Cost Per Pound: The Real Math on GLP-1 Weight Loss

Here's a question nobody asks: What are you actually paying per pound lost?

We obsess over monthly costs—$149 for Wegovy pill, $299 for Zepbound vials, $350 for compounded tirzepatide. But monthly cost doesn't account for the variable that matters most: how much weight you actually lose.

A cheaper drug that produces less weight loss might actually cost more per pound than a pricier option that delivers better results. Let's do the math nobody else is doing.

The Methodology

To calculate cost-per-pound, we used:

• Starting weight: 220 pounds (rough average for GLP-1 trial participants)
• Treatment duration: 12 months
• Weight loss: Based on clinical trial data for each drug
• Monthly costs: January 2026 cash-pay prices (averaged across titration and maintenance)

Caveat: Individual results vary significantly. These are averages based on published data—your results could be better or worse.

The Numbers

*Based on 220-pound starting weight. Individual results vary significantly.

Key Insights

1. Insurance Is Still the Best Deal—If You Can Get It

At $7-9 per pound lost, insured patients with savings cards pay roughly 10x less than cash-pay patients. The math is overwhelming: fight for coverage if there's any chance.

Use every tool: prior authorization appeals, step therapy completion, documentation of comorbidities, and new indications (CV risk, MASH, sleep apnea) to improve your odds.

2. Compounded Tirzepatide Has the Best Cash-Pay Value

At ~$52/pound, compounded tirzepatide offers the best cost-per-pound for cash-pay patients. This is because:

• Tirzepatide produces more weight loss (~21%) than semaglutide (~15%)
• Compounded pricing (~$200/month) is lower than brand LillyDirect (~$374/month)
• The combination of higher efficacy + lower price creates best value

The catch: Regulatory uncertainty means supply could be disrupted.

3. Wegovy Pill Isn't the Best "Value"—But Has Other Advantages

At ~$87/pound, Wegovy pill costs more per pound than compounded options. But cost-per-pound isn't everything:

• No injections (huge for needle-averse patients)
• No refrigeration needed
• FDA-approved certainty
• No regulatory risk

If the convenience of an oral medication keeps you compliant, it might be worth the premium.

4. Tirzepatide Beats Semaglutide on Cost-Per-Pound

Even at similar monthly prices, tirzepatide wins because it produces ~40% more weight loss (21% vs 15%). This makes tirzepatide options more cost-effective pound-for-pound:

• Compounded tirz (~$52/lb) beats compounded sem (~$73/lb)
• Zepbound vials (~$98/lb) beats Wegovy injection (~$127/lb)

The Long-Term Perspective

This analysis assumes 12 months of treatment. But GLP-1s are typically long-term medications—most patients regain weight if they stop.

For ongoing maintenance:

• Some patients can maintain on lower doses, reducing costs
• Others need full maintenance doses indefinitely
• The "cost per pound" becomes less relevant—you're paying to keep weight off, not lose more

Think of it like a gym membership: the initial transformation has a high cost-per-pound, but ongoing maintenance is about preserving results, not achieving new ones.

Comparison to Other Weight Loss Methods

How does GLP-1 cost-per-pound compare to alternatives?

Observation: GLP-1s occupy a middle ground—more expensive than behavioral programs but less than surgery, with better results than programs but (typically) less dramatic than surgery. For many patients, they hit the sweet spot of meaningful weight loss at manageable cost.

What This Analysis Can't Capture

Cost-per-pound is a useful metric, but it misses important factors:

• Health improvements: Reduced diabetes risk, better blood pressure, improved sleep apnea—hard to put a dollar value on
• Quality of life: Increased energy, mobility, self-confidence
• Individual variation: Some people lose 25%+ on semaglutide; others struggle to lose 10% on tirzepatide
• Side effect burden: A cheaper option isn't worth it if side effects make it intolerable
• Sustainability: Long-term weight maintenance matters more than initial loss

The Bottom Line

If you're optimizing purely for cost-per-pound:

1. Insurance with savings card (~$7-9/lb) — if available
2. Compounded tirzepatide (~$52/lb) — best cash-pay value
3. Compounded semaglutide (~$73/lb) — if tirz unavailable
4. Wegovy pill (~$87/lb) — if you value oral convenience
5. Zepbound vials (~$98/lb) — brand tirz for FDA certainty

But remember: the "best" option isn't always the cheapest per pound. It's the one you'll actually take consistently, that produces results for your body, with side effects you can tolerate, at a price you can sustain.

Use cost-per-pound as one input—not the only one.