Cost Per Pound Lost: A Different Way to Compare GLP-1 Prices
Monthly price ignores how much a drug actually does. A cost-efficiency framing built only on published trial percentages — with its limits stated up front.
Bottom line
- In the ATTAIN trials, the highest orforglipron dose produced an average of 12.4% weight loss.
- Compounded products have no trial data of their own — any efficacy assumption for them is borrowed from the approved drug they copy.
- Cross-trial comparison between separately designed studies is not evidence of superiority; only a randomized head-to-head trial answers that.
- The framing is useful for thinking about your own decision. It is not a ranking.
Monthly price treats every GLP-1 as interchangeable. They are not. A cheaper drug that produces less weight loss is not cheaper per unit of result, and a drug you discontinue because you cannot tolerate it costs whatever you paid for zero result.
What follows is a way of thinking, not a league table. The limits matter more than the arithmetic, so they come first.
Cross-trial comparison is the most common analytical error in consumer GLP-1 coverage. ATTAIN, STEP, and SURMOUNT enrolled different populations under different criteria with different endpoints. Placing their headline percentages side by side and drawing a conclusion about which drug is better is not something the data supports. Only a randomized head-to-head trial does that, and one has not been run across these agents.
What the published percentages are
For orforglipron, the figure on the record is an average of 12.4% weight loss at the highest dose in clinical trials, from a phase 3 program of two global, randomized, double-blind, placebo-controlled trials over 72 weeks, with ATTAIN-1 enrolling 3,127 adults.
Three qualifiers travel with that number and must not be dropped: it is the highest-dose figure, it is an average with wide individual variation around it, and it comes from a trial setting where adherence is monitored and higher than in ordinary use.
The arithmetic, applied to one drug
Illustrative: orforglipron self-pay, 220 lb starting weight
| Input | Value | Derived |
|---|---|---|
| Starting weight | 220 lb | — |
| Trial average at highest dose | 12.4% | ~27.3 lb |
| Self-pay floor, 12 months | $149/mo | $1,788/yr |
| Cost per pound at trial average | — | ~$65/lb |
| Insured + savings card, if held 12 mo | $25/mo | $300/yr → ~$11/lb |
Illustrative only. Assumes the $149 lowest-dose price holds at all doses, which we have not verified, and assumes trial-average response, which no individual is guaranteed. Savings card assumes no annual cap is reached.
Why the same table cannot be built for compounded products
This is the substantive point of the article. Compounded semaglutide and compounded tirzepatide have no clinical trial data of their own. They have never been studied for efficacy as formulated, and they are not FDA-approved, which means the agency has not reviewed them for safety, effectiveness, or manufacturing quality.
Any efficacy figure attached to a compounded product is borrowed from trials of the approved drug it copies. That borrowing assumes the compounded product delivers the same molecule at the same potency, which depends on the compounder's quality systems. The FDA has issued warning letters citing noncompliance with the stated strength, quality, or purity of compounded products, and has warned that some compounded GLP-1 products carry false label information.
A cost-per-pound figure for a compounded product multiplies a real price by an assumed efficacy. The price is verifiable. The efficacy is inherited. That does not make it wrong — most compounded product probably does contain what it says — but it is a different kind of number than one built on a trial result, and it should not be presented as equivalent.
Compare current pricing
All providers below are paid partners. Prices shown were recorded at publication and change without notice — always confirm on the provider's own page before you enrol.
Cash-pay marketplace for appointments with clinicians who prescribe FDA-approved brand-name medication only. No compounded product.
Check current pricing Paid partner linkCompounded oral tablets. Lowest verified oral semaglutide price among providers we list without a regulatory flag.
Check current pricing Paid partner linkInjectable semaglutide only. No oral formulation.
Check current pricing Paid partner linkThe variable that dominates everything
Completion. In the ATTAIN trials, gastrointestinal adverse events predominated and discontinuations were higher with orforglipron than with placebo.
If you stop at month three, you paid three months for a fraction of the result, and your cost per pound is several times any figure above. This is why the cheapest program is frequently not the most cost-efficient one. A program with reachable clinicians who manage your side effects and keep you titrating successfully produces a better cost per pound than a cheaper program you abandon.
How to actually use this
- Use it to compare two options you are personally choosing between, with your own weight and your own verified prices
- Do not use it to rank drugs against each other across separate trials
- Weight the probability that you complete the year at least as heavily as the monthly price
- Treat any efficacy figure attached to a compounded product as inherited rather than measured
The most expensive GLP-1 is the one you pay for and stop taking.
Sources & price verification
- Pharmacy Times, reporting on ATTAIN-1 and ATTAIN-2 results including the 12.4% average weight loss at the highest dose and discontinuation rates.
- HCPLive, coverage of the phase 3 ATTAIN program design and enrollment.
- AJMC, reporting on Foundayo pricing tiers.
- FDA statements on compounded product labelling accuracy and on strength, quality, or purity noncompliance in warning letters.
- Provider pricing recorded from partner program data, September 2026.