Three real routes, and the gap between them is larger than most people expect. Before any of them, one correction that saves a wasted phone call.
The $25 savings cards you will be pointed at almost all require commercial drug insurance. Read Lilly's own wording: the programmes are for someone "with commercial drug insurance that covers" the drug, or "that does not cover" it.3 Both assume you have a plan. If you have no insurance at all, neither applies to you, and neither does Novo's equivalent.
That is the single most useful thing on this page. Everything written about GLP-1 affordability leads with $25, and $25 is not on the table for the uninsured.
Route one: buy it direct from the manufacturer
Both makers now sell to cash patients, and they publish the prices.
Novo Nordisk:1
| Product | Cash price |
|---|---|
| Wegovy tablet, 1.5 mg | $149/mo |
| Wegovy tablet, 4 mg | $199/mo |
| Wegovy tablet, 9 and 25 mg | $299/mo |
| Wegovy pen, 0.25 to 2.4 mg | $349/mo |
| Wegovy HD pen, 7.2 mg | $399/mo |
Eli Lilly:2
| Zepbound dose | Cash price |
|---|---|
| 2.5 mg | $299/mo |
| 5 mg | $399/mo |
| 7.5 mg | $499/mo |
| 10, 12.5 and 15 mg | $699/mo |
Two things worth noticing. The cheapest branded route into this whole market is the Wegovy tablet at $149, not any injection. And Lilly's price climbs with your dose while Novo's pen price does not, so on tirzepatide your bill grows as you titrate.
Against a list price Lilly itself puts at $499 to $1,086.37 per fill, which is the number these programmes exist to avoid.2
Route two: compounded, through a telehealth program
This is what most people paying cash actually do, and it is a fraction of the branded price.
The trade is real and it is not about the molecule: compounded semaglutide and tirzepatide are the same drugs, and their side effects are identical. What differs is that a compounded product is not FDA-approved, so the finished product has not been reviewed for safety, effectiveness or manufacturing quality, and the pharmacy's own licensing carries the weight instead. We set out what compounding does and does not change and how to check a seller separately.
Route three: patient assistance, if your income qualifies
Both manufacturers run assistance programmes separate from the savings cards, and unlike the cards they are aimed at people without coverage. They are income-tested and they require an application and a prescriber's involvement, so they are slower than clicking a coupon.
Lilly's runs through the Lilly Cares Foundation, a charity that in its own words provides prescribed Lilly medicines free for up to 12 months to qualifying US patients.4 The exclusions are as important as the income test, and they are stable:
You are not enrolled in Medicaid, full Low Income Subsidy (LIS, "Extra Help") or Veterans (VA) Benefits; ... You meet the household income guidelines for the Program.
Lilly Cares eligibility
Read that as a map rather than a rejection. If you are on Medicaid or VA benefits, assistance is closed but a public programme is open. If you are uninsured and low-income, this is the route the coupons are not.
We are not going to print the income thresholds, because they are revised and a stale number here would cost somebody a real opportunity. The prescriber writing your prescription can check current eligibility with the manufacturer, and it is worth asking before you commit to paying cash for a year.
What the routes cost, side by side
| Route | Roughly | Catch |
|---|---|---|
| Compounded telehealth | from the board above | Not FDA-approved |
| Wegovy tablet, direct | $149 to $299 | Branded, dose-dependent |
| Wegovy pen, direct | $349 to $399 | Flat across standard doses |
| Zepbound, direct | $299 to $699 | Climbs with your dose |
| Savings card | n/a | Needs commercial insurance |
| Patient assistance | varies | Income-tested, slower |
Before you assume you are uninsured for this
One thing worth five minutes, because people write themselves off wrongly.
"My insurance does not cover weight-loss drugs" and "I have no insurance" are different situations with different routes. If you have a plan that simply excludes weight management, Lilly's second programme applies to you at $499, and your plan may still cover the same molecule under a diabetes indication if one fits. What the major insurers publish is worth reading before you conclude you are paying full freight, and if you are on Medicare or Medicaid those are different routes again.