The August 2026 GLP-1 price index: every route, one basis, catches named
Semaglutide and tirzepatide now sell through at least nine distinct cash routes at prices spanning more than fifteenfold. Almost none of the published comparisons state which dose a figure describes, whether it includes a mandatory fee, or when it was captured — and all three change the number.
Monthly cash cost by route, August 2026
| Route | Product | Approval | Monthly | The condition |
|---|---|---|---|---|
| Oral semaglutide, manufacturer direct | Wegovy oral / reformulated tablet | FDA-approved | ~$149 | Lowest doses. Must be taken fasted with a small sip of water, then wait before eating. |
| Compounded semaglutide | Compounded preparation | Not FDA-approved | $149–$324 | Patient-specific 503A compounding only since the February 2025 shortage resolution. |
| Compounded tirzepatide | Compounded preparation | Not FDA-approved | $215–$429 | Active ingredient costs more; expect a 40–100% premium over semaglutide. |
| Zepbound self-pay | Zepbound vial | FDA-approved | $299–$449 by dose | Conditional on refilling within 45 days of the previous delivery. |
| Wegovy pen, direct | Wegovy | FDA-approved | ~$349 | Cash channel, no insurance required. |
| Wegovy HD | Wegovy 7.2 mg | FDA-approved | ~$399 | For patients who plateau at 2.4 mg. |
| Retail list | Wegovy / Ozempic | FDA-approved | $998–$1,349 | The figure most comparisons still anchor on. Almost nobody pays it. |
| Insurance | Brand under a covered indication | FDA-approved | $0–$25 typical copay | Requires a documented indication. Beats every cash route when it applies. |
| Medicare | Covered brand products | FDA-approved | flat public co-pay | Eligibility set by your specific Part D plan, not by the headline. |
What changed between January and August
Three things, all in the same direction. An oral semaglutide option launched at roughly $149 a month for the lowest doses. Novo cut self-pay pen pricing to about $349. And a higher-dose Wegovy HD arrived at about $399 for patients who plateau at 2.4 mg.
The compounded market moved the other way. After the February 2025 shortage resolution and the enforcement deadlines that followed, several of the largest platforms left compounded GLP-1 entirely, and the cheap end is now served by smaller operators with less brand recognition.
Why the fifteenfold spread is not what it looks like
A reader comparing $149 against $1,349 is not comparing two prices for the same purchase. The first is an oral tablet at its lowest dose through a manufacturer channel; the second is a list price for an injectable pen that almost nobody actually pays.
Price the route you would actually use, at the dose you expect to hold, including every recurring fee. That single correction reorders the market for most people and it is the correction almost no published comparison makes.
Limitations
Manufacturer and retail figures here are reported cash prices from published coverage rather than figures we read on a checkout page. Compounded figures are the lowest we verify at a provider's own pricing page. Where a programme publishes only a ‘starting at’ number, the ladder above it is unpublished and we say so rather than extrapolating.