Zepbound vs Semaglutide: Weight Loss, Side Effects, Price
Zepbound (tirzepatide) and semaglutide are both GLP-1 medicines, weekly injection versus weekly injection or daily tablet. They were tested against each other in SURMOUNT-5. Self-pay starts at $299 per month for Zepbound and $149 per month for Semaglutide.
- Tested head to head
- SURMOUNT-5
Zepbound and Wegovy: a quick overview
Zepbound and Semaglutide compared side by side
| Zepbound | Semaglutide | |
|---|---|---|
| Medicine | Zepbound | semaglutide |
| Active ingredient | tirzepatide | semaglutide |
| Manufacturer | Eli Lilly | Novo Nordisk |
| How it is taken | Weekly injection | Weekly injection or daily tablet |
| Approved for | Weight loss and sleep apnea | Weight loss and MASH liver disease, plus heart risk, type 2 diabetes, and kidney disease when type 2 diabetes is present |
| First FDA approval | 2023 | 2017 |
| Average weight loss in trials | 20.9% (SURMOUNT-1, 72 weeks) | 14.9% (STEP 1, 68 weeks) |
| Most common side effect | Nausea 29% vs 8% on placebo | Nausea 20.3% vs 6.1% on placebo |
| List price | $499 to $1,086 per fill | $1,027.51 per pen |
| Self-pay from | $299 per month | $149 per month |
| Medicare GLP-1 Bridge | $50 per month, eligible Part D | $50 per month, eligible Part D |
| FDA shortage | Resolved December 19, 2024 | Resolved February 21, 2025 |
Sources: FDA label, FDA label (DailyMed), pricinginfo.lilly.com, Novo Nordisk pricing.
Weight loss tested head to head
SURMOUNT-5 gave Zepbound to one group and Semaglutide to another, which allows a direct comparison of the numbers
| Trial | Who took part | Length | Group | Average weight loss |
|---|---|---|---|---|
| SURMOUNT-5 | Adults with obesity, without type 2 diabetes | 72 weeks | Tirzepatide 10 or 15 mg weekly (Zepbound) | 20.2% |
| SURMOUNT-5 | Adults with obesity, without type 2 diabetes | 72 weeks | Semaglutide 1.7 or 2.4 mg weekly (Wegovy) | 13.7% |
Trial sources: SURMOUNT-5 (PubMed).
Side effects compared
Every label tested its participants against a placebo group, so compare each drug with its own placebo first.
| Side effect | Zepbound | Placebo (Zepbound trials) | Ozempic | Placebo (Ozempic trials) |
|---|---|---|---|---|
| Nausea | 29% | 8% | 20.3% | 6.1% |
| Diarrhea | 23% | 8% | 8.8% | 1.9% |
| Constipation | 17% | 5% | 5% | 1.5% |
| Vomiting | 13% | 2% | 9.2% | 2.3% |
| Abdominal Pain | 10% | 5% | 7.3% | 4.6% |
| Dyspepsia | 10% | 4% | Not listed | Not listed |
| Injection Site Reactions | 8% | 2% | Not listed | Not listed |
| Fatigue | 7% | 3% | Not listed | Not listed |
Price and coverage compared
| Medicine | How you pay | Price |
|---|---|---|
| Zepbound | List price before insurance | $499 to $1,086 per fill |
| Zepbound | Zepbound Savings Program (insured) | from $25 for up to a 3-month fill |
| Zepbound | Self-pay: LillyDirect vial or KwikPen 2.5 mg | $299 per month |
| Zepbound | Commercial plan that does not cover it | $299 per month |
| Zepbound | Medicare GLP-1 Bridge (Zepbound KwikPen, eligible Part D) | $50 per month |
 Ozempic | List price before insurance | $1,027.51 per pen |
| Ozempic | Ozempic Savings Offer (insured) | starting at $25 monthly, for a period of up to 3 months |
| Ozempic | Self-pay: Ozempic pill (from 1.5 mg) | $149 per month |
 Wegovy | List price before insurance | $1,349.02 per month |
| Wegovy | Wegovy Savings Offer (insured) | from $25 per month |
| Wegovy | Self-pay: Wegovy pill 1.5 mg | $149 per month |
| Wegovy | Medicare GLP-1 Bridge (Wegovy, eligible Part D) | $50 per month |
 Rybelsus | List price before insurance | $1,027.51 per 30 tablets |
| Rybelsus | RYBELSUS Savings Offer (insured) | fills of 1, 2 or 3 months start at $25 |
Prices checked November 2026 (10)
pricinginfo.lilly.com, zepbound.lilly.com, Eli Lilly, CMS, Novo Nordisk pricing 1 2, NovoCare 1 2, TrumpRx, rybelsus.com.
Who should pick which?
- For type 2 diabetes, only Semaglutide has approval.
- For sleep apnea, Zepbound is approved as a treatment.
- With kidney disease and type 2 diabetes, Semaglutide holds that approval.
- MASH liver disease: Semaglutide is approved for this use.
- For heart risk, approval covers lowering the risk of heart attack and stroke with Semaglutide.
- For children under 18, Semaglutide has approval to treat some of them.
- If you pay cash, Semaglutide starts at a lower price of $149 per month.
Coverage, other medicines and your health history are weighed by your prescriber. Whether you switch between them is your prescriber's decision.