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Zepbound vs Wegovy: which loses more weight, and how do side effects, cost and coverage compare?

The one head-to-head trial, each label’s side effects, the makers’ cash prices and why Medicare and insurers treat them differently. Not a recommendation.

GLP Guidebook teamPublished Oct 12, 20266 min read15 sourcesWritten from published sources

Written for the United States. Reading from India? India version

The short answer

In the one head-to-head trial, SURMOUNT-5, people lost 20.2% of their weight on Zepbound (tirzepatide) and 13.7% on Wegovy (semaglutide) over 72 weeks. Side effects were mostly stomach-related for both. Cash prices are $299 to $449 a month for Zepbound and $349 for Wegovy pens.

Key takeaways

  • In SURMOUNT-5, a 72-week head-to-head trial in 751 adults without diabetes, average weight loss was 20.2% on Zepbound and 13.7% on Wegovy.1
  • Zepbound contains tirzepatide, which acts on two gut-hormone receptors (GIP and GLP‑1); Wegovy contains semaglutide, which acts on GLP‑1 only.2,3
  • Stomach effects were the most common side effects of both in SURMOUNT-5, mostly mild to moderate and mainly while the dose went up.1
  • Wegovy is also approved to lower heart risk and for a liver disease called MASH; Zepbound is also approved for moderate-to-severe sleep apnea with obesity.3,2
  • Medicare’s $50 GLP‑1 Bridge covers Wegovy pens and pills, but only the KwikPen form of Zepbound, not its vials or single-dose pens.4
Before you go further
  • This compares labels and trials. It doesn’t say which medicine suits you, and we don’t rank brands: a prescriber decides.
  • Prices are the makers’ published cash prices, never a seller’s.
  • Both carry the same class of risks: see below and our side effects guide.
On this page
  1. What is the difference between Zepbound and Wegovy?
  2. Which loses more weight?
  3. How do the side effects compare?
  4. How do the cash prices compare?
  5. Why might insurance cover one and not the other?
  6. Questions people ask
  7. How we researched this
  8. Sources

What is the difference between Zepbound and Wegovy?

They are different medicines: Zepbound is tirzepatide, which acts on GIP and GLP‑1 receptors, and Wegovy is semaglutide, which acts on GLP‑1 receptors.2,3

GLP‑1 and GIP are hormones your gut releases after eating. Medicines that copy them slow how fast the stomach empties and reduce hunger. Tirzepatide copies both; semaglutide copies GLP‑1.2,3

Eli LillyZepboundTirzepatide, weekly. Weight; sleep apnea with obesity2
Eli LillyMounjaroTirzepatide. Type 2 diabetes5
Novo NordiskWegovySemaglutide, weekly or daily pill. Weight; heart risk; MASH (shot only)3
Novo NordiskOzempicSemaglutide. Type 2 diabetes6

Doses differ too. Zepbound starts at 2.5 mg and is kept at 5, 10 or 15 mg.2 Wegovy starts at 0.25 mg and usually stays at 2.4 mg, with a 7.2 mg Wegovy HD dose.3 Mounjaro and Zepbound are compared in Mounjaro vs Zepbound.

Which loses more weight?

In the head-to-head SURMOUNT-5 trial, Zepbound: 20.2% average weight loss against 13.7% on Wegovy over 72 weeks.1

SURMOUNT-5 put 751 adults with obesity but without diabetes on the highest dose each person could tolerate: Zepbound 10 or 15 mg, or Wegovy 1.7 or 2.4 mg. Both groups knew which medicine they had (open-label). Eli Lilly, Zepbound’s maker, paid for it.1

SURMOUNT-5
Zepbound vs Wegovy, head to head
751 adults with obesity, without diabetes · 72 weeks · no placebo group
Zepbound-20.2%
Wegovy-13.7%
Average change in body weight. Waist: 7.2 in (18.4 cm) smaller on Zepbound, 5.1 in (13.0 cm) on Wegovy.1

For someone starting at 220 lb (100 kg), that is about 44 lb (20 kg) against 30 lb (14 kg) on average. Some people lost much more and some very little.

The Wegovy HD 7.2 mg dose wasn’t in this trial. In its own trial, 7.2 mg gave 18.8% loss over 72 weeks, against 15.5% on 2.4 mg and 3.9% on placebo.3 That is a separate trial, so it can’t be set against SURMOUNT-5.

How do the side effects compare?

Both mostly cause stomach effects, worst while the dose rises; the labels count them in separate trials, so the numbers aren’t a straight comparison.1,2,3

  • Zepbound: 25 to 29 in 100 felt sick, against 8 in 100 on placebo. Stomach side effects made 2 to 4 in 100 stop, against under 1 in 100.2
  • Wegovy 2.4 mg: 44 in 100 felt sick, against 16 in 100 on placebo. Side effects of any kind made about 7 in 100 stop, against 3 in 100.3

In SURMOUNT-5 itself, stomach effects were the most common in both groups, mostly mild to moderate.1

RisksThe risks, in brief
  • Stomach effects. In the main trials, about 44 in 100 people on Wegovy 2.4 mg injection felt sick (nausea), against about 16 in 100 on a dummy injection (placebo);3 about 25 to 29 in 100 people on Zepbound felt sick, against about 8 in 100 on a dummy injection.2 It mostly comes while the dose goes up.
  • Gallstones were reported in 16 in 1,000 people on Wegovy injection, against 7 in 1,000 on placebo;3 11 in 1,000 on Zepbound, against 10 in 1,000 on placebo, with gallbladder inflammation in 7 in 1,000 against 2 in 1,000.2
  • Pancreatitis (an inflamed pancreas): severe stomach pain that won’t go away and may spread to the back. The labels say to stop the medicine if it is suspected.3,2
  • Thyroid warning. The labels carry a boxed warning: these medicines are not for people with a personal or family history of medullary thyroid cancer (MTC) or MEN 2, a rare inherited condition that causes gland tumors.3,2
  • Dehydration from vomiting or diarrhea can harm the kidneys. Tell the team before any surgery or sedation, because a slower-emptying stomach raises the risk of breathing in food or fluid.3,2
  • Pregnancy. The Wegovy label says to stop at least 2 months before a planned pregnancy;3 Zepbound can make birth-control pills less reliable for about 4 weeks after starting and after each dose step.2
Full detail in our side effects guide →
Get help now: call 911 or go to the ER for severe stomach pain that won’t go away, with or without vomiting (it can be pancreatitis), or for swelling of the face or throat or trouble breathing. For a possible overdose, Poison Control is 1-800-222-1222.3,2,7
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How do the cash prices compare?

Paying cash, Wegovy pens are $349 a month at every dose; Zepbound vials and KwikPens are $299 to $449, by dose.8,9

  • Wegovy: $349 a month from 0.25 to 2.4 mg; $199 for a new patient’s first 2 fills through Dec 31, 2026; $399 for Wegovy HD 7.2 mg.8
  • Zepbound: $299 at 2.5 mg, $399 at 5 mg, $449 at 7.5 to 15 mg if each refill comes within 45 days.9

List prices, which insured people’s costs can be based on, are $1,349 a month for Wegovy and $1,087 for Zepbound.10 Wegovy’s falls to $675 on January 1, 2027.11 A year at cash prices is worked out in GLP‑1 costs without insurance.

Why might insurance cover one and not the other?

Because coverage follows approved uses and each plan’s preferred list: Medicare can pay for Wegovy for heart risk and Zepbound for sleep apnea, and plans pick preferred brands.12,13

Medicare. Part D plans can’t cover drugs for weight loss, but can cover them for heart risk or sleep apnea.12 The FDA approved Wegovy to cut the risk of heart attack, stroke and heart death in adults with heart disease and obesity or overweight in March 2024.14 Zepbound for sleep apnea followed in December 2024.15 For weight alone, the GLP‑1 Bridge covers Wegovy and the Zepbound KwikPen only.4

Employer plans. Pharmacy benefit managers choose preferred brands. One of the largest made Zepbound a preferred option again from October 1, 2026, and employers can still customize their lists.13 Ask your plan which is preferred: see prior authorization, step by step.

Questions people ask

Is Zepbound stronger than Wegovy?

In SURMOUNT-5, average weight loss was 20.2% on Zepbound and 13.7% on Wegovy over 72 weeks. The trial was paid for by Zepbound’s maker and was open-label.1

Can you switch from Wegovy to Zepbound?

A prescriber can switch you, but the labels say not to use tirzepatide or semaglutide together with any other GLP‑1 medicine.2,3

Which has more side effects, Zepbound or Wegovy?

Both mostly cause stomach effects. The labels report them from separate trials, so the numbers can’t be compared directly.2,3

Is Zepbound cheaper than Wegovy without insurance?

It depends on the dose. Zepbound is $299 to $449 a month; Wegovy pens are $349, or $199 for a new patient’s first 2 fills.9,8

Does Medicare cover Zepbound or Wegovy?

Through the GLP‑1 Bridge, Medicare covers Wegovy and the Zepbound KwikPen for weight at $50 a month for those who qualify.4

How we researched this

We used the SURMOUNT-5 paper (New England Journal of Medicine, 2025), the current US labels for Zepbound and Wegovy, the makers’ self-pay prices and Medicare’s Bridge documents, all checked on October 12, 2026.1,2,3,4

Weight and waist conversions are our arithmetic.

Before you move on

  • Ask which brand your plan prefers.
  • Ask whether heart or sleep-apnea coverage could apply to you.
  • Compare cash prices at the dose you’d likely reach.
  • Plan for stomach side effects while the dose rises.
  • Never take two GLP‑1 medicines together.
Cost calculatorSide effects and risksWhat GLP‑1s do

More from the US blog

USUnited StatesWegovy pill vs Foundayo vs Wegovy injection: how do the GLP‑1 pills differ from the shot?USUnited StatesMounjaro vs Zepbound: what is the difference, and why is coverage different?USUnited StatesZepbound for sleep apnea: who qualifies, and why do insurers cover it differently?
About GLP Guidebook

The monthly US update

An independent guide to GLP‑1 medicines. We don’t sell medicines, take drug-company money, earn commissions or link to any provider. Once a month: FDA approvals and warnings, Medicare and Medicaid changes, and makers’ price changes. How we write

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Sources

  1. Aronne LJ, et al. Tirzepatide as compared with semaglutide for the treatment of obesity (SURMOUNT-5). N Engl J Med 2025;393:26-36. doi:10.1056/NEJMoa2416394. PMID 40353578. Funded by Eli Lilly. Link
  2. Eli Lilly. Zepbound (tirzepatide): US prescribing information. Revised 8/2026. Link
  3. Novo Nordisk. Wegovy (semaglutide) injection and tablets: US prescribing information. Revised 06/2026. Link
  4. Medicare.gov. Medicare GLP-1 Bridge: GLP-1 drugs for $50 a month (fact sheet). CMS Product No. 12234, June 2026. Link
  5. Eli Lilly. Mounjaro (tirzepatide): US prescribing information. Revised 8/2026. Link
  6. Novo Nordisk. Ozempic (semaglutide) injection: US prescribing information. Revised 05/2026. Link
  7. Poison Control (National Capital Poison Center). Poison help line 1-800-222-1222. Link
  8. Novo Nordisk. Price your Wegovy (NovoCare): self-pay prices by dose, new-patient offer and savings-card terms. Checked Oct 12, 2026. Link
  9. Eli Lilly. LillyDirect Zepbound self-pay page (vial and KwikPen prices; regular prices if not refilled within 45 days), lilly.com/lillydirect. Checked Oct 12, 2026. Not linked because the page sells medicine.
  10. TrumpRx.gov. Home page GLP-1 listings (“Lowest Presidential Deal” and “Original Price”). Checked Oct 12, 2026. Link
  11. Novo Nordisk. Novo Nordisk announces significant reduction in US list price for Wegovy, Ozempic and Rybelsus. News release, February 24, 2026. Link
  12. KFF. What to know about the BALANCE Model for GLP-1s in Medicare and Medicaid and the Medicare GLP-1 Bridge. May 11, 2026. Link
  13. CVS Health. CVS Caremark delivers affordability and access to GLP-1 weight management medications with expanded coverage options. News release, May 28, 2026. Link
  14. FDA. FDA approves first treatment to reduce risk of serious heart problems specifically in adults with obesity or overweight. Press release, March 8, 2024. Link
  15. FDA. FDA approves first medication for obstructive sleep apnea. Press release, December 20, 2024. Link

Last checked Oct 12, 2026 · Next review due Apr 12, 2027 · Report an error

How this post was made. Written by the GLP Guidebook team from the sources above. It’s general information, not medical advice. Talk to your doctor, pharmacist or prescriber before starting, stopping or changing any medicine. We don’t sell, prescribe or recommend any brand or provider. How we write