Where the advertised price is not the price
Every figure below is the difference between the advertised starting price of a medication and what it costs once you are on a maintenance dose. It is worked out from the same prices that drive the scores here, so it changes when they do.
The gap, medication by medication
| Medication | Advertised | At maintenance | Gap | A year at maintenance |
|---|---|---|---|---|
| Wegovy pill (oral semaglutide 25 mg) | $149 | $299 | +$150 (101%) | $3,588 (12 fills) |
| Zepbound (tirzepatide) | $299 | $449 | +$150 (50%) | $5,837 (13 fills) |
| Foundayo (orforglipron) | $149 | $299 | +$150 (101%) | $3,588 (12 fills) |
| Wegovy (semaglutide injection) | $199 | $349 | +$150 (75%) | $4,537 (13 fills) |
| Ozempic (semaglutide, diabetes label) | $199 | $349 | +$150 (75%) | $4,537 (13 fills) |
| Qsymia (phentermine/topiramate) | $66 | $75 | +$9 (14%) | $900 (12 fills) |
Zepbound (tirzepatide), Wegovy (semaglutide injection), Ozempic (semaglutide, diabetes label) are billed by a 28-day month, so a year of them is thirteen fills — anyone budgeting twelve payments is short one. The rest are counted at twelve.
Prices with a condition or an end date
- Foundayo (orforglipron)Price conditional on refill timing
LillyDirect self-pay, read 11 September 2026: $149 a month at 0.8 mg and 2.5 mg, $199 at 5.5 mg, and $299 at 9 mg, 14.5 mg and 17.2 mg. The page reads "0.8 mg dose (starting dosage) Self-pay price: Starting at $149/month" and "17.2 mg dose Self-pay price: Starting at $299/month". The 2.5 mg and 5.5 mg prices are temporarily reduced through 31 December 2026. The $299 at 14.5 mg and 17.2 mg requires a refill within 45 days under the Foundayo Self Pay Journey Program; without it those doses are $349. List price $649.
- LillyDirectPrice conditional on refill timing
Zepbound $299–$449 by dose and Foundayo $149–$299, both read from Lilly's own pages on 19 Aug 2026. Lilly's Zepbound page reads "2.5 mg/0.6 mL (starting dosage) Self-pay price: Starting at $299/month". Higher doses of each hold that price only with a refill inside 45 days; otherwise Zepbound reaches $699 and Foundayo $349.
- NovoCare PharmacyPrice expires soon
Read from NovoCare on 5 September 2026: oral Wegovy is $149 a month at 1.5 mg, $199 at 4 mg, and $299 at 9 mg and 25 mg. Pens are $199 for the first two fills for new patients through 31 December 2026, then $349 for standard doses and $399 for Wegovy HD 7.2 mg. The Wegovy page reads "Patients pay $149 for each month of 1.5 mg" and "then $349 per month for Wegovy® 0.25 mg, 0.5 mg, 1 mg, 1.7 mg, or 2.4 mg".
- Zepbound (tirzepatide)Price conditional on refill timing
LillyDirect self-pay, read 19 Aug 2026: $299 at 2.5 mg, $399 at 5 mg, $449 at 7.5–15 mg. The page reads "2.5 mg/0.6 mL (starting dosage) Self-pay price: Starting at $299/month" and "15 mg/0.6 mL Self-pay price: Starting at $449/month". The $449 applies only under the Zepbound Journey Program, which requires a refill within 45 days. Miss it and the price is $499 at 7.5 mg and $699 at 10, 12.5 and 15 mg. Same prices for vial and KwikPen. Lilly defines a month as 28 days.
How the gap is created
- Why is the advertised GLP-1 price usually not what you pay?
- Three mechanisms. An introductory rate covers the first fills and then ends. A starting dose is priced low but the label says it is not for maintenance, so nobody stays on it. And dose-scaled pricing quotes the bottom of a range you titrate straight out of.
- What is the 28-day month?
- Eli Lilly defines a month of Zepbound as 28 days — one KwikPen or four vials. A year is therefore about 13 fills rather than 12. At $449 that is $5,837 a year against the $5,388 that 'per month' implies. Novo's injection month is one box of four weekly pens, which works out the same way.
- What does conditional pricing mean?
- Lilly's advertised ceiling for Zepbound holds only while you refill within 45 days. Lapse once and 10 mg and above cost $699 instead of $449 — 56% more than the number in the advert. Foundayo works the same way at a smaller gap.
Worked out from the prices on each medication's own page, not written by hand, so these figures move when the prices do. Information only, not medical advice.
The documents behind who cannot use these offers
Every trap listed here is a condition someone is shut out by. These are the official sources for the ones written into law rather than into a footnote.
- Social Security Act §1927(d)(2), Office of the Law Revision Counsel — The statute itself, listing “agents when used for anorexia, weight loss, or weight gain” among the drugs a program may exclude.
- Manufacturer safeguards may not prevent copayment coupon use for Part D drugs, HHS Office of Inspector General — Why a manufacturer copay card cannot be used with a federal program, from the office that enforces it.
- Weight-loss drugs, Medicare.gov — Medicare's own page on what it does and does not cover for weight loss.