Oral vs Injectable: The 12-Month Total Cost of Ownership
Monthly price is the wrong unit. Here is what a full year of therapy actually costs on each route, including the months most comparisons leave out.
Bottom line
- Titration months are cheaper on dose-tiered pricing and are usually omitted from annual estimates, which distorts comparisons in both directions.
- Four-weekly billing adds roughly one extra payment per year versus a monthly quote.
- Injectable compounded programs carry supply costs and, more importantly, the transition risk created by the compounding wind-down.
- The cost that matters is cost per year completed, not cost per month started.
Almost every GLP-1 price comparison multiplies a monthly figure by twelve. That is wrong in at least three ways, and the errors do not cancel out.
What a twelve-month model has to include
- Titration months. You do not start at maintenance dose. On dose-tiered pricing, months one through three or four typically cost less than months five through twelve.
- Billing period. Four-weekly billing produces thirteen charges per year.
- Consultation and membership fees. Charged separately by some programs, sometimes annually rather than monthly.
- Supplies. Injectable compounded programs may or may not include syringes, alcohol swabs, and sharps disposal.
- Discontinuation probability. In the ATTAIN trials, gastrointestinal adverse events predominated and discontinuations were higher than with placebo. A meaningful share of people who start do not finish a year.
Cost per year completed, not cost per month started. A cheaper program you abandon in month three because you could not tolerate titration or could not reach a clinician is more expensive than a costlier one you complete.
Worked example: approved oral, self-pay
Foundayo self-pay starts at $149/month for the lowest dose. Because dose-tier pricing above the lowest dose is not something we can verify at publication, the honest model has a known floor and an unknown ceiling.
Approved oral, self-pay, 12 months
| Scenario | Assumption | 12-month total |
|---|---|---|
| Floor | $149/mo held at all doses | $1,788 |
| If tiered | Higher doses priced above $149 | Above $1,788 — ask the provider |
| Insured + savings card | As little as $25/mo, subject to annual cap | From $300, until any cap is reached |
| Medicare Part D, eligible | $50/mo from July 1 2026 | From $600 |
Savings programs commonly carry annual caps. Confirm the cap and what your cost reverts to once it is reached.
Worked example: compounded oral
Compounded oral, 12 months, providers we list
| Provider | Quoted | Billing | 12-month total |
|---|---|---|---|
| Wellorithm (sema) | $147/mo | Monthly | $1,764 |
| Wellorithm (tirz) | $249/mo | Monthly | $2,988 |
| MadeMed (SL sema) | ~$99–$169/mo | Monthly | ~$1,188–$2,028 |
| Direct Meds (SL sema) | $179–$249/mo | Monthly | $2,148–$2,988 |
| Found Health (sema) | $189 / 4 wks | 4-weekly | $2,457 (13 cycles) |
Excludes any separately charged consultation or membership fees. Compounded drug products are not FDA-approved. Providers carrying FDA warning letters are excluded from this cost table and are covered separately in our full price list.
Wellorithm's compounded oral semaglutide at $1,764 per year and Foundayo's self-pay floor at $1,788 are effectively the same number. At a $24 annual difference, price is not the deciding variable — FDA review of the finished product, supply durability, and defined dose tiers are.
Verify current pricing before modelling your year
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 linkSublingual semaglutide and oral tirzepatide, compounded.
Check current pricing Paid partner linkThe injectable column
Injectable compounded programs in our listing generally price as monthly plans, and the plan price commonly changes with dose. We do not publish twelve-month totals for them because a total built on an unverified maintenance price would be worse than no number.
What we can say about the injectable cost structure:
- Ask whether syringes, swabs, and sharps disposal are included
- Ask for the plan price at 2.5 mg and above, not just the starting tier
- Multidose vials require patient-performed dose measurement, which is the configuration associated with documented 10-fold dosing errors from syringe unit confusion — a prefilled presentation costs more and removes that failure mode
The line item everyone omits
Transition risk. On April 30, 2026 the FDA proposed removing semaglutide, tirzepatide, and liraglutide from the 503B Bulks List. If your compounded supplier stops filling mid-year, you need a new appointment, a new prescription, and product in hand before your last dose — and if there is a gap, you re-titrate.
Re-titration is weeks of side effects you have already been through, plus the months of lower-dose therapy repeated. In a twelve-month model, that is not a rounding error. Price a compounded year with a realistic probability of that happening, and the gap against the approved product narrows further than the table suggests.
Sources & price verification
- AJMC, reporting on Foundayo pricing tiers, savings card eligibility, and Medicare Part D access from July 1, 2026.
- Provider pricing and billing-period data recorded from partner program data, September 2026.
- Pharmacy Times, coverage of ATTAIN-1 and ATTAIN-2 adverse events and discontinuation rates.
- Drug Discovery Trends, reporting on compounded GLP-1 dosing errors from syringe unit confusion.
- FDA proposed action on 503B Bulks List status, April 30, 2026.