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The pharmacy pays $1,302. The patient pays $299

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By JOHN SAMARAS

A US retail pharmacy pays $1,302 to acquire one month of branded Wegovy. That figure comes from the Centers for Medicare and Medicaid Services National Average Drug Acquisition Cost file, effective August 19, 2026, for the 25 mg oral tablet at 30 tablets a month.

The cheapest cash price I verified on a seller’s own published page, for the same month of the same product, is $299. That is oral Wegovy at the maintenance dose, at Sam’s Club Member Health, which sells at the manufacturer’s published self-pay price, checked August 31, 2026.

The two numbers are more than a thousand dollars apart.

Where the second number comes from

Every Monday I check what each US GLP-1 telehealth program publishes as its price, on the program’s own page, and record it. Not the advertised starting rate. Not the prepaid annual plan divided by twelve. The all-in monthly cost of staying on the drug at a maintenance dose.

This month that record turned into an index. Across a fixed panel of 11 programs the median all-in price was $348 a month in August, the same figure in all five weekly checks. It did not move against July.

One program cut its price in August and none raised one. GoodRx for Weight Loss went from $388 to $338 on August 31, and it sits outside the panel. Three other apparent cuts in the record were mine rather than the programs’. Ivim Health and Sesame Care were sitting on prepaid plan rates, and my Costco through Sesame row was carrying $408 for a plan that was $398 all month. Putting each on the rate a reader can start on today lands in the series as a step. The revision log on the September release itemizes all three. The cheapest verified compounded semaglutide route held at $178 a month, at Mochi Health, which posts one flat all-in price at every dose. Sam’s Club Member Health was the cheapest verified branded route at $299 for the Wegovy pill. Both figures were checked on August 31, 2026.

The method fits in a paragraph. For the floors, take the lowest published all-in price in each route on every Monday of the month, then take the median of those weekly lows. For the median, take the middle of the fixed panel each Monday, then the median of those five weekly figures. The panel is fixed on purpose, so a change in which programs I track cannot read as a change in price. The number sits at a dated URL and does not change after publication. A correction becomes a numbered revision with a note.

NADAC measures acquisition cost

The distance between $1,302 and $299 is not pharmacy margin. NADAC measures what pharmacies pay their wholesaler. It says nothing about dispensing costs, the clinician visit, shipping, or what a manufacturer charges through a channel it owns.

46brooklyn Research has published NADAC dashboards free since 2019, and every derivative here rests on their work. What I added is the join: their acquisition data against verified consumer cash prices, which nobody had put side by side.

The two prices sit in different channels. Insurance routes a patient into the pharmacy channel, where the $1,302 sits. The $299 is a cash price, paid by a buyer with no coverage.

The packaging gap

The same NADAC file holds a second finding. Lilly sells Zepbound both as single-dose pens and as a multi-dose KwikPen. At 15 mg, a pharmacy pays $672 a month for the KwikPen and $1,051 a month for the equivalent single-dose pens. The only difference is the container. The spread is 1.56x, or $379 a month. At the 2.5 mg starting dose it is $482 against $1,052, or 2.18x.

Why nobody else has this number

Prices in this category move weekly and nobody records them. A patient cannot tell an introductory rate from a maintenance rate. A reporter covering a price cut has no baseline to say whether it was a cut at all, and the only public numbers are the ones a manufacturer put in a press release.

The fix is somebody writing the price down every week and publishing the method with a version number on it.

Everything above is free to reuse under CC BY 4.0, with a link and no registration. The CSV and the JSON sit at https://glpchart.com/price-index/. If you want a different cut, by state, by drug or by program, ask and you will have it inside a day.

From October the release lands on the first Tuesday of the month. The next one is October 6, 2026.

John Samaras is the founder of GLP Chart, which verifies the cash price of every US GLP-1 telehealth program every Monday. He writes about price, coverage and market structure, and leaves the clinical questions to clinicians.

The same 10mg Zepbound costs $449 or $699

By JOHN SAMARAS

Eli Lilly sells a month of 10mg Zepbound for $449 through LillyDirect, its own pharmacy. That price holds only if you refill within 45 days of your last fill. Refill on day 46 and the same box is $699. The $250 is a late fee.

Here are the two ways to buy branded Zepbound that publish a cash price. Both ship Lilly’s single-dose vials from Lilly’s own pharmacy.

LifeMD prescribes Zepbound and fills it through the same LillyDirect. It charges $349 to $549 for the drug where Lilly charges $299 to $449, and bills $149 a month on top of that.

Zepbound is tirzepatide. Compounded semaglutide is a different molecule on a different price ladder. Of the 15 programs I track that dispense compounded GLP-1, five name the pharmacy that makes it. Ten do not.

Where you buy itPublished cash priceFee on top
Lilly direct, self-pay$299 at 2.5mg, $399 at 5mg, $449 at 7.5mg and abovenone
LifeMD$349 to $549 by dose$149 a month, $39 first month

FDA wrote to three of those sellers on February 20. It told Strut to stop selling its compounded drugs as “Generic Zepbound, Mounjaro.” It told Medvi to drop “Same active ingredient as Wegovy and Ozempic.” For Ivim the problem was the label. Printing “Ivim” on the vial implied Ivim had compounded the drug. It had not.

All three letters are about what the sellers wrote on a page.

I price these programs every Monday, and the Internet Archive holds what they charged before I started, so the letters have a before and an after. Strut advertised $149 for its starting-dose compounded semaglutide injection a month before its letter and publishes $149 today. Medvi has published $299 for compounded semaglutide refills at every Monday check since May 25.

None of the three letters required a program to name the pharmacy that fills the order.

John Samaras is the founder and editor of GLP Chart, which tracks what every major GLP-1 program charges, checked every Monday, and publishes its methodology. No program pays to be listed or ranked.

To Improve Health, Design for Agency

By DAVID SHAYWITZ

Agency — the conviction I can shape my future — is a vital driver of human health and human potential.

It is also the factor overlooked by most digital health platforms.

University of Pennsylvania psychologist Martin Seligman, who has spent decades studying this, says agency boils down to the belief “I can make a positive difference in the world.” People with high agency believe there is something they can do next that might help – and then they actually try.

As Seligman emphasizes, the moments when we “try hard…persist against the odds…[and] make new, creative departures” are precisely when agency is at work. That extra effort and sustained determination — not just the mindset — shows up as improved performance, greater achievement, and enhanced health.  It also manifests as resilience, enabling us not only to recover from adversity but (ideally) to bounce back as an even better version of ourselves.

GLP-1s highlight the power and promise of newfound agency.  For many living with obesity, past attempts at weight loss reinforced a “cycle of despair” – trying harder mostly meant failing again. With the advent of GLP-1 medicines, many found that their weight would come down — and stay down.  Oprah Winfrey called the feeling “a relief, like redemption, like a gift.”

The deeper change is psychological: for the first time in years, effort feels rewarded. GLP-1s unlock an agentic dividend: the motivational boost that comes from finally being able to take control of your health. That surplus sense of possibility can be channeled into the familiar health basics — moving more and sleeping better — but also, often more importantly, into how we show up in our relationships and communities, in the enthusiasm we bring to our hobbies and pursuits, into the totality of experiences that make life so meaningful.

Agency is the motivational currency of health, the ATP of behavior change – it lets success in one domain drive progress in others.

Connected fitness platforms have a similar opportunity. Each discrete achievement — finishing a class, riding three times in a week, noticing that the stairs feel easier or the back hurts less — is a small proof of “I can do this.”  

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The ‘After Phase’ Is Missing: Why Every GLP-1 Prescription Needs an Exit

By HOLLI BRADISH-LANE

I’ve seen clients start GLP-1 medications full of hope—and stop them feeling betrayed by their own biology.

Some reached their limit with side effects: relentless nausea, fatigue, or the quiet loss of joy in eating. Others simply couldn’t afford to stay on. A few never saw the promised results at all. But for nearly all of them, the story ended the same way—one step forward, five steps back.

We celebrate the success stories of GLP-1s, but we rarely talk about the crash that follows when treatment stops. And it’s not just psychological. The body rebounds fast—hunger, weight, and metabolic chaos rush back in.

The problem isn’t the medication itself. It’s that we’ve built an elegant on-ramp for GLP-1s—and almost no off-ramp at all.

The Evidence Is Already Warning Us

The data couldn’t be clearer. In the STEP-1 extension trial, participants who stopped semaglutide regained roughly two-thirds of the weight they had lost within one year. Their blood pressure, cholesterol, and blood-sugar levels slid back toward baseline.

A nearly identical pattern appeared in the SURMOUNT-4 trial for tirzepatide: those who continued therapy maintained—or even deepened—their weight loss; those who stopped rapidly regained.

Meanwhile, the SELECT cardiovascular outcomes trial showed semaglutide reduced major cardiac events in people with overweight and obesity. That’s a major win—but also a reminder that stopping abruptly can erase much of the benefit.

Both the American Diabetes Association 2025 Standards of Care and the American Gastroenterological Association guidelines now emphasize continuing anti-obesity pharmacotherapy beyond initial weight loss goals.

The implication is simple: for most patients, GLP-1s are not a 12-week intervention—they’re chronic therapy.

Yet in real life, chronic use isn’t always realistic.

Why So Many Will Stop Anyway

Insurance coverage ends. Supplies run short. A job changes, or a deductible resets. Some patients plan a pregnancy, experience intolerable side effects, or simply want to know who they are without the injection. Others plateau despite perfect adherence and feel the drug has stopped working.

In each case, the result is the same… withdrawal without a plan.

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Sami Inkinen, Virta Health

Virta Health is in the diabetes reversal business. It’s a medical group that for a decade has been aggressively coaching people with diabetes and cardiometabolic disease to radically change their eating habits–basically to eat the right things for them, to saity. Some how in a nation obsessed with processed food and carbs they have succeeded for a lot of people. And the business is growing fast, with over $160m in annual run rate. Ten years in since it started I spoke with CEO Sami Inkinen about how and why it works, and what the future for this approach is in a world of GLP1s (and no there’s no GLP sales in that revenue number!)–Matthew Holt

Seriously, Aon, you think weight loss drugs save money?

By AL LEWIS

Last month Aon, the major benefits consulting firm, released a “study” claiming:

A significant opportunity to reduce healthcare costs for employers and enhance overall workforce health through a comprehensive obesity management program that includes GLP-1 medications.

This, of course, is the opposite of what most researchers have shown.  And in the immortal words of the great philosophers Dire Straits: “Two men say they’re Jesus, one of them must be wrong.” We’ll shortly see who’s wrong (um, meaning about weight loss drugs) when we dive into the study in a minute. But first, let’s review Aon’s previous analyses. 

A brief history of Aon

Aon claimed that Accolade saved 8%, but it looks like they must coincidentally have been absent both on the day that the biostatistics professor explained how control groups work, and also on the day the fifth-grade math teacher explained how averages work. 

Then, they claimed that Lyra – which is a mental health company – achieved the following non-mental improvements in the set of patients who had at least one mental health encounter with one of their “220,000 high-quality providers”:

§  A 30% reduction in non-mental health-related ER visits

§  A 30% reduction in generic drug spending

§  A 20% reduction in specialty drug spending

Thanks in part to starting the y-axis at $4000 to improve the optics, Aon also revealed that Lyra achieved a very high “efficiency ratio”:

A graph of a number of people AI-generated content may be incorrect.

I can’t object to that finding because – despite three decades in this field, about 100 articles/interviews/quotes/citations including the Wall Street Journal, two trade-bestselling books and one Harvard Business School case study – I still don’t know what an “efficiency ratio” is, other than that has nothing to do with comparing participants to non-participants in a mental health study. Apparently an “efficiency ratio” in healthcare measures how quickly a hospital turns over its inventory. So Aon’s use of the term recalls the immortal words of the great philosopher Bob Uecker: “Juuussst a bit outside.”

When publicly and privately asked to explain any of these things, Aon clammed up. That was likely wise on their part.

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