Wegovy vs Zepbound: What the Head-to-Head Actually Showed
Wegovy (semaglutide, Novo Nordisk) vs Zepbound (tirzepatide, Eli Lilly)
Last verified November 2026
The verdict
One head-to-head settles the weight question but not the whole question. SURMOUNT-5 put Zepbound at −20.2% against Wegovy's −13.7% at 72 weeks, a 6.5-point gap under one protocol. Wegovy answers a different question: SELECT cut major cardiovascular events 20%. Tirzepatide's own outcomes trial, SURPASS-CVOT (NEJM, December 2025), was run in type 2 diabetes, and the cardiovascular indication it earned sits on the Mounjaro label, not Zepbound's. Cash pricing is close: $349 a month for Wegovy through NovoCare, $299–$449 for Zepbound through LillyDirect. So the split is magnitude of weight loss against proven event reduction, and that is a prescriber's call, not a table's.
Side-by-side comparison
| Field | Wegovy | Zepbound |
|---|---|---|
| Mean weight loss (TBWL) | −14.9% / 68 weeks (STEP-1) | −20.9% / 72 weeks (SURMOUNT-1) |
| Head-to-head (SURMOUNT-5) | −13.7% | −20.2% |
| Mechanism | GLP-1 receptor agonist | Dual GIP / GLP-1 agonist |
| Dosing | Once-weekly subq (5-step titration) | Once-weekly subq (6-step titration) |
| Cash price (manufacturer) | $349/mo via NovoCare ($199 for the first two fills for new patients) | $299–$449/mo via LillyDirect Self Pay (KwikPen) |
| Cardiovascular outcome | MACE −20% (SELECT, 2023) | No CV indication; in type 2 diabetes, tirzepatide matched dulaglutide in SURPASS-CVOT (HR 0.92) |
| Most common adverse event | Nausea (44%) | Nausea (29%) |
| FDA-approved indications | Chronic weight management; CV risk reduction | Chronic weight management; obstructive sleep apnea |
What each one costs in the compounded market
Standing monthly cash prices from the 734 sellers on this register. These are compounded preparations, not the approved products compared above.
Wegovy — semaglutide
from $47 /mo
463 sellers publish a standing price. This is the lowest of all 463; the median is $174 a month.
Where to get semaglutide — a selection of sellers, not a price ranking
- Embody review$79/mo
- SnagRx review$99/mo
- Collective review$59/mo + membership
Zepbound — tirzepatide
from $69 /mo
453 sellers publish a standing price. This is the lowest of all 453; the median is $228.28 a month.
Where to get tirzepatide — a selection of sellers, not a price ranking
- Embody review$129/mo
- SnagRx review$149/mo
- Collective review$69/mo + membership
⚠ 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, Wegovy or Zepbound?
On the trial evidence, Zepbound. Wegovy recorded −14.9% / 68 weeks (STEP-1) and Zepbound −20.9% / 72 weeks (SURMOUNT-1), and the head-to-head comparison put Wegovy at −13.7% against Zepbound at −20.2%. 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 Wegovy and Zepbound the same drug?
No. Wegovy is semaglutide and Zepbound is tirzepatide — different molecules, and they work differently: GLP-1 receptor agonist against Dual GIP / GLP-1 agonist. Results with one do not predict results with the other.
Is Wegovy or Zepbound cheaper?
On the manufacturers' own cash pricing: Wegovy at $349/mo via NovoCare ($199 for the first two fills for new patients), Zepbound at $299–$449/mo via LillyDirect Self Pay (KwikPen). 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?
Wegovy does. Wegovy: MACE −20% (SELECT, 2023). Zepbound: No CV indication; in type 2 diabetes, tirzepatide matched dulaglutide in SURPASS-CVOT (HR 0.92). 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.
Which has worse side effects, Wegovy or Zepbound?
The most common adverse event reported was Nausea (44%) for Wegovy and Nausea (29%) for Zepbound. Rates come from separate trial populations and are not a like-for-like comparison. In practice how fast the dose is escalated affects tolerability at least as much as which drug it is, which is one reason a slower titration is worth asking for.
How is each one taken?
Wegovy: Once-weekly subq (5-step titration). Zepbound: Once-weekly subq (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 734 sellers in this register, the cheapest standing monthly cash prices we hold are semaglutide from $47 a month and tirzepatide from $69 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 Wegovy 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.Wilding JPH, Batterham RL, Calanna S, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity (STEP 1). N Engl J Med. 2021. PMID: 33567185.
- 2.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.
- 3.Eli Lilly and Company. Zepbound self-pay pricing on LillyDirect — $299 (2.5 mg), $399 (5 mg), $449 (7.5–15 mg) when refilled within 45 days. LillyDirect. 2026. https://www.lilly.com/lillydirect/zepbound
- 4.Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and Cardiovascular Outcomes in Obesity Without Diabetes (SELECT). N Engl J Med. 2023. PMID: 37952131.
- 5.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.
- 6.Nicholls SJ, et al. Cardiovascular Outcomes with Tirzepatide versus Dulaglutide in Type 2 Diabetes N Engl J Med. 2025. PMID: 41406444.
Related comparisons
- Mounjaro vs Zepbound
- Ozempic vs Zepbound
- Wegovy vs Ozempic
- Wegovy vs Mounjaro
- Ozempic vs Mounjaro
- Semaglutide vs Tirzepatide
See the full drug-vs-drug verdict index or provider rankings.