Cost Per Milligram

The arithmetic

A monthly dose is four weekly injections. At 2.5 mg that is 10 mg of active drug a month; at 10 mg it is 40 mg; at the 15 mg ceiling, 60 mg. Dividing the all-in monthly price by milligrams delivered removes the dose from the comparison entirely.

On a flat-rate programme, cost per milligram falls by three quarters between initiation and maintenance. On a dose-scaled programme it barely moves. That single fact is the entire economic argument for flat pricing.

Where per-milligram misleads

It ignores what is bundled. A programme including clinician access, labs and responsive support is not comparable per milligram to one that ships a vial and nothing else. Use it as one lens, not the only one.

What to ask before you enrol

One question does most of the work: what will I pay in total in month six at 10 mg, including every fee? A programme that answers in one sentence has flat, all-inclusive pricing. A programme that needs three sentences has a structure worth reading carefully. A programme that cannot answer has told you something.

Then four more: which pharmacy fills the prescription, is the prescriber licensed in my state, does the quoted rate hold at renewal, and what is refundable before shipment.

Where these numbers come from

One dataset, re-read on October 15, 2026 (NexLife as of November 6, 2026), with a read date on every record. Every price shown was read on the program’s own pages; we no longer show figures taken from third-party round-ups. Where sources disagree we show the conflict rather than choosing. The whole file is downloadable.

Why this distinction changes what you pay

Every structural difference in this market resolves into money at a maintenance dose. Whether a programme charges a membership, whether it reprices with the dose, whether it demands a term, and whether it bundles or splits its charges together account for most of the gap between the lowest and highest all-in prices we track.

None of those differences is visible in an advertised headline figure, which is the reason this site exists in the form it does.

How to act on it this week

Price the dose you expect to maintain on rather than the starter dose. Add every recurring fee. Ask whether the quoted rate holds at renewal. Establish who compounds the medicine. And do not enter a prepaid term until you have held a maintenance dose for a cycle.

Those five steps take under an hour and reliably beat any amount of comparison reading, because they surface the information that comparison tables omit.

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 15 programs we can price at 10 mg, that runs from $129 to $399 a month all-in, about three times as much at the top as at the bottom, for compounded tirzepatide from the same category of licensed pharmacy.

One of those 15 programs charges a recurring program fee on top of medication, and 10 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

15 of the 32 programs we track have a month-to-month 10 mg price we read on the program’s own site (October 15, 2026; NexLife as of November 6, 2026). The rest print no comparable price, blocked our reader or sell brand Zepbound only, and we show no third-party figure for them. Every table on this site marks which is which, and the comparison matrix lets you filter to verified prices only.

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. Compounded tirzepatide is made with the drug in Zepbound but is not the same product, and FDA does not review it before sale; 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.