Wegovy vs. Zepbound: Head-to-Head

Prices verified May 2026 · Compare GLP-1 Editorial Team

The Only Comparison That Matters

Wegovy and Zepbound are the only two FDA-approved injectable GLP-1 receptor agonists specifically indicated for chronic weight management (as opposed to their diabetes-indicated siblings, Ozempic and Mounjaro). If your doctor is prescribing a GLP-1 for weight loss and you have insurance willing to cover it, the choice almost always comes down to these two.

Clinical Trial Data

Wegovy's STEP 1 trial showed an average of 16.9% body weight loss over 68 weeks at the 2.4mg maintenance dose. Zepbound's SURMOUNT-1 trial showed 22.5% at the 15mg dose over 72 weeks. In the head-to-head SURMOUNT-5 trial, tirzepatide outperformed semaglutide at maximum doses.

Wegovy has published cardiovascular outcomes data (the SELECT trial) showing a 20% reduction in major adverse cardiovascular events — heart attack, stroke, and cardiovascular death. This is a significant clinical differentiator. Zepbound's cardiovascular outcomes trial (SURPASS-CVOT) is ongoing but results haven't been published yet.

Insurance Coverage

Coverage for both medications varies dramatically by plan. Many commercial insurers cover one but not the other, and prior authorization is almost always required. Medicare Part D does not cover either medication for weight management (though coverage for diabetes indications exists).

Novo Nordisk's NovoCare program and Eli Lilly's LillyDirect both offer savings cards that can reduce out-of-pocket costs for commercially insured patients. Check both programs to see which offers a better deal with your specific insurance.

Side Effects

Both medications share the same GI side effect profile: nausea, diarrhea, vomiting, and constipation, particularly during the titration period. Neither has shown a significantly worse side effect profile than the other in clinical trials, though individual tolerance varies.

Both carry a boxed warning about thyroid C-cell tumors based on animal studies. Neither should be used by patients with a personal or family history of medullary thyroid carcinoma or MEN2.

Our Verdict

If cardiovascular risk reduction is clinically important for you — for example, if you have a history of heart disease or elevated cardiovascular risk — Wegovy has the published evidence. If maximum weight loss is the priority and cardiovascular risk isn't a primary concern, Zepbound's trial data gives it the edge.

In practice, the deciding factor is often insurance coverage. Check what your plan covers before getting attached to one over the other.

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