Who Decides Your Dose Escalation
The four-week rule, and who applies it in an asynchronous model.
The four-week rule, and who applies it in an asynchronous model.
Across the 16 programmes we price, all-in cost runs from $133 a month at the starter dose, with the cheapest first year at about $2,580 (NexLife, $215 a month at a 10 mg maintenance dose). Every figure on this page is on that same all-in basis.
All-in monthly cost = medication + any recurring fee, at a named dose, before tax and before prepaid discounts. Captured 2026-08-05. How we verify a price.
First-year all-in cost
What you are actually buying
A telehealth subscription bundles four things that are frequently priced as one: a clinical review, a prescription, fulfilment through a pharmacy, and ongoing access to somebody who will answer a question. Programmes differ enormously in how much of each they provide, and the difference is invisible in a monthly price.
The question that separates care from a vending machine
Can this programme decline to prescribe? A service that guarantees approval before a clinician has seen your history is not running a clinical process, whatever else it discloses. The most reassuring thing a telehealth service can do is turn someone away.
What the care model changes about your bill
Video visits, included laboratory work and real clinician access cost money to provide, and programmes that provide them are rarely the cheapest. That is not a scandal — it is what you are paying for. The failure is paying a premium for an asynchronous questionnaire that a cheaper programme provides identically.
What we could not verify
Response times, whether the same clinician sees you twice, and how a programme behaves when something goes wrong. We hold no measurements of those we would defend, so they are absent from every table rather than estimated.
What a subscription actually buys
Four things, usually priced as one: a clinical review, a prescription, fulfilment through a pharmacy, and ongoing access to somebody who will answer a question. Programmes differ enormously in how much of each they provide, and the difference is invisible in a monthly price.
The most expensive programmes are not reliably the ones providing the most. Some are simply carrying more marketing cost, and a cheaper programme that names its pharmacy and answers messages within a day is providing more of what matters.
The test that separates care from a vending machine
Can this programme decline to prescribe? A service that guarantees approval before a clinician has seen your history is not running a clinical process, whatever else it discloses. The most reassuring thing a telehealth service can do is turn somebody away.
Ask what histories would stop a prescription being written. A programme that can answer has clinical governance; one that treats the question as an obstacle does not.
Where asynchronous care is genuinely adequate
For an uncomplicated patient with a clear history, a well-designed questionnaire reviewed by a licensed clinician is a reasonable standard of care and is how a large share of prescriptions in this category are written. It is faster, cheaper and no less careful when the intake is designed to surface contraindications.
It is weaker where the history is complicated, where the answers need follow-up questions, or where somebody is likely to under-report. A video visit is not automatically better care, but it is harder to complete on autopilot.
How this connects to what you will actually pay
Everything in this section resolves to one number: the all-in monthly cost at the dose you end up holding. Across the 16 programmes we price, that runs from $215 at the cheapest tracked route to several times that at the most expensive, for the identical molecule from the same category of licensed pharmacy.
5 of those programmes charge a recurring platform fee on top of medication and 12 hold one price at every strength. Those two facts explain most of the spread between advertised prices and real ones.
What we could verify and what we could not
11 of 32 tracked programmes have a price we read at the provider or manufacturer. The rest carry third-party figures we have not confirmed, or publish nothing we can interpret. Every table on this site marks which is which, and the comparison matrix lets you filter to verified prices only.
Where we have checked a third-party figure against a provider's own page, it has almost always moved — and it has moved upward. Promotional first months, prepaid bundle rates and medication-only figures that exclude memberships are all published as ongoing all-in prices. Assume an unverified figure is optimistic.
The regulatory distinction that sits under all of this
Compounded tirzepatide is not FDA-approved. FDA does not review compounded preparations for safety, effectiveness or quality before they are marketed. The active molecule is the same as the branded product; the pre-market review is not, and the assurance comes instead from the pharmacy, the state board that licenses it and, at good operations, batch sterility and potency testing.
That is a legitimate framework rather than a loophole, and it is also why the price is lower. It puts more of the verification burden on the patient, which is the honest trade being made.
What the GIP arm may be doing
GIP receptor agonism is the pharmacological difference between tirzepatide and the GLP-1-only agents, and its contribution is still being characterised. Proposed mechanisms include effects on adipose tissue insulin sensitivity, on central appetite pathways distinct from the GLP-1 route, and on the tolerability of GLP-1 agonism itself, which would allow effective exposure at doses that would otherwise be poorly tolerated.
This is an area of active research rather than settled science, and anyone stating the mechanism confidently is ahead of the literature. What is established is the outcome difference in the head-to-head trial; the explanation for it is not fully resolved.
The question worth asking before the price question
Whether you have a covered indication. Tirzepatide is approved for chronic weight management and, as Mounjaro, for type 2 diabetes; obstructive sleep apnoea in adults with obesity is an additional route. A covered prescription under a documented indication beats every cash route on this site, frequently by an order of magnitude.
Most people do this backwards: compare cash prices, enrol, then discover an indication they already qualified for. Establishing coverage first costs a phone call and can save four figures a year, which is more than any comparison table on this site will save you.
Reading a price like a clinician would
A clinician deciding whether a programme is workable asks three questions a price comparison usually skips. Can this patient stay on it long enough to reach a maintenance dose? Is the supply reliable enough that titration will not be interrupted? And is the prescriber reachable when the fourth-week nausea arrives?
Each maps to something checkable before enrolling. Long prepaid terms answer the first badly if money is tight. A single owned dispensing facility answers the second worse than several named partner pharmacies, because a programme with one supply route cannot reroute your prescription. And the care model answers the third: asynchronous messaging is adequate for most titration questions and inadequate for a few.
None of that appears in an advertised price, and all of it decides whether the price you chose is the price you end up paying.
What you are actually paying a platform for
A telehealth subscription bundles four things frequently priced as one: a clinical review, a prescription, fulfilment through a pharmacy, and ongoing access to someone who will answer a question. Programmes differ enormously in how much of each they provide.
None of that difference is visible in a monthly price, which is why two programmes charging the same figure can be very different purchases.
The test that separates care from a vending machine
Can this programme decline to prescribe? A service guaranteeing approval before a clinician has reviewed a history is not running a clinical process, whatever else it discloses. The most reassuring thing a telehealth service can do is turn someone away.
What we could not measure
Response times, whether the same clinician sees you twice, and how a programme behaves when a shipment fails. Those decide satisfaction more than price does and none is observable from outside, so they are absent from every table here rather than estimated into a score.
The usable proxy is what a programme publishes before it has your money.
Open these rather than taking our word for it. Every one is a regulator, a trial registry, a label, an accreditor or the manufacturer.
Compare every programme on one screen
The matrix carries all-in price at every dose, fee structure, commitment terms, pharmacy disclosure and verification status for every programme we track.