Comparison

Ozempic vs. Trulicity vs. Mounjaro: Trials, Heart Labels and Cost

Updated October 20269 min readSources cited inline

Across the head-to-head trials, the ranking for type 2 diabetes is consistent: Mounjaro lowered A1C and weight the most, Ozempic came second, and Trulicity third. All three now carry an FDA cardiovascular risk-reduction indication, with Mounjaro's added on August 28, 2026, and only Ozempic adds a kidney indication. Trulicity's case in October 2026 rests on its broader heart label, its pediatric approval and a $389 cash price.

Key takeaways

SUSTAIN 7: Ozempic 1 mg beat Trulicity 1.5 mg on A1C (−1.8 vs. −1.4 points) and weight (−6.5 vs. −3.0 kg) over 40 weeks.
SURPASS-2: Mounjaro beat Ozempic 1 mg on A1C (−2.01 to −2.30 vs. −1.86) and weight (−7.6 to −11.2 kg vs. −5.7 kg) over 40 weeks.
SURPASS-CVOT: Mounjaro was non-inferior to Trulicity for heart attack, stroke and cardiovascular death (hazard ratio 0.92), but not proven superior.
Trulicity's heart label is the broadest, covering adults with established heart disease or multiple risk factors. Ozempic alone has a kidney-outcomes indication.
October 2026 cash prices: Ozempic $349 ($499 at 2 mg), Trulicity $389, Mounjaro from $499.

The three drugs in brief

Ozempic (semaglutide, Novo Nordisk) is a weekly GLP-1 injection dosed from 0.25 mg up to a 2 mg maximum (Ozempic prescribing information). Trulicity (dulaglutide, Eli Lilly) is a weekly GLP-1 injection from 0.75 mg up to 4.5 mg (Trulicity prescribing information). Mounjaro (tirzepatide, Eli Lilly) is a weekly injection that acts on both GIP and GLP-1 receptors, dosed from 2.5 mg up to 15 mg (Mounjaro prescribing information).

No single trial has tested all three at once. Instead there are three pairwise trials, and together they form a chain: Ozempic versus Trulicity, Mounjaro versus Ozempic, and Trulicity at higher doses versus its own standard dose.

The head-to-head evidence

Trial	What was compared	A1C change	Weight change
SUSTAIN 7 (40 weeks, 1,199 adults)	Ozempic 1 mg vs. Trulicity 1.5 mg	−1.8 vs. −1.4 points	−6.5 vs. −3.0 kg
SUSTAIN 7 (lower doses)	Ozempic 0.5 mg vs. Trulicity 0.75 mg	−1.5 vs. −1.1 points	−4.6 vs. −2.3 kg
SURPASS-2 (40 weeks, 1,879 adults on metformin)	Mounjaro 5 / 10 / 15 mg vs. Ozempic 1 mg	−2.01 / −2.24 / −2.30 vs. −1.86 points	−7.6 / −9.3 / −11.2 vs. −5.7 kg
AWARD-11 (36 weeks, 1,842 adults on metformin)	Trulicity 4.5 / 3 / 1.5 mg	−1.8 / −1.6 / −1.5 points	−4.6 / −3.8 / −3.0 kg

Sources: SUSTAIN 7 via Healio; SURPASS-2 via Eli Lilly and GPnotebook (Frías et al., NEJM 2021); AWARD-11 via Eli Lilly. SURPASS-2 and AWARD-11 figures use the treatment-regimen estimand, which counts everyone regardless of whether they stayed on the drug.

What the chain tells you

Ozempic outperformed Trulicity at matched dose levels in SUSTAIN 7, and Mounjaro outperformed Ozempic at every dose in SURPASS-2 (Healio; Eli Lilly). Even Mounjaro 5 mg, the lowest dose tested, lowered A1C more than Ozempic 1 mg.

Trulicity's higher doses close some of the gap. In AWARD-11, the 4.5 mg dose lowered A1C by 1.8 points and weight by 4.6 kg, and it was the only higher dose proven superior to 1.5 mg on A1C under the treatment-regimen analysis (Eli Lilly).

The caveats

These trials compared the doses available when they ran. SUSTAIN 7 and SURPASS-2 used Ozempic 1 mg, but its label now goes to 2 mg. SUSTAIN 7 used Trulicity 1.5 mg, before the 3 mg and 4.5 mg doses existed. And numbers from different trials, with different patients and baselines, cannot be lined up as if they came from one study. The direction of each comparison is solid; the exact gaps at today's top doses are not established.

Side effects

Stomach effects lead the list for all three. In SURPASS-2, nausea occurred in 17.4% to 22.1% of people on Mounjaro versus 17.9% on Ozempic, and stopping because of side effects was 5.1% to 7.9% on Mounjaro versus 3.8% on Ozempic (Eli Lilly). Lilly reported that Trulicity's higher doses had a safety profile consistent with 1.5 mg, led by gastrointestinal events (Eli Lilly).

Comparing diabetes GLP-1 options?

See what current programs charge for Ozempic, Mounjaro and other options.

Explore Ivim Health ↗Explore Sesame Care ↗

Paid links. We may earn a commission; it never changes what we write. See all options. Compounded medications are not FDA-approved.

If you are already on Trulicity 1.5 mg

Switching brands is not the only next step. Trulicity's label allows increases in 1.5 mg steps, at least four weeks apart, up to 4.5 mg (Trulicity prescribing information). In AWARD-11, moving from 1.5 mg to 4.5 mg added about 0.3 points of A1C reduction and about 1.6 kg of weight loss on average. Whether to raise the dose or change drugs is a decision to make with your prescriber, based on how far you are from your A1C goal.

Cardiovascular and kidney labels

For many people with type 2 diabetes, the heart label matters as much as A1C. As of October 2026, all three drugs have one, but the wording and evidence differ.

Label feature	Ozempic	Trulicity	Mounjaro
Who the heart indication covers	Adults with type 2 diabetes and established CV disease	Adults with type 2 diabetes and established CV disease or multiple CV risk factors	Adults with type 2 diabetes at high risk for CV events
Key outcome trial	SUSTAIN 6 vs. placebo: hazard ratio 0.74 (0.58 to 0.95)	REWIND vs. placebo	SURPASS-CVOT vs. Trulicity: hazard ratio 0.92 (0.83 to 1.01)
Kidney indication	Yes (FLOW: hazard ratio 0.76)	No	No
Ages for blood sugar use	Adults	Adults and children 10+	Adults and children 10+
Maximum dose	2 mg weekly	4.5 mg weekly	15 mg weekly

Sources: Ozempic PI (05/2026); Trulicity PI (3/2026); Mounjaro PI (8/2026); Eli Lilly SURPASS-CVOT release.

Three points stand out. First, Trulicity's indication extends to adults with multiple cardiovascular risk factors who do not yet have established heart disease, which is broader wording than Ozempic's (Trulicity prescribing information).

Second, Mounjaro's heart evidence comes from a trial against an active drug, not placebo. SURPASS-CVOT randomized 13,299 adults with type 2 diabetes and atherosclerotic heart disease to Mounjaro or Trulicity 1.5 mg. Over a median of about four years, Mounjaro had an 8% lower event rate, enough to show it was at least as good, but superiority was not established (Eli Lilly). That makes it the only direct heart-outcomes comparison among these three.

Third, Ozempic's kidney indication is unique here. It is approved to reduce the risk of kidney function decline, end-stage kidney disease and cardiovascular death in adults with type 2 diabetes and chronic kidney disease, based on FLOW (Ozempic prescribing information).

Cost in October 2026

All three manufacturers now sell directly to cash-paying patients:

Ozempic: $349 a month for 0.25 to 1 mg, $499 for 2 mg, with $199 for each of the first two months for new patients on the lowest doses through December 31, 2026 (NovoCare).
Trulicity: starting at $389 a month at every dose through LillyDirect (LillyDirect).
Mounjaro: starting at $499 a month at every dose through LillyDirect (LillyDirect). Its list price is about $1,112 per 28 days (Mounjaro FAQ).

With commercial insurance, manufacturer savings cards can cut copays to as little as $25 for covered prescriptions. Mounjaro's card can also bring the price to as low as $499 a month when a plan does not cover it, but it requires an FDA-approved use and excludes government plans (GoodRx). On Medicare, these three drugs run through your regular Part D plan at that plan's price, so the formulary tier sets your cost. Medicare's separate $50-a-month GLP-1 Bridge is for weight loss and excludes people with type 2 diabetes, who are told to check with their drug plan instead (Medicare.gov).

Matching the drug to the patient

Largest A1C and weight reduction is the priority: Mounjaro has the strongest head-to-head results.
Type 2 diabetes with chronic kidney disease: Ozempic is the only one with a kidney-outcomes indication.
Multiple heart risk factors but no diagnosed heart disease: Trulicity's label is written for this group.
Lowest cash price: Ozempic at $349 (doses up to 1 mg) or Trulicity at $389.
Children 10 and older: Trulicity and Mounjaro are labeled for pediatric type 2 diabetes; Ozempic is not.

The verdict

On blood sugar and weight, the trials rank Mounjaro first, Ozempic second and Trulicity third. That makes Mounjaro the default when maximum effect is the goal and coverage allows. Ozempic is the better pick for diabetes with chronic kidney disease and is the cheapest cash option at lower doses. Trulicity is no longer the efficacy leader, but its broader heart label, pediatric approval and $389 cash price keep it a reasonable choice for some patients. Bring your A1C goal, kidney and heart history, and coverage details to your prescriber.

See current diabetes GLP-1 pricing

Cash and program prices changed several times in 2026, so compare before you fill.

Explore HealthRX ↗Compounded / not FDA-approved Explore BiltRx ↗Verify formulation

Paid links. We may earn a commission; it never changes what we write. See all options. Compounded medications are not FDA-approved.

Frequently asked questions

Which lowers A1C the most: Ozempic, Trulicity or Mounjaro?

In head-to-head trials, Mounjaro lowered A1C more than Ozempic 1 mg (SURPASS-2), and Ozempic lowered it more than Trulicity 1.5 mg (SUSTAIN 7). No single trial tested all three together.

Do Ozempic, Trulicity and Mounjaro all reduce heart risk?

As of October 2026, all three have an FDA indication to reduce the risk of major cardiovascular events in certain adults with type 2 diabetes. Mounjaro's was added on August 28, 2026, based on SURPASS-CVOT, where it was non-inferior to Trulicity.

Which one has a kidney indication?

Only Ozempic. Its label includes reducing the risk of kidney function decline, end-stage kidney disease and cardiovascular death in adults with type 2 diabetes and chronic kidney disease, based on the FLOW trial.

Which is cheapest without insurance?

As of October 2026, Ozempic costs $349 a month cash for doses up to 1 mg ($499 at 2 mg), Trulicity starts at $389 a month on LillyDirect, and Mounjaro starts at $499 a month on LillyDirect.

Sources

Medical disclaimer: This article is general information, not medical advice, and does not replace a licensed clinician who knows your history. Approvals, labels, coverage and prices change; check the linked sources and talk with your prescriber or pharmacist before making decisions about any medication.