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The hierarchy supported by current data: Triple agonists (retatrutide): ~24% weight loss at top dose, phase 2 Dual GLP-1/GIP agonists (tirzepatide): ~22.5% weight loss at top dose, SURMOUNT-1 GLP-1 monoagonists (semaglutide, orforglipron): ~14.7-14.9% weight loss at top dose Cost: list price, self-pay, and compounded options Zepbound pricing as of late 2025: List price (pen presentation): approximately $1,059/month LillyDirect self-pay program (vial presentation): approximately $499-549/month depending on dose Insurance copay (covered plans): typically $25-100/month Insurance copay (non-covered plans): full out-of-pocket cost Compounded tirzepatide (when available through 503A pharmacies): typically $200-400/month Orforglipron pricing (speculative, drug not yet approved): Likely list price: $800-1,200/month range, similar to Zepbound Self-pay program: uncertain whether Lilly will launch a parallel direct-pay program at launch Insurance copay: very limited at launch, expanding over 12-24 months Compounded versions: not available, because 503A pharmacies cannot compound small-molecule oral drugs in the same way they compound peptides The patient who currently accesses compounded tirzepatide at $250/month should not assume orforglipron will be cheaper