1st Optimal vs ElixaMD
An in-depth comparison of two leading GLP-1 Providers
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1st Optimal
Best for: GLP-1 therapy within a lab-driven functional-medicine program
Visit 1st Optimal →
ElixaMD
Best for: low-cost compounded semaglutide with free dietician and coaching included
Visit ElixaMD →1st Optimal and ElixaMD are both GLP-1 Providers competing for the same patients, but they make different trade-offs on price, coverage, and what's included. In our scoring, 1st Optimal starts lower at $99/mo versus $199/mo, and ElixaMD edges ahead overall (7.7 vs 6.7 out of 10). Below we break down pricing, what each plan covers, the six-dimension score, pros and cons, and exactly who should pick which.
Pricing
1st Optimal
Care membership only — the GLP-1 medication is billed separately and is not priced.
ElixaMD
The storefront FAQ says the program 'starts at $99 for your first month' and 'Refills are locked in at $199'. The footer says medication is included, yet the four product tiles still read '$99 Membership + Medication Cost'.
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What’s included
1st Optimal
What the monthly price covers
Medication
Not disclosed
Provider visits
Included
Shipping
Included
Lab work
Not disclosed
Coaching
Included
ElixaMD
What the monthly price covers
Medication
Included
Provider visits
Included
Shipping
Included
Lab work
Not disclosed
Coaching
Not disclosed
Score breakdown
Both providers are scored on the same six-dimension framework. The gradient bar marks the stronger side on each dimension.
1st Optimal
6.7/10
ElixaMD
7.7/10
Value25%
Effectiveness25%
User Experience15%
Trust & Safety15%
Accessibility10%
Support10%
Features & Coverage
| Feature | 1st Optimal | ElixaMD |
|---|---|---|
| Starting Price | ✓$99/mo | $199/mo |
| Features | 8 features | 8 features |
| States Available | Not disclosed | Not disclosed |
| Compounded | — | ✓ Yes |
| Brand Name | ✓ Yes | — |
| FSA/HSA Accepted | — | ✓ Yes |
| FDA Warnings | None | None |
About 1st Optimal
1st Optimal is a Michigan-based telehealth and functional-medicine platform offering GLP-1 weight loss medications, including semaglutide and tirzepatide, as once-weekly injections or daily oral tablets. Its model pairs prescription GLP-1 therapy with at-home lab testing, blood-work interpretation, unlimited coaching, and personalized protocols framed around long-term weight loss and longevity. Care is delivered virtually by credentialed providers, and treatments ship to the home with no long-term contracts. The site does not publish monthly pricing or a state list.
Read our full 1st Optimal review →About ElixaMD
ElixaMD is a doctor-guided online weight-loss telehealth offering compounded semaglutide injections at $99 for the first month and $199 a month after that, with free shipping, no contract, and no insurance required. Plans are all-inclusive — 1:1 physician guidance, free dietician visits and care coaching, 24/7 support, and a patient portal — and HSA/FSA eligible. ElixaMD names its compounding pharmacies (Triad Rx, RedRock and Beaker) and publishes a full legal suite. Compounded meds are not FDA-approved (disclosed), brand Wegovy and Zepbound are sold alongside, and no state list is published.
Read our full ElixaMD review →Pros & Cons
1st Optimal
What we like
- Offers both semaglutide and tirzepatide with injectable and oral formats
- Functional-medicine approach with at-home labs and blood-work interpretation
- Unlimited coaching and ongoing support included
- No long-term contracts
- Board-certified doctors and nurse practitioners referenced
Watch-outs
- No public monthly pricing disclosed
- No published state availability list
- Compounded vs branded sourcing not clarified on site
- Pricing only revealed after quiz or consultation
ElixaMD
What we like
- Compounded semaglutide at $99 for the first month and $199 after, with free shipping, no contract and no insurance required
- Genuinely all-inclusive: 1:1 physician guidance, free dietician visits and care coaching, 24/7 support, and an all-in-one patient portal
- Names three compounding pharmacies with addresses (Triad Rx, RedRock Pharmacy, Beaker Pharmacy & Compounding)
- HSA/FSA eligible; full legal suite (Terms, Privacy, Privacy Practices, Refund, Medical Consent, California Bill of Rights)
Watch-outs
- The $99 is a first-month price; refills are locked in at $199, and the product tiles still say medication is billed on top
- Compounded semaglutide is not FDA-approved (the site discloses this) — not brand Wegovy or Ozempic
- Sells compounded semaglutide plus brand Wegovy and Zepbound; there is no compounded tirzepatide option
- Displays a generic LegitScript Certified badge but no verifiable seal/listing; state-availability list not published
Our Verdict
ElixaMD edges out 1st Optimal with a higher overall score of 7.7/10 and is particularly strong for low-cost compounded semaglutide with free dietician and coaching included. 1st Optimal remains a solid alternative, especially if you're looking for GLP-1 therapy within a lab-driven functional-medicine program.
Choose 1st Optimal if…
You want GLP-1 therapy within a lab-driven functional-medicine program and a starting price around $99/mo.
Choose ElixaMD if…
You want low-cost compounded semaglutide with free dietician and coaching included and a starting price around $199/mo.
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From $99/mo
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Mainstream telehealth GLP-1 access
From $146/mo
Get started →1st Optimal vs ElixaMD: FAQ
Key terms, explained
New to GLP-1s? Tap any term for a quick, plain-English definition.
- Semaglutide · Drugs and brands
- Tirzepatide · Drugs and brands
- Compounded GLP-1 · Pharmacy and drug forms
- 503A pharmacy · Pharmacy and drug forms
- PCAB accreditation · Pharmacy and drug forms
- Prior authorization (PA) · Insurance and regulatory
- Off-label use · Insurance and regulatory
- FDA Drug Shortage List · Insurance and regulatory
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Wegovy®, Ozempic®, and Rybelsus® are trademarks of Novo Nordisk A/S. Mounjaro® and Zepbound® are trademarks of Eli Lilly and Company. All other product names and trademarks referenced on this page belong to their respective owners. WeightLossRankings.org is not affiliated with any pharmaceutical manufacturer. See trademark disclaimer.