What the dose ladder costs: the brand market prices milligrams, the compounded market prices months
The approved labels don't let you start at the dose the trials measured. Wegovy's own schedule puts maintenance at week 17, four full months of climbing first. What that climb costs depends entirely on which market you are in: of 23 brand rungs inside a multi-price group on our roster, 19 name a milligram dose and 0 name a plan term — and on the compounded side the split runs almost exactly the other way.
What this comes down to
- Wegovy is initiated at 0.25 mg for four weeks and titrated every four weeks: 0.5 mg at weeks 5 to 8, 1 mg at 9 to 12, 1.7 mg at 13 to 16, and maintenance from week 17.
- Zepbound starts at 2.5 mg for four weeks and increases in 2.5 mg increments; the label says the 2.5 mg dosage is not approved as a maintenance dosage. Maintenance is 5, 10 or 15 mg.
- Nineteen of 23 brand rungs in a multi-price group name a milligram dose and none names a plan term. On the compounded side, 152 of 184 name a plan term and only 6 name a dose.
- A flat compounded price across doses is not generosity. It usually means the vial concentration changes instead, and the FDA has adverse event reports from exactly that.
The climb is in the label, not in the marketing
Wegovy's dosing table is explicit. Initiation is 0.25 mg once weekly for weeks 1 through 4; escalation is 0.5 mg for weeks 5 through 8, 1 mg for weeks 9 through 12, and 1.7 mg for weeks 13 through 16; maintenance begins at week 17 at either 1.7 mg or 2.4 mg once weekly[1]. If a dose is not tolerated, the label says to consider delaying escalation by four weeks — which lengthens the climb rather than shortening it.
Zepbound is built the same way and says the quiet part outright: the starting dosage is 2.5 mg once weekly for four weeks, increased in 2.5 mg increments after at least four weeks, and the 2.5 mg dosage is for treatment initiation and is not approved as a maintenance dosage[2]. Maintenance is 5, 10 or 15 mg, with 15 mg the maximum.
Clinically the escalation exists to limit gastrointestinal side effects. Commercially it means the first four months consume less drug than every month afterward, and whether that shows up in your invoice is a decision the seller makes, not the label.
Two markets, two things being priced
We group the roster into what we call ladders: one seller, one molecule, one form, carrying three or more different prices. There are 60 of them across 39 sellers[5]. Five are brand and 55 are compounded, and reading what the seller's own labels vary by separates them completely.
| Brand | Compounded | |
|---|---|---|
| Rungs inside a multi-price group | 23 | 184 |
| Naming a milligram dose | 19 | 6 |
| Naming a plan term | 0 | 152 |
What a multi-price group varies by, counted from the seller's own wording on each rung.
A seller writes its own labels, so this counts a rung as dose-priced when its label carries a milligram figure. Across the whole roster that matcher hits 39 of 602 GLP-1 lines — a minority, which is what stops the brand column being an artifact of the ruler. Both matchers and both denominators are printed here rather than left in a comment.
What a brand ladder actually charges
| How the seller writes the line | A month |
|---|---|
| Wegovy tablets 1.5 mg | $149 |
| Ozempic tablets 1.5 mg | $149 |
| Wegovy tablets 4 mg | $199 |
| Ozempic tablets 4 mg | $199 |
| Wegovy tablets 9 mg and 25 mg | $299 |
| Wegovy pen | $349 |
| Ozempic pen 0.25 mg to 1 mg | $349 |
| Wegovy HD pen 7.2 mg | $399 |
| Ozempic pen 2 mg | $499 |
NovoCare Pharmacy: every published semaglutide price, in the seller's own wording. The top of this ladder is 3.3 times the bottom.
| How the seller writes the line | A month |
|---|---|
| Wegovy Pill, 1.5 mg | $149 |
| Wegovy Pen, new-patient offer | $199 |
| Wegovy Pen, 0.25 mg | $349 |
Knownwell: every published semaglutide price, in the seller's own wording. The top of this ladder is 2.3 times the bottom.
Those are the cheapest places on this roster to buy the approved product, and they're also the clearest illustration of the problem: the price rises as the label's own schedule tells you to climb. Budgeting off the starting rung budgets for the four months you will spend getting past it. The wider brand-versus-compounded spread puts those ladders next to the compounded market.
Why a flat compounded price is not a free upgrade
Most compounded sellers charge the same monthly figure whatever dose you're on. The drug is drawn from a vial, so more milligrams mean drawing more units rather than buying a different product. What changes instead is the vial's concentration, and concentration isn't standardized between compounders.
The FDA has received multiple adverse event reports, some requiring hospitalization, that may relate to dosing errors with compounded injectable semaglutide — patients measuring and self-administering the wrong amount, and in some cases clinicians miscalculating[3]. The agency also notes that consumers buying through telehealth platforms may not know the identity of the compounder that produced the drug[4]. Those two facts together are what make the escalation the riskiest part of a compounded course.
A compounded vial is drawn with an insulin syringe marked in units while the prescription is written in milligrams, and the conversion depends on that vial's concentration. A new dose from a new vial from a new pharmacy is the moment this goes wrong. Deliberately staying low to avoid it has its own problem, which is that nothing has tested it — see the microdosing evidence.
Staying below the approved maintenance dose as a strategy is its own subject with its own empty trial record, and a seller offering it as a cheaper tier is selling a dose the manufacturer says is not a maintenance dose.
Budgeting the climb instead of the first month
The practical version is short. If your seller prices by dose, the number to budget is the maintenance rung, not the starting one. If your seller prices flat by plan term, the number to budget is the month-to-month rate, because that is what you pay if the drug does not agree with you in week six. Of the 190 sellers we have written up, 110 publish a month-to-month price for everything they sell, 41 publish one for nothing, and 39 do it for some drugs and not others[5].
The calculator takes a medication price, a recurring fee and a number of months, which is the only way to compare a dose ladder against a flat rate. How we grade explains why publishing a month-to-month figure is the fact this site grades on.
Questions people actually ask
How long does it take to reach a maintenance dose of Wegovy?
Sixteen weeks under the approved schedule. The label puts 0.25 mg at weeks 1 to 4, 0.5 mg at weeks 5 to 8, 1 mg at weeks 9 to 12 and 1.7 mg at weeks 13 to 16, with maintenance from week 17 at 1.7 mg or 2.4 mg once weekly.
Does a GLP-1 cost more as the dose goes up?
In the brand market, usually yes: on our roster almost every brand rung inside a multi-price group names a milligram dose in its own label, and the price rises with it. In the compounded market it usually does not, because the same monthly figure covers a differently concentrated vial.
Is it cheaper to stay on the starting dose?
Where a seller prices by dose, yes, and that is exactly why it is offered. Zepbound's label states that its 2.5 mg starting dosage is for treatment initiation and is not approved as a maintenance dosage, and no randomized trial has tested staying below the studied dose.
Why does my compounded vial look different at a higher dose?
Usually because the concentration changed rather than the volume you inject. Concentration is not standardized between compounders, and the FDA has received adverse event reports, some requiring hospitalization, tied to patients and clinicians getting that conversion wrong.
Sources
Every source here was fetched and read for this article, with the identifier taken off the record that came back and the claim it supports written down beside it. All of it was read in September 2026, the same session the rest of this page draws on.
- 1.WEGOVY (semaglutide) injection — FDA prescribing information. U.S. Food and Drug Administration, Structured Product Labeling, 2024. Source · Document dated April 2024Table 1 of the approved label: initiation at 0.25 mg once weekly for weeks 1 through 4, escalation to 0.5 mg for weeks 5 through 8, 1 mg for weeks 9 through 12 and 1.7 mg for weeks 13 through 16, and maintenance from week 17 onward at 1.7 mg or 2.4 mg once weekly; and the instruction to consider delaying escalation by four weeks if a dose is not tolerated.
- 2.ZEPBOUND (tirzepatide) injection — FDA prescribing information. U.S. Food and Drug Administration, Structured Product Labeling, 2026. Source · Document dated August 2026A recommended starting dosage of 2.5 mg injected subcutaneously once weekly for 4 weeks, increased in 2.5 mg increments after at least 4 weeks; the statement that the 2.5 mg dosage is for treatment initiation and is not approved as a maintenance dosage; maintenance dosages of 5, 10 or 15 mg once weekly; and a maximum recommended dosage of 15 mg once weekly.
- 3.FDA's Concerns with Unapproved GLP-1 Drugs Used for Weight Loss. U.S. Food and Drug Administration, 2026. Source · Document dated September 2026Multiple adverse event reports, some requiring hospitalization, that may relate to dosing errors with compounded injectable semaglutide, resulting from patients measuring and self-administering incorrect doses and in some cases from health care professionals miscalculating doses.
- 4.Compounding and the FDA: Questions and Answers. U.S. Food and Drug Administration, 2025. Source · Document dated September 2025Compounded drugs are not FDA approved, and consumers who buy compounded drugs online through telehealth platforms may not know the identity of the compounder that produced the drug, including whether it is appropriately licensed and regulated.
- 5.The Telehealth Graded price record. Telehealth Graded, 2026. SourceThe ladder counts, the dose-versus-term split, every price in the ladder tables and the month-to-month publication counts are computed at build time from the site's own price records and review fields.
Key figures