The two-part structure
Most online providers separate the programme fee from the medication cost. The programme fee covers the consultation, the prescription and whatever support is bundled. The medication is billed separately, either through your insurance or as cash pay.
Some providers bundle both into a single monthly figure, which is genuinely simpler but makes it harder to see what you are paying for each part — and harder to compare against a provider who itemises.
The first question to ask any provider is which model they use, because an advertised $99 that excludes medication is not comparable to an advertised $299 that includes it.
Introductory pricing is the default deception
A large share of headline prices in this market apply to the first month only, or require an annual prepayment to achieve. The ongoing monthly rate is frequently double or more, and is often disclosed only after you have completed an intake form.
When you see a price, find the answer to three questions before going further: what does this cost in month two, what does it cost if I pay monthly rather than annually, and does it include the medication.
Dose escalation can raise your cost
GLP-1 treatment starts low and titrates upward over months. Where a provider prices per milligram or by dose tier — common with compounded products — your monthly cost rises as your dose does.
This is rarely prominent in the advertising. Ask specifically what the cost is at the maintenance dose you are likely to reach, not the starting dose you will be on for the first month.
The costs that sit outside the monthly fee
Budget for these separately, because most providers do not include them in the headline.
- Baseline lab work, where required and not covered by insurance
- Shipping, particularly cold-chain shipping for injectables
- Sharps container and disposal
- Follow-up consultations beyond any included allowance
- The cost of restarting if you pause and lose your titration
Manufacturer self-pay channels
Both manufacturers operate direct cash-pay routes for people without insurance coverage — LillyDirect for Zepbound and NovoCare for Wegovy — at prices well below historical list price. These are worth pricing before you assume a telehealth subscription is cheaper.
Manufacturer savings cards for people with commercial insurance are a separate mechanism again, and typically exclude anyone with government insurance including Medicare and Medicaid.
Work out the twelve-month number
Take the ongoing monthly programme fee, not the introductory one. Add the medication cost at your likely maintenance dose. Multiply by twelve. Add labs, shipping and any consult fees.
That number is what you are actually deciding about. It is frequently several times the figure on the homepage, and it is the only basis on which providers can be honestly compared.
Before you prepay for a year
Annual prepayment discounts are real and can be substantial. They also transfer all the risk to you.
Roughly a fifth to a third of people discontinue GLP-1 treatment relatively early, most often because of side effects. If you prepay twelve months against a fourteen-day refund window and stop at week six, you have bought ten months of nothing. Check the refund terms specifically for the case where you stop for medical reasons, and get the answer in writing.