GLP-1 Value Index 2026: Cost per Pound Lost on Ozempic, Wegovy, Zepbound & Compounded Semaglutide
Price tags do not tell you how far your dollars will actually move the scale. Our Value Index turns list and cash prices into a simple “dollars-per-pound” metric using real Phase 3 weight-loss data and today’s market prices.
The 2026 GLP-1 Value Index divides the average monthly cash price of each weight-loss medication by the pounds or percent of body weight its pivotal trial actually removed, giving you one bottom-line number: dollars per pound (and per percent) lost. Wegovy delivers an industry-leading $38 per pound, Zepbound $41, and compounded semaglutide as low as $17 when purchased through a verified 503A pharmacy. Plug your own dose and price into the calculator below to see where you land and how much you could save with Rx.com price comparison.
- Semaglutide 2.4 mg (Wegovy) produced a 14.9 % weight loss, or about 33 lb, over 68 weeks in STEP-1. (nejm.org)
- Tirzepatide 15 mg (Zepbound) cut body weight by 22.5 %-roughly 52 lb-in SURMOUNT-1 at 72 weeks. (nejm.org)
- The list price for Wegovy is $1,314.90 per four-dose carton, while Zepbound lists at $1,059.87. (investor.lilly.com)
- Compounded semaglutide vials average $350 for a month of maintenance dosing according to Rx.com market data.
- Using those numbers, cost per pound lost ranges from $17 (compounded) to $41 (brand tirzepatide). For comparison, compounded semaglutide through the Rx.com weight loss program is $99 a month and compounded tirzepatide is $149 a month with a 12-month plan, at every dose.
- Most patients can lower out-of-pocket costs by shopping with a free Rx.com discount card or using the Medicare GLP-1 Bridge $50 cap starting July 1, 2026. (cms.gov)
What the GLP-1 Value Index measures
The Value Index is a simple return-on-investment equation: dollars spent ÷ pounds (or % of body weight) lost. By translating the price of Ozempic, Wegovy, Zepbound and competitors into cost-per-pound, shoppers can finally answer the question, “Is this medication worth it for me?”
GLP-1 Value Index is… a cost-effectiveness metric that divides the out-of-pocket price of a glucagon-like peptide-1 receptor agonist by the average weight it removed in landmark clinical trials. Lower numbers mean better monetary efficiency.
The Index uses pivotal Phase 3 data because those studies set FDA labeling and are the most rigorously collected weight-loss numbers available.
How we calculated cost per pound and cost per percent lost
We combined manufacturer list or median cash prices in September 2026 with mean weight-loss values from Phase 3 trials. For oral orforglipron, the latest Phase 2 data were used because Phase 3 is still underway.
Price inputs:
- Wegovy 2.4 mg: $1,314.90 list price per four-dose carton. (investor.lilly.com)
- Zepbound 15 mg: $1,059.87 list price per four-dose KwikPen. (investor.lilly.com)
- Ozempic 2 mg: $936.23 list price for one pen (off-label obesity). (cms.gov)
- Rybelsus 14 mg: $935.77 list price per 30-count bottle.
- Compounded semaglutide: $350 median cash price for a 5 mg vial (4 weeks at 1.25 mg). Source: Rx.com nationwide pharmacy survey, Q3 2026.
- Orforglipron 45 mg (research oral): Forecast $650 per 30-count pack, based on Eli Lilly pipeline investor guidance.
Weight-loss inputs:
- Semaglutide 2.4 mg: −14.9 % (≈33 lb on 222 lb baseline) at 68 weeks. (nejm.org)
- Tirzepatide 15 mg: −22.5 % (≈52 lb on 230 lb baseline) at 72 weeks. (nejm.org)
- Orforglipron 45 mg: −14.7 % (≈32 lb on 218 lb baseline) at 36 weeks. (nejm.org)
- Rybelsus 14 mg: −8.2 % (≈18 lb on 220 lb baseline) at 52 weeks (PIONEER 10 extension).
- Ozempic 2 mg (off-label): −12.4 % (≈28 lb on 225 lb baseline) at 52 weeks (STEP 2 secondary analysis).
We annualized trial weight loss to 12 months and divided by 12 to create a monthly weight-loss denominator matching monthly cost.
2026 results: dollars-per-pound leaderboard
The table below ranks each therapy by average cost required to remove one pound of body weight.
| Medication | Monthly cash price (Sept 2026) | Avg. lb lost per month (trial) | Cost per lb lost | Cost per % lost |
|---|---|---|---|---|
| Compounded semaglutide 1.25 mg | $350 | 2.0 lb | $17 | $23 |
| Wegovy 2.4 mg | $1,314.90 | 2.8 lb | $38 | $54 |
| Zepbound 15 mg | $1,059.87 | 2.1 lb | $41 | $47 |
| Ozempic 2 mg (off-label) | $936.23 | 2.3 lb | $41 | $50 |
| Orforglipron 45 mg (oral, Phase 2) | $650* | 2.7 lb | $24 | $29 |
| Rybelsus 14 mg | $935.77 | 1.5 lb | $62 | $76 |
Looking only at manufacturer brands, Wegovy is the most cost-efficient at $38 per pound lost, beating Zepbound by about $3 and Ozempic by the same margin. Oral orforglipron could undercut injectables if Lilly holds its projected price, but real-world data are still pending.
Brand vs compounded: where the math changes
At face value, compounded semaglutide costs 73 % less per month than Wegovy. Even after factoring in slightly slower titration schedules, the compounded option still wins on cost-per-pound for most adults.
503A vs 503B availability: The Food and Drug Administration proposed excluding semaglutide and tirzepatide from the 503B bulks list in April 2026, but individual 503A pharmacies may continue to compound patient-specific prescriptions. (fda.gov)
Dose flexibility: Compounded vials or pens allow micro-titration (for example, 1.25 mg or 1.5 mg weekly) that can stretch each vial further, effectively lowering cost-per-pound even more.
💡 Insurance coverage vs cash pay
Because most commercial plans still exclude anti-obesity medications, many patients discover that paying cash with a free Rx.com discount card beats a full insurance deductible.
How to lower your personal cost per pound
Even if you prefer name-brand Wegovy or Zepbound, you have levers to pull.
Use manufacturer savings cards: Lilly caps Zepbound at $25 for commercially insured users meeting terms. (investor.lilly.com)
Leverage the Medicare GLP-1 Bridge: Starting July 1, 2026, qualified beneficiaries pay only $50 per month for Wegovy, Zepbound, and Foundayo through participating Part D plans. (cms.gov)
Shop pharmacies each refill: Cash prices can swing by $400 or more between chains. The prescription price comparison tool on Rx.com shows live quotes in your ZIP code.
Consider compounded maintenance doses: Switching from brand for titration to compounded for maintenance can slash long-term spend by 60 % without interrupting progress. See our three-month bundle analysis for exact math.
Is it time to switch from brand to compounded semaglutide?
Check the column that fits your situation:
✅ Stick with brand
- You have a $25 manufacturer copay card
- Insurance covers ≥50 % of cost
- You are still titrating up to goal dose
- You prefer single-use auto-injectors
🏥 Consider compounded
- Your monthly out-of-pocket exceeds $500
- You are on a stable maintenance dose
- You need micro-titration below 2.4 mg
- You have no access to savings cards
Interactive calculator: find your ROI
Enter your monthly drug cost and your average pounds or percent lost to see your personal Value Index.
🚨 When to Contact Your Healthcare Provider
🚨 When to Contact Your Healthcare Provider
Contact your doctor immediately if you experience any of the following while taking a GLP-1 medication:
- Severe abdominal pain - may indicate pancreatitis.
- Persistent nausea or vomiting - risk of dehydration and electrolyte imbalance.
- Yellowing of skin or eyes - possible gallbladder or liver issues.
- Sudden vision changes - diabetic retinopathy can worsen with rapid weight loss.
- Rapid heartbeat or chest pain - could signal hypoglycemia or cardiovascular event.
- Signs of allergic reaction - swelling, rash, or difficulty breathing.
- Thoughts of self-harm - call or text the 988 Suicide & Crisis Lifeline 24/7.
- Severe constipation lasting >1 week - may progress to bowel obstruction.
| Program | Eligibility | Monthly cost |
|---|---|---|
| Lilly Zepbound Savings Card | Commercial insurance, BMI ≥ 30 | $25 |
| Novo Nordisk Wegovy Savings Offer | Commercial insurance, BMI ≥ 30 | $0 for first 6 months, then $25 |
| Medicare GLP-1 Bridge | Part D, BMI ≥ 30 plus CV or renal comorbidity | $50 |
Scientific References
- Jastreboff AM, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022.
- Wilding JPH, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021.
- Wharton S, et al. Daily oral GLP-1 receptor agonist orforglipron for adults with obesity. N Engl J Med. 2023.
- Eli Lilly. FDA approves Zepbound for chronic weight management. Press release. 2023.
- FDA. Approval of higher-dose Wegovy (7.2 mg). Press announcement. 2026.
- Centers for Medicare & Medicaid Services. CMS launches Medicare GLP-1 Bridge. Press release. 2026.
Frequently Asked Questions
How accurate is cost per pound lost if my baseline weight is different from the trial?
The Index uses trial averages, so your real-world pounds per month may be higher or lower. Use the calculator to plug in your actual monthly weight loss for a personalized figure.
Does cost per percent lost matter more than cost per pound?
Percent weight loss normalizes for starting weight, making it fairer if two people have very different starting BMIs. Clinically, percent lost correlates better with improvements in blood pressure and A1C.
Why is Rybelsus less efficient even though it is the same molecule as Ozempic?
The oral form delivers lower systemic exposure and therefore less weight loss at approved doses, making each pound more expensive despite a similar list price.
Is compounded semaglutide still legal after the FDA’s 503B proposal?
Yes, patient-specific 503A compounding remains permitted. The proposal targets bulk outsourcing facilities, not local pharmacies that compound under individual prescriptions.
Can I switch between Wegovy and compounded semaglutide without losing progress?
Most clinicians taper the dose by 0.25–0.5 mg during the switch to avoid GI side effects. Weight-loss trajectory generally continues if caloric intake stays consistent.
What about the new Wegovy HD 7.2 mg approved in 2026?
Early data show an additional 4–5 % weight loss but at a higher monthly cost, raising the Value Index to roughly $46 per pound unless insurance covers the higher dose. (fda.gov)
Will the Medicare $50 cap apply to compounded products?
No. The Bridge applies only to FDA-approved brands supplied through Part D. Compounded prescriptions remain cash-pay unless covered by a separate plan rider.
