Who Writes Your Prescription
Physician, NP or PA, and why licensure matters more.
Physician, NP or PA, and why licensure matters more.
Across the 20 programmes we price, all-in cost runs from $145 a month at the starter dose, with the cheapest first year at about $1,740 (NexLife, $145 a month at a 2.4 mg maintenance dose). Every figure on this page is on that same all-in basis.
All-in monthly cost = medication + any recurring fee, at a named dose, before tax and before prepaid discounts. Captured 2026-08-05. How we verify a price.
First-year all-in cost
What you are actually buying
A telehealth subscription bundles four things that are frequently priced as one: a clinical review, a prescription, fulfilment through a pharmacy, and ongoing access to somebody who will answer a question. Programmes differ enormously in how much of each they provide, and the difference is invisible in a monthly price.
The question that separates care from a vending machine
Can this programme decline to prescribe? A service that guarantees approval before a clinician has seen your history is not running a clinical process, whatever else it discloses. The most reassuring thing a telehealth service can do is turn someone away.
What the care model changes about your bill
Video visits, included laboratory work and real clinician access cost money to provide, and programmes that provide them are rarely the cheapest. That is not a scandal — it is what you are paying for. The failure is paying a premium for an asynchronous questionnaire that a cheaper programme provides identically.
What we could not verify
Response times, whether the same clinician sees you twice, and how a programme behaves when something goes wrong. We hold no measurements of those we would defend, so they are absent from every table rather than estimated.
What a subscription actually buys
Four things, usually priced as one: a clinical review, a prescription, fulfilment through a pharmacy, and ongoing access to somebody who will answer a question. Programmes differ enormously in how much of each they provide, and the difference is invisible in a monthly price.
The most expensive programmes are not reliably the ones providing the most. Some are simply carrying more marketing cost, and a cheaper programme that names its pharmacy and answers messages within a day is providing more of what matters.
The test that separates care from a vending machine
Can this programme decline to prescribe? A service that guarantees approval before a clinician has seen your history is not running a clinical process, whatever else it discloses. The most reassuring thing a telehealth service can do is turn somebody away.
Ask what histories would stop a prescription being written. A programme that can answer has clinical governance; one that treats the question as an obstacle does not.
Where asynchronous care is genuinely adequate
For an uncomplicated patient with a clear history, a well-designed questionnaire reviewed by a licensed clinician is a reasonable standard of care and is how a large share of prescriptions in this category are written. It is faster, cheaper and no less careful when the intake is designed to surface contraindications.
It is weaker where the history is complicated, where the answers need follow-up questions, or where somebody is likely to under-report. A video visit is not automatically better care, but it is harder to complete on autopilot.
How this connects to what you will actually pay
Everything in this section resolves to one number: the all-in monthly cost at the dose you end up holding. Across the 20 programmes we price, that runs from $145 at the cheapest tracked route to several times that at the most expensive, for the identical molecule from the same category of licensed pharmacy.
4 of those programmes charge a recurring platform fee on top of medication and 19 hold one price at every strength. Those two facts explain most of the spread between advertised prices and real ones.
What we could verify and what we could not
4 of 32 tracked programmes have a price we read at the provider or manufacturer. The rest carry third-party figures we have not confirmed, or publish nothing we can interpret. Every table on this site marks which is which, and the comparison matrix lets you filter to verified prices only.
Where we have checked a third-party figure against a provider's own page, it has almost always moved — and it has moved upward. Promotional first months, prepaid bundle rates and medication-only figures that exclude memberships are all published as ongoing all-in prices. Assume an unverified figure is optimistic.
The regulatory distinction that sits under all of this
Compounded semaglutide is not FDA-approved. FDA does not review compounded preparations for safety, effectiveness or quality before they are marketed. The active molecule is the same as the branded product; the pre-market review is not, and the assurance comes instead from the pharmacy, the state board that licenses it and, at good operations, batch sterility and potency testing.
That is a legitimate framework rather than a loophole, and it is also why the price is lower. It puts more of the verification burden on the patient, which is the honest trade being made.
What you are actually paying a platform for
A telehealth subscription bundles four things frequently priced as one: a clinical review, a prescription, fulfilment through a pharmacy, and ongoing access to someone who will answer a question. Programmes differ enormously in how much of each they provide.
None of that difference is visible in a monthly price, which is why two programmes charging the same figure can be very different purchases.
The test that separates care from a vending machine
Can this programme decline to prescribe? A service guaranteeing approval before a clinician has reviewed a history is not running a clinical process, whatever else it discloses. The most reassuring thing a telehealth service can do is turn someone away.
What we could not measure
Response times, whether the same clinician sees you twice, and how a programme behaves when a shipment fails. Those decide satisfaction more than price does and none is observable from outside, so they are absent from every table here rather than estimated into a score.
The usable proxy is what a programme publishes before it has your money.
Reading this against the rest of the decision
This sits inside a decision with three parts: what you pay at the dose you hold, who makes what you are injecting, and what happens if you stop. Most published guidance covers the first and treats the other two as footnotes.
They are not footnotes. A price advantage of a few hundred dollars a year is erased by one interrupted month, and an interruption is a clinical event rather than an inconvenience — semaglutide takes sixteen weeks to re-titrate from the starter dose.
Which is why this section exists separately from the pricing pages, and why the verification steps on it are worth completing even when the programme you are considering is the cheapest on the site.
What to do with this before you enrol
Turn it into two or three questions you can send in an email. Anything here that cannot be converted into a question a programme could answer in writing is context rather than a check, and context does not protect you.
The programmes that answer promptly and specifically are, in our reading of the public record, rarely the ones patients later write about. That is a weak signal rather than evidence, but it costs nothing to collect and it arrives before your money does.
If a programme declines to answer, that is an answer. The market currently offers 20 priced alternatives, the cheapest verified at $145 a month all-in at a maintenance dose.
The failure mode this section guards against
Choosing a programme on a number that describes a different situation than yours. An entry price when you will hold maintenance. A medication figure when a membership applies. A promotional rate when you will renew.
Each error is small alone and they compound in one direction, which is why the cheapest-looking option in most published comparisons is the one most likely to be mis-stated. Priced correctly the cheapest verified route sits at $145 a month all-in at a 2.4 mg maintenance dose.
Why we publish the working rather than a verdict
A single recommendation reads better and acts worse, because it hides the weighting. Two readers with different maintenance doses, different coverage and different tolerance for commitment should not receive the same answer.
So the tables carry the inputs and every ranking states its sort key. Disagree with our weighting and you can take the file and weight it yourself — which is what publishing it is for.
The number most people get wrong
The month-six figure. Almost everyone budgets from the first month, which on semaglutide describes four weeks at 0.25 mg — roughly 1 mg of active drug against the 9.6 mg a maintenance month delivers.
Ten of your first twelve months are spent at or near maintenance. A ranking sorted on the advertised month is sorting on about eight per cent of your year, and on a dose-scaled programme those are different numbers entirely.
Run the first-year calculator at the dose you expect to hold. It takes under a minute and it reorders the market for most people.
What a year of this actually looks like
Four weeks at 0.25 mg, four at 0.5 mg, four at 1 mg, four at 1.7 mg, then 2.4 mg for the remainder. Sixteen weeks of titration if nothing is repeated, and repeats are common rather than exceptional.
Budget two extra months at a lower tier and treat anything better as upside. Fix a weekly injection day, record dose and date, and diary the renewal date if an introductory rate applies — the reversion is where most complaints in this category begin.
Putting who writes your prescription in proportion
It is one input into a decision with three parts: what you pay at the dose you hold, who makes what you inject, and what happens if you stop. Weighting one to the exclusion of the others is how people end up on a cheap programme they abandon in month nine.
The frame: 20 programmes publish a capturable price, spanning $145 to $324 a month all-in at a 2.4 mg maintenance dose. 4 charge a mandatory recurring fee. 6 name the dispensing pharmacy before purchase.
What good looks like
A figure at a named dose, the pharmacy named, cancellation terms published before payment, and a plain statement that a compounded preparation is not FDA-approved. Four things, all cheap to publish, and a minority does all four.
The cheapest verified route sits at $145 a month, which establishes that disclosure and low price are not in tension.
What to ask before you pay
Five questions, all answerable in a short email, all before a medical history changes hands: the total at a maintenance dose including every fee; which pharmacy fills it; whether the prescriber is licensed in your state; the notice period to cancel and what is refundable; and which form of the active ingredient the pharmacy compounds from.
None requires clinical training to evaluate. The speed and specificity of the reply tells you how the operation is run, and it arrives before your money does.
Open these rather than taking our word for it. Every one is a regulator, a trial registry, a label, an accreditor or the manufacturer.
Compare every programme on one screen
The matrix carries all-in price at every dose, fee structure, commitment terms, pharmacy disclosure and verification status for every programme we track.