1st Optimal vs StackMD
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 →
StackMD
Best for: shoppers who want an exact price for their specific dose before committing
Visit StackMD →1st Optimal and StackMD 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 $125/mo, and StackMD edges ahead overall (7.5 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.
StackMD
Published per-dose ladder on /product/semaglutide-compounded-glp-1: 1mg $125, 2mg $149, 4mg $175, 6mg $199, 10mg $225 — all 1ml vials of semaglutide with B12 and glycine, billed as a monthly plan ('Plans starting at just $125/month'). No membership or platform fee on top.
Published per-dose ladder on /product/tirzepatide-compounded-glp-1-gip: 5mg $199, 10mg $249, 15mg $299, 20mg $349, 25mg $399, 30mg $449 — all 2ml vials of tirzepatide with B12 and glycine. A patient titrated to a high dose pays more than double the advertised starting price.
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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
StackMD
What the monthly price covers
Medication
Included
Provider visits
Not disclosed
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
StackMD
7.5/10
Value25%
Effectiveness25%
User Experience15%
Trust & Safety15%
Accessibility10%
Support10%
Features & Coverage
| Feature | 1st Optimal | StackMD |
|---|---|---|
| Starting Price | ✓$99/mo | $125/mo |
| Features | 8 features | 8 features |
| States Available | Not disclosed | 50 |
| 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 StackMD
StackMD is a New York telehealth platform (Medical 360 HC PLLC) selling compounded semaglutide and tirzepatide, both formulated with B12 and glycine, alongside NAD+, sermorelin and other longevity peptides. It prices every dose strength openly instead of quoting one 'from' number: semaglutide runs $125 to $225 a month across five strengths and tirzepatide $199 to $449 across six. There are no membership fees, and prescribing is handled by its named partner SamaritanMD.
Read our full StackMD 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
StackMD
What we like
- Publishes an exact price for every dose strength rather than a single 'from' figure — semaglutide $125-$225, tirzepatide $199-$449
- Names both its legal entity (Medical 360 HC PLLC) and its prescribing telehealth partner, SamaritanMD
- No membership or platform fee — the medication price is the whole price
- States plainly that its compounded medications are 'not FDA-approved and have not been evaluated by the FDA for safety, efficacy, or quality'
- Telehealth offered in all 50 states per its terms, with free discreet shipping and FSA/HSA eligibility
- Discloses the full formulation, including the B12 and glycine compounded into both GLP-1s
Watch-outs
- All sales are final — 'No refunds are issued except as described below', and dispensed medication cannot be returned
- Compounding pharmacies are never named, only 'a licensed third-party pharmacy'
- Price rises steeply with dose: tirzepatide runs $199 at 5mg to $449 at 30mg
- Billing and refunds are handled by SamaritanMD — StackMD 'has no authority to issue refunds' on its behalf
- Terms impose binding arbitration in New York and waive jury trial and class-action participation
- Both GLP-1s are compounded with added B12 and glycine rather than the single active ingredient
- Availability of specific treatments may still vary by state despite the all-50-states claim
- No LegitScript certification or pharmacy accreditation displayed
Our Verdict
StackMD edges out 1st Optimal with a higher overall score of 7.5/10 and is particularly strong for shoppers who want an exact price for their specific dose before committing. 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 StackMD if…
You want shoppers who want an exact price for their specific dose before committing and a starting price around $125/mo.
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Mainstream telehealth GLP-1 access
From $99/mo
Get started →1st Optimal vs StackMD: 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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