Semaglutide approved for MASH with moderate to advanced fibrosis

FDA granted accelerated approval in August 2025 for adults with non-cirrhotic MASH and F2–F3 fibrosis, based on ESSENCE Part 1.

Coverage tracks the indication far more than the molecule, so a documented liver disease is a different conversation with a payer than a BMI threshold.

It does not extend to compounded preparations, which carry no indication of any kind.

What this changes for what you pay

Most developments in this category move one of three things: the price of the branded product, which programmes are operating, or what may lawfully be compounded. Very few change the prescription requirement, the pharmacy licensing framework or the clinical review behind a prescription.

The cheapest verified compounded route we track currently sits at $215 a month all-in at a 10 mg maintenance dose, about $2,580 for a first year. Where a development moves that figure, our tables move with it on the next build.

How to verify this yourself

Regulatory claims should be checked against the agency rather than against coverage of the agency. FDA publishes warning letters searchable by company name, a shortage database, and its compounding pages. Trial claims should be checked against the registry entry rather than a press release.

Every source behind this item is linked below, and where a story is still moving we say so rather than implying it is settled.

Reading this alongside the rest of the site

Pricing pages isolate one component. Provider reviews carry the whole record for one programme. Comparisons run two side by side at every dose. The rankings sort the same dataset on different questions. None is the whole picture and none is meant to be.

If you read one other page, make it how to verify a pharmacy. Price is the easiest thing to compare and rarely the thing that goes wrong.

What we would need to change our mind

A programme publishing a figure at a dose tier currently blank. A named dispensing pharmacy with a checkable licence. A pricing model changing in either direction. A regulatory action. Or a correction from a reader with a source we can open.

All five are logged with the date they landed, on the change log and in the dataset. Prices here were captured 2026-08-05.

What this site will not do

Publish an estimated price for a programme that does not publish one. Rank a programme higher because it pays. Present a compounded preparation as equivalent to an approved product. Or carry a figure without the date it was captured.

Those four rules cost us pages, rankings and revenue, and they are the only reason a reader has to prefer this to a round-up assembled in an afternoon. A price without its date is not a fact, and a comparison built from undated prices is not a comparison.

Who this site is not for

Anyone with coverage under a documented indication, who should use it rather than read a cash comparison. Anyone looking for a source without a prescription, which this site will not help with. And anyone wanting a single confident recommendation, because the honest answer depends on your dose, your coverage and your tolerance for commitment.

If you want the short version anyway: price the dose you will hold, add every fee, verify the pharmacy, and avoid long prepaid terms until you have tolerated a maintenance dose for a cycle.

Why titration is a pricing question

Tirzepatide is started at 2.5 mg weekly and increased in 2.5 mg steps at intervals of at least four weeks. The starter dose is a tolerance-building dose rather than a therapeutic one, and the gastrointestinal effects that cause most discontinuation cluster in the days after each increase.

Reaching a maintenance dose therefore takes at least eight to twelve weeks when nothing is repeated, and repeats are common rather than exceptional. Most of a first year is spent at or near maintenance, which is why every figure on this site is stated at 10 mg and why 12 of the 16 priced programmes holding one price across the ladder is a materially different offer from the rest.

The molecule, and why it costs more than semaglutide

Tirzepatide is a single peptide that activates two incretin receptors: GLP-1, which semaglutide also targets, and GIP, which it does not. Both receptors influence insulin secretion, gastric emptying and central appetite signalling, and the working hypothesis for the larger effect size is that engaging both produces effects the GLP-1 arm alone does not.

That dual action is also part of why it costs more to make. The peptide is longer and more structurally complex than semaglutide, the synthesis is harder, and the active pharmaceutical ingredient sells at a premium to compounding pharmacies. Across programmes carrying both molecules, tirzepatide typically runs forty to a hundred per cent above the same programme's semaglutide price.

The commercial consequence is that a compounded tirzepatide programme has less room to discount than a compounded semaglutide one. When a tirzepatide price looks dramatically below the market, the explanation is usually a promotional rate, a prepaid term or a starting dose rather than a cheaper supply chain.

What the head-to-head trial actually showed

SURMOUNT-5 randomised adults with obesity to tirzepatide or semaglutide and reported a larger mean reduction in body weight on tirzepatide over 72 weeks. It is the strongest direct comparison available and it is the reason many people arrive at this molecule specifically rather than at GLP-1 therapy in general.

Three caveats are worth carrying. A mean is not a prediction for an individual, and the distribution around it is wide. Trial participants received structured support most telehealth programmes do not replicate. And the trial compared maximum tolerated doses, which is a different question from what a given person will tolerate.

Read as a purchasing decision, it says the more expensive molecule does more on average. It does not say it will do more for you, and it says nothing about which programme should supply it.