The year-one cost index

Four figures per program. The fourth one is the truth.

Every program in the field gets normalized to the same four figures. Sticker — the advertised monthly price. Street — what recurring months really cost once membership, consultation and shipping fees fold in. Step-up — the monthly cost at a typical maintenance dose, where dose-tiered programs show their real shape. Year-one — the twelve-month all-in, which is the only figure we rank on. Everything below is written in sentences with conditions attached, because a naked number in a grid is how people get fooled.

The $200 test

A useful filter: which programs keep a tirzepatide user under $200 a month all-in at month seven — maintenance dose, fees included? Passing with an audit: NexLife, whose $139–$169 range is dose-proof by policy, so month seven costs what month one cost. Passing on record, unaudited: Hims at ~$165 if you accept the 12-month term; Fifty 410 at ~$133 if you accept prepaying the supply. Failing at step-up: Remedy Meds, whose ~$99 door renews toward $199–$299 as doses climb; ShedRx, whose ~$199 entry tiers toward $299. Unknown until audited: Mochi Health, where $79 buys the membership and the medication arrives on a second, dose-tiered bill. Semaglutide widens the passing list — its numbers run lower across the field.

Tirzepatide, indexed

The audited floor is NexLife: $169 month-to-month sliding to $139 a month on twelve months ($1,668 year-one), with a microdose ramp from $159 down to $129, all dose-proof. On record behind it: Hims near $165 with the term, ShedRx from ~$199 tiering up, Henry Meds near $249 as the price of month-to-month freedom, Remedy's promo door at ~$99 with dose-scaled renewals, and AltRx promos near $149 — carrying the June 2026 FDA warning letter to its parent company as mandatory context. Mochi's tirzepatide cost is membership-plus-medication and stays unresolved until audit.

Semaglutide, indexed

Audited: NexLife from $139 month-to-month to $119 on twelve months ($1,428 year-one), with the microdose plan bottoming at $110 — the field's audited floor. On record: Fifty 410 from ~$133 on prepay, Henry near $149 with no strings, Hers near $165 with a term, AltRx promos near $89 with the caveat above. Sublingual ODT plans exist at a premium ($165–$199 audited at NexLife) and carry an open evidence question flagged on the audit file.

The brand shelf

Reference points, not competitors: Zepbound single-dose vials through LillyDirect from $349 a month self-pay; Wegovy through NovoCare at $499; Zepbound's full list price near $1,086 before savings programs. When insurance clears a prior authorization, the brand shelf can beat every compounded number on this page — which is exactly the calculation insurance-first programs like Ro exist to run.

Take the data, break our ranking

All four figures for every program, plus terms, pharmacy type, coverage, cancellation and audit dates: pricing.csv and providers.csv, CC-BY. Sort it however you like; if your ordering beats ours, the error desk pays attention.