Semaglutide, tirzepatide, orforglipron — weekly shots, daily pills, different brand names for the same molecule. Choosing between GLP-1 medications is confusing, and the right answer depends on your health, your coverage and what your prescriber recommends. This hub lays out the real differences, backed by the clinical trials, so you can walk into that conversation informed.
Start here
- Tirzepatide vs. semaglutide — how Zepbound/Mounjaro and Wegovy/Ozempic differ in how they work, results, side effects and cost.
- Ozempic vs. Wegovy — same drug, different approvals, doses and coverage rules.
- Wegovy pill vs. injection — daily tablet or weekly shot: convenience, results and price.
The main GLP-1 medications at a glance
| Medication | Active ingredient | Form | Approved for |
|---|---|---|---|
| Wegovy | Semaglutide | Weekly injection or daily tablet | Chronic weight management; cardiovascular risk reduction; MASH (a form of fatty liver disease) |
| Ozempic | Semaglutide | Weekly injection | Type 2 diabetes |
| Zepbound | Tirzepatide | Weekly injection | Chronic weight management; obstructive sleep apnea with obesity |
| Mounjaro | Tirzepatide | Weekly injection | Type 2 diabetes |
| Foundayo | Orforglipron | Daily pill | Chronic weight management |
Brand names matter for insurance: the same molecule can be covered under one brand (for diabetes) and excluded under another (for weight loss). See our Cost & Access hub for how that plays out.
What the head-to-head evidence shows
In the STEP 1 trial, adults without diabetes taking semaglutide 2.4 mg lost an average of 14.9% of body weight over 68 weeks, compared with 2.4% on placebo (NEJM, 2021). In SURMOUNT-1, tirzepatide produced average losses of 15% to 20.9% over 72 weeks depending on dose (NEJM, 2022).
The two were compared directly in SURMOUNT-5: tirzepatide users lost an average of 20.2% of body weight versus 13.7% with semaglutide over 72 weeks (NEJM, 2025). Averages hide wide individual variation, and side effects, coverage and your own health history all matter as much as the headline number.
Questions that decide which one fits
- What is it being prescribed for? Diabetes, weight management, heart risk or sleep apnea each map to different brands and coverage.
- Pill or injection? Daily pills avoid needles but come with timing rules; weekly shots are once and done.
- What does it cost you? Compare your plan’s copay with manufacturer self-pay prices, and check the $50 Medicare GLP-1 Bridge if you’re on Medicare.
- How have you tolerated GI side effects before? Nausea is the most common reason people struggle early. Our side effects hub covers what helps.
Only your prescriber can recommend a specific medication and dose. Bring these questions — our Doctor Visit Prep Kit has checklists for exactly this appointment.
Sources
- Wilding JPH, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity (STEP 1). NEJM, 2021.
- Jastreboff AM, et al. Tirzepatide Once Weekly for the Treatment of Obesity (SURMOUNT-1). NEJM, 2022.
- Aronne LJ, et al. Tirzepatide as Compared with Semaglutide for the Treatment of Obesity (SURMOUNT-5). NEJM, 2025.
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Medical disclaimer: Content on OnSemaglutide.com is for informational purposes only and is not medical advice. Talk with a licensed healthcare provider before starting, stopping or changing any medication. Read the full disclaimer.