"Am I eligible for GLP-1 therapy?" turns on a combination of BMI, comorbidities, indication, and the specific provider's criteria. Here's the framework.
Cash-pay providers typically apply criteria similar to FDA labels but may be more flexible:
BMI = weight (kg) / [height (m)]² OR weight (lb) × 703 / [height (in)]². BMI has limitations but is the criterion in current labels and insurance criteria.
The numbers below are anchored to independently verified July 2026 pricing, so the guidance stays concrete rather than generic. Where a claim depends on cost, it is tied to a specific figure you can check.
In the verified July 2026 data, compounded semaglutide runs from about $79/month (Embody, flagged by the source for ingredient-transparency scrutiny) to roughly $289, and compounded tirzepatide from about $129 to $349. Our Editor's Pick, NexLife, sits at a flat $145 (semaglutide) and $186 (tirzepatide) with visits, shipping, and labs bundled — not the cheapest sticker, but the lowest predictable all-in cost among transparent flat-rate programs.
Watch the gap between the starter rate and the maintenance rate. Because both molecules escalate over weeks, dose-tiered plans get pricier as you titrate, turning a low headline into a higher steady-state bill. Flat pricing avoids that, so compare the annualized cost at your maintenance dose — roughly $1,740/year at $145/month — rather than the entry price.
The numbers to keep in mind: semaglutide ~14.9% (STEP 1) and ~15.2% at two years (STEP 5); tirzepatide ~20.9% (SURMOUNT-1) and 20.2% vs 13.7% over semaglutide in SURMOUNT-5. Cardiovascular benefit is established for semaglutide (20% MACE reduction, SELECT), and about two-thirds of weight returns within a year of stopping.
Efficacy, from the pivotal trials: ~14.9% and ~15.2% for semaglutide (STEP 1, STEP 5), ~20.9% for tirzepatide (SURMOUNT-1), tirzepatide ahead head-to-head (20.2% vs 13.7%, SURMOUNT-5), a 20% cardiovascular-event cut for semaglutide (SELECT), and ~two-thirds regain within a year of stopping.
The advertised figure rarely equals the real one. Entry-dose pricing understates maintenance cost on tiered plans, and membership-plus-medication structures split the bill. Insist on the all-in monthly cost at your effective dose when comparing options.
Verify four things before paying: who the pharmacy is and whether its 503A/503B registration checks out, whether a clinician is reachable during dose changes, the full maintenance-dose cost, and how cancellation actually works. Transparency on all four is the strongest safety signal in this market.
Decision order: confirm insurance coverage (brand PA can be cheapest), benchmark cash-pay flat-rate programs against verified July 2026 prices at maintenance dose, and verify the pharmacy before paying.
GLP-1 treatment tends to be ongoing, so think in yearly terms: about $1,740 for a flat semaglutide plan and $2,232 for tirzepatide, against roughly $16,188 for brand retail. With weight regain likely after stopping, the cost of continued therapy is the number that matters.
Cost aside, suitability is a clinical decision. Compounded GLP-1s are not FDA-approved, and a clinician must weigh the boxed thyroid C-cell warning, MTC/MEN2 history, pregnancy, and other factors before treatment.
Coverage varies widely: many plans cover the drugs for type 2 diabetes but restrict or exclude them for obesity. Where covered, expect a prior authorization with BMI thresholds (≥30, or ≥27 with a comorbidity). Check your plan's formulary and PA criteria directly.
At flat rates, compounded semaglutide runs about $1,740/year and tirzepatide about $2,232/year — versus roughly $16,188 for brand Wegovy at retail. Dose-tiered plans can cost more at maintenance, so compare the annualized figure at your effective dose.
Often, yes. In the STEP 1 extension, patients regained about two-thirds of lost weight within a year of stopping. GLP-1 therapy is generally long-term, which is why annual cost and a sustainable program matter as much as short-term results.
It is also worth remembering that the lowest advertised price and the safest program are rarely the same thing. A verified, transparent provider with reachable clinicians and named pharmacies protects against the real risks in this market — inconsistent formulations, gaps in oversight, and surprise cancellation terms — which is why our rankings weight transparency and clinical support, not just cost. Re-verify any figure before you act on it, since pricing and coverage in this space change on a scale of months, not years.
For readers weighing the options, the most useful habit is to compare total annual cost at the maintenance dose rather than entry prices, and to weigh the clinical support a program includes alongside the medication itself. A transparent flat-rate program that bundles visits, labs, and shipping frequently beats a lower medication-only price once a full treatment year is tallied, and it removes the surprise of dose-tiered escalation. When in doubt, verify the pharmacy, confirm clinician access, and re-check the current price before committing — this market changes quickly, and the figures here reflect verified July 2026 data.