Quick answer: Zepbound (tirzepatide, Eli Lilly) and Wegovy (semaglutide, Novo Nordisk) are FDA-approved weekly GLP-1 injections for weight loss. In SURMOUNT-5, the only trial that compared them directly, Zepbound averaged 20.2% weight loss at 72 weeks versus 13.7% on Wegovy. Self-pay, Zepbound vials or KwikPens cost $299–$449 a month through LillyDirect and the Wegovy pen $349 through NovoCare ($199 for the first two fills for new patients through Dec 31, 2026); Wegovy also comes as a 7.2 mg HD pen ($399) and a daily pill (from $149). Zepbound is approved for sleep apnea; Wegovy for lowering heart attack and stroke risk and for MASH liver disease.
Zepbound and Wegovy are brand-name, prescription GLP-1 medicines approved for chronic weight management. Zepbound contains tirzepatide, which acts on two gut hormones (GIP and GLP-1); Wegovy contains semaglutide, which acts on one (GLP-1). This page compares the brands as you would buy them in 2026: the pens, vials and pill, what each costs without insurance, what each is approved for, and what the head-to-head trial found. For the molecule-level science, see our tirzepatide vs semaglutide update.
- SURMOUNT-5 (751 adults without diabetes, 72 weeks): Zepbound 20.2% average weight loss, Wegovy 13.7%; 48.4% vs 27.3% lost a fifth of their body weight.
- Self-pay: Zepbound vial or KwikPen $299 at 2.5 mg up to $449 a month; Wegovy pen $349 at every dose to 2.4 mg, Wegovy HD $399, Wegovy pill $149–$299.
- Approvals differ: Zepbound for obstructive sleep apnea; Wegovy for heart-risk reduction, MASH liver disease (pen) and teens 12 and older (pen).
Zepbound vs Wegovy at a glance
| Zepboundtirzepatide · Eli Lilly | Wegovy pensemaglutide 2.4 mg or 7.2 mg (HD) · Novo Nordisk | Wegovy pilloral semaglutide 25 mg · Novo Nordisk | |
|---|---|---|---|
| Forms | Single-dose pen; KwikPen (4 weekly doses per pen); single-dose and multi-dose vials (vials only through LillyDirect) | Single-dose pens 0.25–2.4 mg, the 7.2 mg Wegovy HD pen, and a FlexTouch pen (4 doses of 2.4 mg) | Daily tablet, 30 per bottle |
| How you take it | Once a week, any time of day, with or without food | Once a week, any time of day, with or without food | Every morning on an empty stomach with up to 4 oz of water, then wait 30 minutes before eating, drinking or other pills |
| FDA-approved for | Weight reduction in adults; moderate-to-severe obstructive sleep apnea in adults with obesity (Dec 2024) | Weight reduction in adults and ages 12+; lowering heart attack, stroke and cardiovascular death risk in adults with heart disease (Mar 2024); MASH with moderate-to-advanced fibrosis (Aug 2025, accelerated approval). HD 7.2 mg: adult weight reduction only (Mar 2026) | Weight reduction and heart-risk reduction in adults (approved Dec 2025); no teen or MASH approval |
| Dose steps | 2.5 mg for 4 weeks, then up 2.5 mg at a time every 4+ weeks; maintenance 5, 10 or 15 mg | 0.25, 0.5, 1 and 1.7 mg, 4 weeks each, then 2.4 mg (or 1.7 mg); 7.2 mg only after 4+ weeks on 2.4 mg | 1.5 mg, 4 mg and 9 mg, 30 days each, then 25 mg |
| Maximum dose | 15 mg weekly | 7.2 mg weekly (Wegovy HD) | 25 mg daily |
| Self-pay from | $299 a month (2.5 mg) | $199 a month for the first two fills, then $349 | $149 a month (1.5 mg) |
Zepbound vs Wegovy results: what the trials show
Only the first two rows come from a trial that gave people one drug or the other. The Wegovy pill has never been tested against Zepbound, and the last row puts separate trials side by side.
| Result | Zepboundtirzepatide · Eli Lilly | Wegovy pensemaglutide 2.4 mg or 7.2 mg (HD) · Novo Nordisk | Wegovy pilloral semaglutide 25 mg · Novo Nordisk |
|---|---|---|---|
| Average weight loss, head-to-headCounting: everyone randomized, including people who stopped (treatment-regimen) | 20.2%SURMOUNT-5, 751 people, 72 weeks; 10 or 15 mg | 13.7%SURMOUNT-5, 751 people, 72 weeks; 1.7 or 2.4 mg | Not studied |
| Lost 20% or more of body weight, head-to-headCounting: everyone randomized, including people who stopped (treatment-regimen) | 48.4%SURMOUNT-5, 751 people, 72 weeks | 27.3%SURMOUNT-5, 751 people, 72 weeks | Not studied |
| Average weight loss at the top dose, each drug's own placebo trialCounting: everyone randomized, including people who stopped (treatment-regimen / treatment-policy) | 20.9%SURMOUNT-1, 2,539 people, 72 weeks; 15 mg; placebo 3.1% | 18.7%STEP UP, 1,407 people, 72 weeks; Wegovy HD 7.2 mg; 2.4 mg arm 15.6% | 13.6%OASIS 4, 307 people, 64 weeks; 25 mg; placebo 2.2% |
Percentages are average body-weight change counting everyone who started, so people who stopped the drug are included. The top-dose row compares different trials with different people and lengths: read it as a ballpark, not a ranking. Trial results apply to the FDA-approved branded drugs only.
SURMOUNT-5: the Zepbound vs Wegovy head-to-head
SURMOUNT-5 is the only trial to give adults either Zepbound or Wegovy and compare the results. It enrolled 751 adults with obesity and without type 2 diabetes, open-label, for 72 weeks; each person climbed to the highest dose they tolerated (Zepbound 10 or 15 mg, Wegovy 1.7 or 2.4 mg). Lilly funded it. Results were published in the New England Journal of Medicine in May 2025 (Aronne et al., DOI 10.1056/NEJMoa2416394).
- Weight: 20.2% average loss on Zepbound versus 13.7% on Wegovy. The trial's estimate had everyone stayed on treatment and reached the top dose (15 mg vs 2.4 mg) was 21.8% versus 15.4% (ClinicalTrials.gov results, NCT05822830).
- Waist: 18.4 cm smaller on Zepbound versus 13.0 cm on Wegovy.
- Tolerability: nausea, diarrhea and constipation were about equally common; vomiting was less common on Zepbound (15.0% vs 21.3%), injection-site reactions more common (8.6% vs 0.3%), and 6.1% versus 8.0% stopped because of side effects.
- What it did not test: Wegovy HD 7.2 mg (approved later), the Wegovy pill, people with type 2 diabetes, or heart and liver outcomes.
Pens vs vials: how you buy each one
Zepbound comes in three self-injected formats. The KwikPen holds four weekly doses and takes separate pen needles; vials are drawn up with a syringe and are sold only through LillyDirect; the single-dose pen is the format most insurers cover. LillyDirect's $299–$449 self-pay prices apply to the KwikPen and vials, not the single-dose pen (Lilly savings terms). Drawing from a vial? The tirzepatide dose calculator converts a prescribed dose to syringe units.
Wegovy comes as prefilled single-dose pens (one per week), a FlexTouch pen holding four 2.4 mg doses, the 7.2 mg Wegovy HD pen, and the daily pill. NovoCare's self-pay price is the same at every pen dose up to 2.4 mg. There is no Wegovy vial.
Zepbound or Wegovy: who each one fits
| If you… | What the labels and trials point to |
|---|---|
| Are comparing average weight loss | Higher on Zepbound in the only head-to-head trial (20.2% vs 13.7%) |
| Have heart disease or a past heart attack or stroke | Wegovy (pen or pill): approved to lower that risk after the SELECT trial. Zepbound has no heart-risk approval |
| Have obstructive sleep apnea and obesity | Zepbound is the one approved for it |
| Have MASH (fatty liver with fibrosis) | Wegovy pen has the (accelerated) approval |
| Are 12 to 17 years old | Wegovy pen is approved from age 12; Zepbound is adults only |
| Would rather not inject | Wegovy pill, or Lilly's pill Foundayo (a different molecule; see Foundayo vs Zepbound) |
| Already on Wegovy 2.4 mg and stalled | Wegovy HD 7.2 mg or a switch to Zepbound are both options to raise with a prescriber |
| Take birth-control pills | Zepbound's label says to switch to a non-oral method or add a barrier method for 4 weeks after starting and after each dose increase; Wegovy's label has no such warning |
Coverage often matters most: a drug on your plan's formulary can cost far less than either self-pay price. The weight-loss labels generally require a BMI of 30 or more, or 27 or more with a weight-related condition. Diabetic? Read Mounjaro vs Ozempic for the diabetes-labelled versions.
Zepbound vs Wegovy side effects and label warnings
Both are mostly stomach-and-gut side effects that peak after each dose increase. In the head-to-head trial the rates were close:
| Side effect | Zepboundtirzepatide · Eli Lilly | Wegovy pensemaglutide 2.4 mg or 7.2 mg (HD) · Novo Nordisk | Wegovy pilloral semaglutide 25 mg · Novo Nordisk |
|---|---|---|---|
| Nausea | 43.6% | 44.4% | Not in this trial |
| Constipation | 27.0% | 28.5% | Not in this trial |
| Diarrhea | 23.5% | 23.4% | Not in this trial |
| Vomiting | 15.0% | 21.3% | Not in this trial |
| Stopped because of side effects | 6.1% | 8.0% | Not in this trial |
Both labels carry a boxed warning about thyroid C-cell tumors and rule the drugs out for anyone with a personal or family history of medullary thyroid cancer or MEN 2. Both list pancreatitis, gallbladder disease, kidney injury from dehydration, severe stomach reactions, low blood sugar with insulin or sulfonylureas, allergic reactions, diabetic eye complications in type 2 diabetes, and aspiration risk under anesthesia. Wegovy's label adds a raised heart rate; Zepbound's adds the oral-contraceptive warning above. Sources: Zepbound label, Wegovy label. More: Mounjaro and Zepbound side effects and which GLP-1 has the fewest side effects.
Zepbound vs Wegovy cost without insurance
Self-pay prices now overlap, but Zepbound rises with the dose and the Wegovy pen does not, so the first-year total is the fairer comparison:
| Option | Month 1 | Usual maintenance month | First-year estimate | Source |
|---|---|---|---|---|
| Zepbound vial or KwikPen (LillyDirect) | $299 (2.5 mg) | $399 at 5 mg; $449 at 7.5–15 mg if refilled within 45 days ($499–$699 if later) | $5,188 | LillyDirect Zepbound |
| Wegovy pen (NovoCare) | $199 (intro, first two fills, new patients) | $349 at any dose to 2.4 mg | $3,888 | NovoCare Wegovy |
| Wegovy HD 7.2 mg pen (NovoCare) | Not a starting dose | $399 | Not estimated† | NovoCare Wegovy |
| Wegovy pill (NovoCare) | $149 (1.5 mg) | $299 at 9 or 25 mg | $3,338 | NovoCare Wegovy |
First-year estimates are our arithmetic from each maker's published self-pay prices, counted as 12 fills, medication only (a prescriber visit is extra). Zepbound: 1 fill at 2.5 mg, 1 at 5 mg, then 10 at 7.5 mg or higher refilled within 45 days (staying on 5 mg instead: $4,688). Wegovy pen: two $199 intro fills, then 10 at $349. Wegovy pill: 1.5 mg, 4 mg, then 10 at 9 or 25 mg. Zepbound and Wegovy pen fills last 4 weeks, so a full calendar year takes 13 fills: add one more maintenance fill. †Wegovy HD only follows at least 4 weeks on 2.4 mg. The $199 Wegovy offer must be filled by Dec 31, 2026.
With insurance: both makers run savings cards for commercially insured patients whose plan covers the drug: "as little as $25" a fill, with each card capping savings at $100 a month (Lilly also caps Zepbound at $1,300 a year) (Zepbound card terms, which end Dec 31, 2026; Wegovy card terms). Neither card works with Medicare, Medicaid or other government plans. Many employer plans exclude weight-loss drugs or require prior authorization; see does insurance cover Wegovy and Zepbound. Medicare: the Medicare GLP-1 Bridge charges eligible Part D members $50 a month from July 1, 2026 through Dec 31, 2027, with prior authorization; it covers Wegovy (pen or pill) but only the Zepbound KwikPen, not Zepbound vials or single-dose pens. Price detail for each brand: Zepbound cost without insurance and Wegovy cost without insurance.
Switching between Zepbound and Wegovy
There is no milligram conversion between them, and neither label gives a switching schedule. Moving from Wegovy to Zepbound means a new prescription that starts at 2.5 mg for 4 weeks, the Zepbound label's starting dose for everyone; moving the other way starts Wegovy at 0.25 mg. Your prescriber sets the timing. Step by step: switching from semaglutide to tirzepatide.
What about compounded tirzepatide or semaglutide?
Telehealth companies also sell compounded tirzepatide and semaglutide, mixed by state-licensed compounding pharmacies. They are not FDA-approved, have not been reviewed by the FDA for safety, effectiveness or quality, and are not the same products as Zepbound or Wegovy. None of the trial results on this page apply to them. Background: FDA on drug compounding. More in compounded tirzepatide vs Zepbound and compounded semaglutide vs Wegovy. What each costs, brand and compounded, provider by provider: how much tirzepatide costs without insurance and semaglutide prices by provider.
Related comparisons
- Tirzepatide vs Semaglutide: 2026 Head-to-Head Update
- Foundayo vs Zepbound: Pill vs Shot, Results & Price
- Ozempic vs Wegovy
- Zepbound vs Ozempic
- Oral vs injectable semaglutide
- GLP-1 cost comparison
Frequently asked questions
Is Zepbound better than Wegovy for weight loss?
In SURMOUNT-5, the only head-to-head trial, average weight loss was higher on Zepbound: 20.2% of body weight at 72 weeks versus 13.7% on Wegovy. Individual results vary, and Wegovy has approvals Zepbound lacks, such as lowering heart attack and stroke risk.
Wegovy vs Zepbound: which costs less without insurance?
Over 12 fills at self-pay prices, the Wegovy pen comes to about $3,888 and Zepbound to about $5,188, by our arithmetic. Wegovy's first two fills are $199 for new patients who fill by Dec 31, 2026, then $349; Zepbound starts at $299 and rises to $449 at 7.5 mg and up.
Which has fewer side effects, Zepbound or Wegovy?
Neither has a clear edge: in SURMOUNT-5, nausea, diarrhea and constipation rates were close, vomiting was less common on Zepbound (15.0% vs 21.3%), and 6.1% versus 8.0% stopped because of side effects.
Can you switch from Wegovy to Zepbound?
Yes, with a new prescription; the Zepbound label starts everyone at 2.5 mg for 4 weeks, and the two drugs do not convert milligram for milligram.
Is Wegovy HD as effective as Zepbound?
Unknown: in their own placebo-controlled trials, Wegovy HD 7.2 mg averaged 18.7% weight loss (STEP UP) and Zepbound 15 mg 20.9% (SURMOUNT-1), but the two have never been compared in the same trial. Wegovy HD is only for people who already tolerate 2.4 mg.
Are Zepbound and Wegovy the same drug?
No: Zepbound is tirzepatide from Eli Lilly, which acts on GIP and GLP-1 receptors, and Wegovy is semaglutide from Novo Nordisk, which acts on GLP-1 receptors only.
Does Medicare cover Zepbound or Wegovy for weight loss?
Through the Medicare GLP-1 Bridge, eligible Part D members pay $50 a month from July 2026 through 2027 for Wegovy (pen or pill) or the Zepbound KwikPen, with prior authorization. Zepbound vials and single-dose pens are not included.
Is there a Zepbound pill?
No, Zepbound is injection-only. Eli Lilly's weight-loss pill is Foundayo (orforglipron), a different molecule approved in April 2026.
Sources and references
- Aronne LJ et al. Tirzepatide as Compared with Semaglutide for the Treatment of Obesity (SURMOUNT-5). NEJM 2025;393:26-36 (accessed Oct 13, 2026)
- SURMOUNT-5 results record, ClinicalTrials.gov NCT05822830 (accessed Oct 13, 2026)
- Jastreboff AM et al. Tirzepatide Once Weekly for the Treatment of Obesity (SURMOUNT-1). NEJM 2022 (accessed Oct 13, 2026)
- Wharton S et al. Semaglutide 7.2 mg in adults with obesity (STEP UP). Lancet Diabetes & Endocrinology 2025 (accessed Oct 13, 2026)
- Wharton S et al. Oral Semaglutide at a Dose of 25 mg in Adults with Overweight or Obesity (OASIS 4). NEJM 2025 (accessed Oct 13, 2026)
- Zepbound (tirzepatide) Prescribing Information, DailyMed (Sep 2026) (accessed Oct 13, 2026)
- Wegovy (semaglutide) injection and tablets, Prescribing Information, DailyMed (Jun 2026) (accessed Oct 13, 2026)
- FDA: first medication for obstructive sleep apnea (Zepbound), Dec 20, 2024 (accessed Oct 13, 2026)
- FDA: first treatment to reduce the risk of serious heart problems in adults with obesity (Wegovy), Mar 8, 2024 (accessed Oct 13, 2026)
- FDA: treatment for MASH (Wegovy), Aug 15, 2025 (accessed Oct 13, 2026)
- FDA: higher-dose semaglutide (Wegovy HD 7.2 mg), Mar 19, 2026 (accessed Oct 13, 2026)
- Novo Nordisk: FDA approves the Wegovy pill, Dec 22, 2025 (accessed Oct 13, 2026)
- LillyDirect: Zepbound self-pay prices (accessed Oct 13, 2026)
- Zepbound savings card and KwikPen terms (Lilly) (accessed Oct 13, 2026)
- NovoCare: Wegovy self-pay prices (pen, HD and pill) (accessed Oct 13, 2026)
- NovoCare: Wegovy savings card terms (accessed Oct 13, 2026)
- CMS: Medicare GLP-1 Bridge (accessed Oct 13, 2026)
- FDA: Human Drug Compounding (accessed Oct 13, 2026)
This page compares published trials, FDA labels and makers' price pages; it is not medical advice, and a licensed prescriber decides which drug and dose fit you. Trial results are for the FDA-approved branded drugs only. Nouri is a publisher; it does not prescribe or sell any medication, and it is not affiliated with Eli Lilly or Novo Nordisk. Facts checked Oct 13, 2026; prices change, so confirm at the source.
Disclosure: Nouri may earn a commission when you sign up with some of the providers we link to. It doesn't change what you pay or how we rank providers. No drug maker paid for this comparison. Full disclosure.
Medical Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider before starting or changing any medication or treatment. Licensed providers review patient assessments before making clinical decisions.
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