybelsus)?
Rybelsus is oral semaglutide, FDA-approved for diabetes. It’s less effective for weight loss than injectable semaglutide because absorption is lower. Most people prefer the weekly injection.
The Bottom Line #
For most people, compounded semaglutide via telehealth is the best starting point.
It's effective (15-17% weight loss), affordable ($129-300/month), and accessible (no insurance battles). If you plateau or want maximum results, you can always switch to tirzepatide later.
The brand name matters less than actually getting the medication. Whether it says "Wegovy" or "compounded semaglutide" on the vial, the molecule doing the work is the same.
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Related Reading #
I'm not a doctor — just someone sharing what I've learned. Always consult your healthcare provider before starting any new medication.
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