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Wegovy vs Zepbound (2026): Weight Loss, Cost, Side Effects

Wegovy (semaglutide, Novo Nordisk) vs Zepbound (tirzepatide, Eli Lilly)

Last verified 2026-05-27

The verdict

Zepbound (tirzepatide) wins on raw efficacy: SURMOUNT-5 head-to-head showed −20.2% body weight at 72 weeks vs Wegovy's −13.7% — a 6.5-percentage-point difference. Wegovy wins on cardiovascular outcomes (SELECT trial reduced MACE 20%) — Zepbound's CV outcomes trial (SURPASS-CVOT) reads out 2027. Cash price is identical at $499/mo via NovoCare and LillyDirect. Choose based on whether weight-loss magnitude or CV risk reduction matters more.

Side-by-side comparison

FieldWegovyZepbound
Mean weight loss (TBWL)−14.9% / 68 weeks (STEP-1)−20.9% / 72 weeks (SURMOUNT-1)
Head-to-head (SURMOUNT-5)−13.7%−20.2%
MechanismGLP-1 receptor agonistDual GIP / GLP-1 agonist
DosingOnce-weekly subq (5-step titration)Once-weekly subq (6-step titration)
Cash price (manufacturer)$349-$499/mo (NovoCare)$349-$499/mo via LillyDirect
Cardiovascular outcomeMACE −20% (SELECT, 2023)SURPASS-CVOT pending 2027
Most common adverse eventNausea (44%)Nausea (29%)
FDA-approved indicationsChronic weight management; CV risk reductionChronic weight management; obstructive sleep apnea

Frequently asked questions

Is Zepbound more effective than Wegovy?

Yes, on weight loss alone. SURMOUNT-5 — the only head-to-head RCT — showed Zepbound -20.2% body weight vs Wegovy -13.7% at 72 weeks (Aronne 2025 NEJM). The 6.5-percentage-point gap is statistically and clinically significant. Wegovy retains the cardiovascular-outcome advantage from SELECT.

Which is cheaper, Wegovy or Zepbound?

Cash prices are now functionally identical: NovoCare offers Wegovy at $349/mo (first 2 months) then $499/mo. LillyDirect offers Zepbound at $349/mo (vials) or $499/mo (autoinjector). Insurance copays vary widely; check your plan's PA criteria.

Are the side effects different?

Both share GI-dominant side effects (nausea, diarrhea, constipation, vomiting). In SURMOUNT-5, Zepbound had slightly lower nausea (29% vs Wegovy's 44%) but higher discontinuation due to AEs (8% vs 6%). Both carry the same FDA boxed warning for thyroid C-cell tumors.

Can I switch from Wegovy to Zepbound?

Yes — most clinicians restart at Zepbound 2.5mg regardless of prior Wegovy dose, since the molecules are different and dose equivalence is not established. Expect a brief titration period. Insurance prior auth typically requires documented inadequate response after 12+ weeks at Wegovy 2.4mg.

Which is approved for sleep apnea?

Zepbound is FDA-approved for moderate-to-severe obstructive sleep apnea in adults with obesity (December 2024 via SURMOUNT-OSA). Wegovy is FDA-approved for cardiovascular risk reduction (March 2024 via SELECT). Both are approved for chronic weight management.

References

References

  1. 1.Wilding JPH, Batterham RL, Calanna S, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity (STEP 1). N Engl J Med. 2021. PMID: 33567185.
  2. 2.Aronne LJ, Horn DB, le Roux CW, et al. Tirzepatide as Compared with Semaglutide for the Treatment of Obesity (SURMOUNT-5). N Engl J Med. 2025. PMID: 40353578.
  3. 3.Eli Lilly and Company. Zepbound SelfPay pricing — $349 starter / $499 maintenance via LillyDirect. Lilly Press Release. 2024. https://www.lilly.com/news/press-releases/lilly-launches-zepbound
  4. 4.Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and Cardiovascular Outcomes in Obesity Without Diabetes (SELECT). N Engl J Med. 2023. PMID: 37952131.
  5. 5.Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide Once Weekly for the Treatment of Obesity (SURMOUNT-1). N Engl J Med. 2022. PMID: 35658024.

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