GLP-1 Compounded Pricing Index 2026

This pricing investigation is part of Weight Loss Rankings' living editorial database — 100+ research articles and 158+ clinically-reviewed GLP-1 telehealth providers, with prices verified directly against each provider's live page on a monthly cadence.

Compounded GLP-1 medications have rewritten the cash-pay weight-loss market. A year ago, brand-name Wegovy at roughly $1,349/month was the only injectable semaglutide most uninsured Americans could access. Today, 152 of the 229 telehealth providers we track offer compounded semaglutide — and the median monthly price is $175, a 87% discount to brand.

That gap, repeated thousands of times across our dataset, is the single biggest force shaping the consumer GLP-1 market right now. This article puts hard numbers on it: the median, the cheapest decile, the most expensive decile, the distribution shape, and how the savings compare against the brand-name baseline. The data updates every time we verify a provider — so the numbers below are always current as of the timestamp at the top of the page.

The headline numbers

Across our entire telehealth dataset, here's what people are actually paying per month for compounded semaglutide and tirzepatide— the same active ingredients in Wegovy and Zepbound respectively:

For semaglutide, the median monthly cost is $175. The cheapest 10% of providers (the “p10”) charge $99 or less. The most expensive decile starts at $299. That spread — roughly 3× from cheapest to priciest — is much wider than most readers expect, and it's the main reason it's worth comparing providers directly instead of taking the first ad you see at face value.^[1]

At the median compounded price, a patient choosing semaglutide saves roughly $14,088 per year versus Wegovy at list price. For tirzepatide, the median compounded price produces an annual savings of about $10,044 versus Zepbound at list. These are real numbers that reset the calculation for anyone whose insurance excludes GLP-1s for obesity (which is most of the privately insured market).^[2]

Pricing magnitude — brand vs manufacturer self-pay vs compounded

The cleanest way to see what the cash-pay GLP-1 market looks like right now is to plot every major channel on a single magnitude axis: the brand retail list price, the manufacturer's own self-pay programs (NovoCare for Wegovy, LillyDirect for Zepbound), and the live median compounded monthly cost from our telehealth dataset.

Two structural observations from this chart. First, the manufacturer self-pay programs already cut the retail list price by 65–90% — Wegovy NovoCare standard pen at $299/month is a 78% discount to the $1,349 retail list, and the Wegovy oral pill tier at $149/month is an 89% discount. The brand retail list price is no longer the realistic ceiling for a cash-pay patient who is willing to enroll directly with the manufacturer. Second, the compounded channel still sits materially below every brand channel — the live median compounded semaglutide is $175/month vs $149–$299 for the cheapest Wegovy NovoCare tiers, and the cheapest decile of compounded providers ($99/month) undercuts even the oral Wegovy pill tier.

How prices are distributed

Aggregate medians hide a lot. The histograms below show how the market actually breaks out by price band. Compounded semaglutide skews heavily toward the $100–$200 range, with a long tail of more expensive providers — usually programs that bundle clinical coaching, lab work, or in-network pharmacy guarantees on top of the injection itself.

Tirzepatide's distribution sits noticeably higher. There are two reasons: tirzepatide's active pharmaceutical ingredient is more expensive at the wholesale level, and the FDA only removed it from the official drug shortage list in late 2024, which constrained the number of 503A pharmacies legally allowed to compound it during most of 2024.^[3]

The cheapest decile right now

The most useful number for most readers isn't the median — it's the actual list of providers at the cheapest end. These update live from our verified dataset:

The lowest list prices are usually first-month introductory deals. Always read the fine print on whether the rate jumps after month one and whether the listed price includes shipping, the consult, and the medication itself, or whether some of those are billed separately. Our individual side-by-side comparisons normalize for these differences.

Why the spread is so wide

A 99–$299 range for what is, at the molecular level, the same drug raises an obvious question: what are buyers in the higher tier actually paying for? Five things, in our experience working through provider data:

1. Sourcing quality. The 503A pharmacies that supply compounded semaglutide vary in size, accreditation, and quality systems. Some publish their certificates of analysis on every batch; others won't share them at all. Providers that source from PCAB-accredited or NABP VPP facilities often charge more.^[4]
2. Bundled clinical care. The cheapest providers tend to be pure prescription delivery — a 5-minute async intake and the medication mailed out. The mid-tier programs include ongoing physician check-ins, dose titration support, and side- effect management. The most expensive include lab work, dietitian access, or in-app coaching.
3. Brand-name fulfillment guarantees. A handful of providers will switch you to brand-name Wegovy (at brand-name prices) if compounded supply is interrupted. This is rare and usually buried in the fine print.
4. State availability. Compounding rules differ state to state. Providers licensed in all 50 states have higher compliance overhead than ones operating in 20.
5. Marketing and CAC. Some of the spread is just customer acquisition cost. The best-funded brands pay $200+ for a new sign-up and recover it through higher monthly prices or longer minimum commitments.

None of these inherently make the more expensive provider a worse deal — but they do mean that comparing on price alone misses the story. Our individual ranked best-of lists score on six dimensions (value, effectiveness, UX, trust, accessibility, support) precisely because price is just one input.

How the gap to brand has evolved

We started tracking GLP-1 telehealth pricing in early 2024. At that point, brand-name Wegovy was effectively unavailable to most uninsured patients — supply constraints meant pharmacies routinely ran out, and the cash price hovered near $1,349 when it could be filled at all. The compounded market existed but was concentrated among a small number of telehealth players, and prices clustered around $250–$350/month.^[5]

Two things changed that. First, the FDA's formal drug shortage designation for semaglutide gave 503A pharmacies clear legal cover to compound it. That brought dozens of new entrants into the market and pushed prices down through ordinary competition. Second, the wholesale cost of semaglutide API itself fell sharply through 2024 and 2025 as more suppliers came online. The combination is why the median sits where it sits today rather than where it sat 18 months ago.^[6]

The current state of play: compounded prices have largely stopped falling, and the cheapest decile is approaching what looks like a floor around $30–$80/month. Brand-name Wegovy and Zepbound, meanwhile, have started offering their own cash-pay programs at roughly half their old retail price as the manufacturers chase share. The gap has narrowed, but it's still meaningful — and for the median patient on the median compounded plan, the savings are still measured in five figures per year.

Methodology

Every price in this index is taken from the public-facing website of the named provider. We re-verify each provider on a rolling basis; the “data as of” stamp at the top of this page reflects the most recent verification across the dataset.

Where a provider lists both an introductory price and an ongoing rate, we use the introductory price (“promo price”) as the comparable monthly cost, because that's what readers actually pay when starting a program. Brand-name comparison baselines come from the manufacturer cash-pay list prices for Wegovy and Zepbound as published by Novo Nordisk and Eli Lilly respectively.

Percentile calculations use linear interpolation between the two surrounding ranks (the same convention as Excel'sPERCENTILE function and NumPy's default). The full source is open on GitHub for anyone who wants to audit it.

Related research

This pricing index is one of several editorial pieces in our compounded GLP-1 market coverage:

• Weight loss injections guide — every FDA-approved option, effectiveness, cost, safety — the discovery-stage companion: anchors readers who searched “weight loss injections” (188K monthly searches, per) into the FDA-approved menu before they hit this pricing index. Cross-references brand-name pen list pricing alongside the compounded distribution this article maps.
• How compounded GLP-1 prices moved over the last 16 months — provider-by-provider trajectories from January 2025 forward, showing every tracked provider has cut prices and the market is converging toward a structural floor near the median this article reports.
• Is $99 compounded semaglutide real? Verifying every floor-price provider — a deep dive on the cheapest tier in the distribution this article describes.
• Compounded tirzepatide vs compounded semaglutide — molecule differences, efficacy (STEP-1 vs SURMOUNT-1 vs SURMOUNT-5 head-to-head), fridge stability, and regulatory status post-Feb 2025 — the compounded-vs-compounded companion to this pricing index.
• What happens when you stop taking semaglutide — important context for the cost calculation: GLP-1 therapy is a long-term commitment, not a course, so per-month price differences compound dramatically over years of expected use.
• GLP-1 insurance coverage at the 10 largest US insurers — for patients deciding between insurance-covered brand name and cash-pay compounded.
• GLP-1 generics 2026: when will each drug go generic? Patent cliff tracker — the post-LOE pricing outlook. Composition-of-matter patents on semaglutide are widely modeled to expire in the early 2030s, tirzepatide in the mid-to-late 2030s. Two generic liraglutides are already FDA-approved (Hikma / Victoza Dec 2024; Teva / Saxenda Aug 2025), but the high-volume franchises Wegovy, Ozempic, Mounjaro, and Zepbound remain patent-protected. For cash-pay patients modeling the long-run pricing trajectory, this is the structural ceiling on how cheap compounded semaglutide can stay before generic competition reshapes the market.
• Maryland Medicaid GLP-1 coverage (2026): HCPCS J3490 medical-benefit pathway for Wegovy ASCVD/MASH — Maryland is the only state in the 17-state Medicaid series that reimburses Wegovy for its non-obesity FDA indications via the physician-administered medical-benefit channel (HCPCS J3490 per invoice) rather than through retail pharmacy. Wegovy is absent from Advisory 282 (the FFS PDL) entirely. Members excluded from the weight-management pathway who are evaluating cash-pay options will find no Medicaid retail-pharmacy route even for the non-obesity carve-outs; the J3490 pathway requires a prescriber office or hospital outpatient department — an access friction point directly relevant to the cash-pay compounded market this index tracks.
• Michigan Medicaid GLP-1 coverage (2026): partial retainment with morbid-obesity gate — a case study in the cash-pay funnel created by state Medicaid tightening. Michigan retained Medicaid GLP-1 coverage for weight management but only at BMI ≥ 40 with a uniquely Michigan bariatric-surgery-avoidance attestation. The ~18,000 weight-management-only users no longer qualifying under Medicaid (BMI 30–39, no T2D or other qualifying indication) represent a structural addition to the cash-pay compounded market — directly relevant to the pricing distribution this article tracks.
• New Jersey Medicaid GLP-1 coverage (2026): dual-authority explicit exclusion with DMAHS-published fiscal transparency — NJ FamilyCare categorically excludes GLP-1s for chronic weight management and is the only state in the 11-state series to publish a dollar-quantified fiscal-impact memo ($208.3M gross full-coverage cost; $37.7M net state-fund increase). NJ FamilyCare enrollees excluded from Medicaid weight-management coverage represent a documented cash-pay demand pool. The memo's actuarial model explicitly lists drug market shares (Saxenda vs. Wegovy vs. Zepbound utilization) as a cost variable — a direct signal that the compounded alternatives in this pricing index are part of the economic calculation NJ policymakers are weighing.
• Arizona Medicaid (AHCCCS) GLP-1 coverage (2026): Agency-Manual Explicit Exclusion — AHCCCS explicitly excludes “Medications used for weight loss treatment” in the AHCCCS FFS Provider Billing Manual, Chapter 12, item #13. Arizona has no MACE, MASH, or OSA carve-back-in as of May 2026. For the ~2.1 million AHCCCS enrollees excluded from weight-management GLP-1 coverage with no structured alternative pathway, the cash-pay compounded market documented in this pricing index is the primary access route.
• Indiana Medicaid (IHCP) GLP-1 coverage (2026): regulatory exclusion + Zepbound-preferred anomaly — Indiana is a structural cash-pay funnel state and the first in the 16-state series where Zepbound is PREFERRED on the Medicaid PDL (December 1, 2025 SUPDL) yet inaccessible for obesity because the PA criteria gate access on type-2 diabetes. Adult Hoosiers without T2D, MASH, or PCOS face the full list-price or compounded market for GLP-1 weight management — a PDL-preferred-anomaly state that creates documented compounded-GLP-1 demand at the Medicaid boundary. The Indiana state employee plan simultaneously dropped GLP-1 weight-loss coverage January 1, 2026 (CVS Caremark). Indiana’s SB 282 (effective July 1, 2026) will regulate the compounding supply side starting January 1, 2027 — a structural variable for the compounded pricing distribution this index tracks.
• Virginia Medicaid (Cardinal Care) GLP-1 coverage (2026): highest BMI threshold in the series + $245/month BALANCE-conditional legislation — Virginia Cardinal Care covers Wegovy and Zepbound for weight management only at BMI > 40, with a two-level step-therapy gate. Active 2026 legislation (SB30 Item 291 #5s) would expand coverage to BMI ≥ 35/30/27 if a $245/month net price target is achieved through the CMS BALANCE Model. Virginia’s $245/month price target directly benchmarks the compounded GLP-1 pricing this index tracks — patients under VA Medicaid who cannot meet the BMI > 40 threshold are exactly the population evaluating cash-pay compounded options at or below that price ceiling.
• GLP-1 shot beginner guide — entry-level explainer for readers who arrive from “glp1 shot” or “weight loss shots” searches before they understand brand names or cost structure. Routes beginner-intent traffic to this pricing index for the next decision step.
• Missouri Medicaid (MO HealthNet) GLP-1 coverage (2026): Pattern #22 — Wegovy demoted to MACE/MASH-only + Foundayo (orforglipron) Preferred first in 22-state series — Missouri is a KFF-confirmed positive-coverage state (Zepbound + Foundayo Preferred) but verbatim excludes Wegovy for chronic weight management: “Wegovy for the reduction of excess body weight or maintenance of weight reduction long term is not covered by MO HealthNet.” Missouri MO HealthNet members and commercially-insured Missourians seeking semaglutide for CWM have no covered pathway unless they meet the MACE (prior MI/stroke/PAD, ≥ 45 yrs, BMI ≥ 27, A1C < 6.5) or MASH (F2/F3 biopsy-confirmed fibrosis) criteria — conditions that exclude the majority of weight-loss-only patients. This structured Wegovy-CWM exclusion in an otherwise positive-coverage state creates a direct cash-pay funnel for semaglutide (compounded or NovoCare self-pay) specifically in Missouri. The Mizzou (University of Missouri) self-insured plan also terminated GLP-1 weight-loss coverage January 1, 2026, citing a projected 28% premium increase — compounding the Missouri cash-pay demand pool for the compounded and brand-name semaglutide this pricing index tracks.
• Minnesota Medicaid GLP-1 coverage (2026): Pattern #20 — positive coverage with dedicated Weight Management Agents PDL class + active hostile HF4142 bill creating January 1, 2027 termination risk — Minnesota is a positive-coverage state where HF4142 (introduced March 9, 2026; laid over March 25, 2026; no Senate companion) creates a prospective termination effective January 1, 2027 if enacted. The bill targets the same fiscal pressure documented in this pricing index: $12,000 per-patient annual cost, 12% of state pharmaceutical spend, 90% utilization growth 2023–2024. If HF4142 or similar omnibus language passes, the ~1.3M MHCP members currently accessing Saxenda and Wegovy through Minnesota Medical Assistance would need to evaluate cash-pay compounded pathways documented in this pricing index. The dedicated Weight Management Agents PDL class makes the coverage harder to dismantle administratively, but the fiscal scale ($80–$90M per biennium) makes it a high-priority budget target.
• Wisconsin Medicaid (ForwardHealth) GLP-1 coverage (2026): positive coverage with 2-lifetime-attempts cap + BMI < 24 renewal-revocation — Wisconsin is the clearest state-Medicaid cash-pay funnel case in the positive-coverage cluster. After two lifetime PA-approved attempts with any covered AOM (Wegovy, Zepbound, Saxenda, Xenical), ForwardHealth returns further requests as noncovered services with no appeal rights. Members who have hit the 2-attempt cap have no further Medicaid pathway for the chronic-weight-management indication and enter the compounded GLP-1 cash-pay market that this pricing index tracks. The BMI < 24 renewal-revocation rule creates a second funnel: patients who succeed and drop below BMI 24 also lose Medicaid coverage at renewal, and may regain weight and return to the cash-pay market on a second attempt cycle.
• Kentucky Medicaid GLP-1 coverage (2026): Pattern #21 — nullified-amendment exclusion state (SB 65 override April 14, 2026) — Kentucky is a confirmed nullified-amendment exclusion state with approximately 350,000 Medicaid members carrying an obesity diagnosis (DMS-attested figure from the proposed 907 KAR 23:010 regulatory filing) and no Medicaid weight-management pathway through at least June 1, 2027. The Beshear administration’s proposed amendment to permit GLP-1 obesity coverage was extinguished by SB 65 veto override April 14, 2026. Those 350,000 members — excluded from Medicaid and without employer coverage equivalent to the Kentucky Employees’ Health Plan (KEHP) — represent a structural addition to the cash-pay compounded GLP-1 market this pricing index tracks. Kentucky’s single-PBM (MedImpact) carve-out architecture creates no MCO-level variance in access, making the exclusion uniform statewide and the population size well-bounded at 350,000 qualifying members.
• Alabama Medicaid GLP-1 coverage (2026): Pattern #23 — categorical exclusion + 5th-highest obesity prevalence nationally — Alabama combines categorical GLP-1 weight-loss exclusion (Ala. Admin. Code r. 560-X-16-.01(2)(b)), non-expansion Medicaid status, and a 39.2% adult obesity prevalence rate (CDC BRFSS 2023, 5th-highest nationally). That structural triple — no Medicaid weight-management coverage, no Medicaid expansion for low-income childless adults, and one of the highest obesity rates in the nation — produces a substantial cash-pay demand pool for compounded and brand-name GLP-1s. Alabama’s only Medicaid pathways are Zepbound for OSA (AHI ≥ 15, BMI ≥ 30, no T2D) and Wegovy for FDA-label MACE risk reduction (established CVD + obesity or overweight) — neither reaches the chronic-weight- management population that forms the core demand pool for the compounded semaglutide and tirzepatide this pricing index tracks.
• Oklahoma Medicaid GLP-1 coverage (2026): Pattern #24 — triple-carve-out + OU College of Pharmacy PA + 7.8% approval rate — Oklahoma SoonerCare’s documented June 2025 approval rate for Anti-Obesity Agent PA requests was 7.8% (8 approved of 102 total, per the July 9, 2025 OHCA DUR Board Packet). The 92.2% of denied applicants — plus the entire population of SoonerCare members who never submit a PA because the chronic-weight- management exclusion is categorical (OAC 317:30-5-72.1(1)(D)) — represent the structural cash-pay demand pool this pricing index serves. Four carve-outs exist (Wegovy CV, Wegovy MASH, Zepbound OSA, Imcivree monogenic-obesity) but none reach the general chronic-weight-management population. Oklahoma is the only state in this 24-state series whose PA is administered by a university college of pharmacy rather than a national PBM.
• Pharmacy Legitimacy Lookup tool — before purchasing from any compounded GLP-1 pharmacy in this pricing index, verify its public record: FDA warning letters, drug recalls (openFDA enforcement), state license status (Texas + Illinois Tier-1 databases), and 503B outsourcing facility registration. Five primary-source disclosure rows, no AI score.