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Ozempic vs Zepbound: Diabetes Label Against Obesity Label

Ozempic (semaglutide, Novo Nordisk) vs Zepbound (tirzepatide, Eli Lilly)

Last verified May 2026

By Ruth Calder · Enforcement Editor
Editorially reviewed & fact-checked against primary sources · How we verify contentLast reviewed

The verdict

Not a fair fight on weight, and not meant to be. Zepbound is dosed and trialed for weight management — −20.9% at 72 weeks in SURMOUNT-1 — while Ozempic's SUSTAIN program recorded −4.5 to −6.5 kg at diabetes doses. Ozempic holds the older cardiovascular win, MACE −26%. The gap that matters to a cash payer is commercial: Zepbound has a $349–$499 LillyDirect tier, Ozempic has no cash-pay program and lists near $998.

Side-by-side comparison

FieldOzempicZepbound
FDA-approved indicationType 2 diabetes; CV risk reduction in T2D + CVDChronic weight management; obstructive sleep apnea
MechanismGLP-1 receptor agonistDual GIP / GLP-1 receptor agonist
Weight loss (pivotal trial)-4.5 to -6.5 kg / 30-40 wk (SUSTAIN program, 1-2 mg)-20.9% TBWL / 72 wk (SURMOUNT-1, 15 mg)
Head-to-head obesity trial (SURMOUNT-5, 72 wk)-13.7% body weight (semaglutide 2.4 mg)-20.2% body weight (tirzepatide 15 mg)
Cardiovascular outcomeMACE -26% (SUSTAIN-6, 2016)SURPASS-CVOT pending 2027
DosingOnce-weekly subq 0.25-2.0 mg (4-step titration)Once-weekly subq 2.5-15 mg (6-step titration)
Cash price (manufacturer direct)~$998/mo retail (no manufacturer cash-pay program)$349 starter / $499 maintenance via LillyDirect
Insurance coverage angleCovered under T2D benefit (A1c >=6.5% + metformin trial)Covered under obesity benefit (BMI >=30, or >=27 + comorbidity); often excluded

What each one costs in the compounded market

Standing monthly cash prices from the 556 sellers on this register. These are compounded preparations, not the approved products compared above.

Ozempic — semaglutide

from $79 /mo

283 sellers publish a standing price; the median is $174 a month.

Zepbound — tirzepatide

from $99 /mo

253 sellers publish a standing price; the median is $240 a month.

⚠ A compounded preparation is not the approved product. No agency has reviewed that specific preparation for safety, effectiveness or manufacturing quality, and the legal ground under compounding these molecules narrowed when the shortages closed. The price gap is real, and so is the difference in oversight. Every seller, with its price record.

Frequently asked questions

Which works better for weight loss, Ozempic or Zepbound?

On the trial evidence, Zepbound. Ozempic recorded -4.5 to -6.5 kg / 30-40 wk (SUSTAIN program, 1-2 mg) and Zepbound -20.9% TBWL / 72 wk (SURMOUNT-1, 15 mg), and the head-to-head comparison put Ozempic at -13.7% body weight (semaglutide 2.4 mg) against Zepbound at -20.2% body weight (tirzepatide 15 mg). A head-to-head is the strongest form of this evidence because both arms run under one protocol — separate trials are not directly comparable however alike they look.

Are Ozempic and Zepbound the same drug?

No. Ozempic is semaglutide and Zepbound is tirzepatide — different molecules, and they work differently: GLP-1 receptor agonist against Dual GIP / GLP-1 receptor agonist. Results with one do not predict results with the other.

Is Ozempic or Zepbound cheaper?

On the manufacturers' own cash pricing: Ozempic at ~$998/mo retail (no manufacturer cash-pay program), Zepbound at $349 starter / $499 maintenance via LillyDirect. ⚠ That is the list-price comparison, and it is not what most people pay. What you actually pay depends on whether your plan covers it, which formulary tier it sits in, and whether you have met your deductible — and for many people the honest comparison is between an insured copay and a cash-pay compounded alternative rather than between these two figures.

Does either one have better cardiovascular evidence?

Ozempic does. Ozempic: MACE -26% (SUSTAIN-6, 2016). Zepbound: SURPASS-CVOT pending 2027. This matters more than it first appears — a drug with a completed outcomes trial has evidence about events that matter, not only about weight, and that is often what decides coverage.

How is each one taken?

Ozempic: Once-weekly subq 0.25-2.0 mg (4-step titration). Zepbound: Once-weekly subq 2.5-15 mg (6-step titration). Worth weighing honestly against your own habits — the best drug for you is partly the one you will still be taking in eight months, and a dosing routine that does not fit a life gets abandoned.

What does a compounded version of each actually cost?

Across the 556 sellers in this register, the cheapest standing monthly cash prices we hold are semaglutide from $79 a month and tirzepatide from $99 a month. ⛔ A compounded preparation is not the approved product: no agency has reviewed that specific preparation for safety, effectiveness or manufacturing quality, and the legal ground under compounding these molecules narrowed once the shortages closed. The price gap is real and so is the difference in oversight.

Can I switch from Ozempic to Zepbound?

Yes, with a prescriber. Expect to re-titrate from the bottom of the new drug's ladder rather than starting where you left off: these are different molecules and tolerance to one does not transfer to the other. Both the old drug's washout and the new drug's schedule apply.

Which one should I ask for?

That is a prescriber's call, and anyone answering it from a table is guessing. What a page like this can do is tell you what the trials measured, what the manufacturers charge, and where the evidence is still missing, so the conversation starts from the record rather than from an advertisement.

References

  1. 1.Marso SP, Bain SC, Consoli A, Eliaschewitz FG, Jodar E, et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes (SUSTAIN-6). N Engl J Med. 2016. PMID: 27633186.
  2. 2.Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide Once Weekly for the Treatment of Obesity (SURMOUNT-1). N Engl J Med. 2022. PMID: 35658024.
  3. 3.Aronne LJ, Horn DB, le Roux CW, et al. Tirzepatide as Compared with Semaglutide for the Treatment of Obesity (SURMOUNT-5). N Engl J Med. 2025. PMID: 40353578.
  4. 4.Frias JP, Davies MJ, Rosenstock J, Perez Manghi FC, Fernandez Lando L, et al. Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes (SURPASS-2). N Engl J Med. 2021. PMID: 34170647.
  5. 5.Novo Nordisk Pharmaceutical Industries, LP. OZEMPIC (semaglutide) injection prescribing information. DailyMed (FDA label). 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=adec4fd2-6858-4c99-91d4-531f5f2a2d79
  6. 6.Eli Lilly and Company. ZEPBOUND (tirzepatide) injection prescribing information. DailyMed (FDA label). 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b

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