Wegovy vs Zepbound: which one fits you?

Zepbound produced more weight loss than Wegovy’s active ingredient in the trial that tested them against each other: in SURMOUNT-5, people on tirzepatide lost 20.2% of their body weight on average over 72 weeks, against 13.7% on semaglutide. Wegovy costs less at full dose, $349 a month self-pay against $449 for Zepbound with on-time refills as of October 2026, and it comes as a daily pill too. The right one depends on your health, your coverage and what you can afford.

Here’s how the two brands compare on the things you’ll actually decide between.

Wegovy and Zepbound at a glance

Sources: the Wegovy and Zepbound labels, NovoCare and LillyDirect prices read October 17, 2026, and the CMS Bridge form.

Weight loss: the head-to-head trial

SURMOUNT-5 randomly assigned 751 adults with obesity but without type 2 diabetes to the highest dose they could tolerate of tirzepatide (10 mg or 15 mg) or semaglutide (1.7 mg or 2.4 mg), once a week for 72 weeks. Tirzepatide averaged 20.2% weight loss and semaglutide 13.7%, and waist size fell 18.4 cm against 13.0 cm. People on tirzepatide were more likely to reach losses of at least 10%, 15%, 20% and 25%.

Two caveats: participants knew which drug they were taking, and Lilly, which makes Zepbound, funded the trial.

Each drug’s own trials point the same way. On the labels, Zepbound 15 mg produced 20.9% average loss over 72 weeks in SURMOUNT-1, against 3.1% on placebo, and Wegovy 2.4 mg produced 14.9% over 68 weeks in STEP 1, against 2.4%. Wegovy HD, the 7.2 mg dose approved on March 19, 2026, reached 18.8% over 72 weeks in STEP UP. Those were separate trials, so compare them with care. Our semaglutide vs tirzepatide guide has the full trial tables.

Side effects

Stomach side effects are the most common on both, mostly while the dose is rising. These rates are from each label’s weight-loss trials; compare each drug with its own placebo column, since the trials differ.

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Both carry a boxed warning for thyroid C-cell tumors, and neither is for anyone with a personal or family history of medullary thyroid carcinoma or MEN 2. Both labels also warn about pancreatitis, gallbladder problems and dehydration-related kidney problems. Our side effects guide covers what helps.

Dosing and devices

Wegovy starts at 0.25 mg a week and steps up every 4 weeks through 0.5, 1 and 1.7 mg to a 2.4 mg maintenance dose from week 17. The label allows 7.2 mg for adults who have tolerated 2.4 mg for at least 4 weeks and need more weight loss. If you’d rather not inject, the Wegovy pill is the same molecule taken daily on an empty stomach.

Zepbound starts at 2.5 mg for 4 weeks, then 5 mg, and can rise in 2.5 mg steps at least 4 weeks apart to 15 mg. It comes as single-dose vials you draw into a syringe, a KwikPen holding 4 weekly doses, or a single-dose pen. LillyDirect’s self-pay prices cover vials and the KwikPen; see Zepbound vials vs KwikPen.

What each costs in October 2026

These are the manufacturers’ self-pay prices for each monthly fill, read on October 17, 2026.

On those paths, Zepbound costs $1,300 more over the first 12 fills. If your Zepbound dose stays at 5 mg, the gap narrows: 12 fills come to $4,688. Wegovy’s $199 new-patient offer ends December 31, 2026, and Lilly’s current savings offers expire the same day. Zepbound refills after 45 days cost $499 at 7.5 mg and $699 at 10 mg to 15 mg. Our Wegovy cost and Zepbound cost guides go dose by dose.

Through an online program

Programs that prescribe both usually pass on these medication prices and add one membership, so the gap stays about $100 a month at maintenance:

• Sesame ($99 a month): Wegovy 2.4 mg comes to $448 a month and Zepbound vials at 7.5 mg and up to $548.
• Measured ($99 a month on its Wegovy and Zepbound pages): $448 and $548.

Compare more on our brand-name GLP-1 rankings, Zepbound rankings and semaglutide rankings.

Insurance and Medicare

With commercial insurance that covers the drug, both makers’ savings offers can cut the cost to as little as $25 a month (Lilly); people with government insurance can’t use them. Your plan may cover one and not the other, so check its drug list before you choose.

The approved uses can matter for coverage. Wegovy is approved to lower the risk of heart attack, stroke and cardiovascular death in adults with established heart disease and obesity or overweight, a use the FDA first approved on March 8, 2024. Zepbound is approved for moderate to severe obstructive sleep apnea in adults with obesity, since December 20, 2024.

On Medicare Part D, the GLP-1 Bridge charges eligible enrollees $50 a month from July 1, 2026 to December 31, 2027, for Wegovy injections, tablets and HD or the Zepbound KwikPen. Heart-risk and sleep-apnea prescriptions go through your regular Part D plan instead. See does Medicare cover Wegovy or Zepbound.

Which one fits you

• For the largest average weight loss, Zepbound led in SURMOUNT-5 and in its own trials.
• For the lower cash price, Wegovy is $100 a month cheaper at full dose, and the pill is $299 at 25 mg.
• If you’d rather take a pill, only Wegovy has one.
• With established heart disease, Wegovy carries the heart-risk indication.
• With obstructive sleep apnea and obesity, Zepbound is the one approved for it.
• If you’re 12 to 17, Wegovy is approved for teens; Zepbound is approved for adults.
• On Medicare, both are on the Bridge; Zepbound only as the KwikPen.

A licensed clinician can weigh these against your history, other medicines and coverage. Our match tool finds programs that prescribe the one you pick.

The bottom line

Zepbound produced more weight loss than semaglutide in the head-to-head SURMOUNT-5 trial, 20.2% against 13.7% over 72 weeks. Wegovy costs less, $349 a month at full dose against Zepbound’s $449 with on-time refills as of October 2026, offers a pill and a 7.2 mg dose, and is approved to lower heart risk. Check which one your insurance or Medicare covers before you compare cash prices, and choose with a licensed clinician. More on both in our weight-loss hub.