By Foundayo and Zepbound are both Eli Lilly medicines for weight management in adults, and both can be bought self-pay from LillyDirect. They are different drugs: Foundayo (orforglipron) is a pill you take once a day, and Zepbound (tirzepatide) is an injection you give once a week. In their main trials, Zepbound’s average weight loss was larger, but the trials were separate, and Foundayo costs less self-pay and needs no needles.
Gentle Health’s doctor prescribes both, in all 41 jurisdictions where our physician is licensed, for the same $28/month of doctor’s care. Here is how they compare.
At a glance
| Foundayo | Zepbound | |
|---|---|---|
| Medicine | orforglipron | tirzepatide |
| How you take it | one tablet a day, with or without food | one injection a week |
| FDA-approved for weight management | April 1, 2026 | November 8, 2023 |
| Also approved for | — | moderate to severe obstructive sleep apnea in adults with obesity |
| Average weight loss in the main 72-week trial | 11.1% on the highest dose (2.1% on placebo) | 20.9% on the highest dose (3.1% on placebo) |
| LillyDirect self-pay price | $149 to $299 a month by dose | $299 to $449 per four weeks by dose |
| Needles to buy | none | pen needles or syringes |
Prices as of October 18–19, 2026, from LillyDirect. Approval and dosing details from the Foundayo and Zepbound prescribing information.
Weight loss: what the trials showed
Foundayo. In its main 72-week trial, in adults with obesity or overweight and without diabetes, people on the highest dose (17.2 mg) lost 11.1% of their body weight on average, against 2.1% on placebo. On 9 mg the average was 8.3%.
Zepbound. In SURMOUNT-1, a 72-week trial in adults with obesity or overweight and without diabetes, the average weight change was −15.0% on 5 mg, −19.5% on 10 mg and −20.9% on 15 mg, against −3.1% on placebo (Jastreboff et al., NEJM 2022).
These were separate trials, not a head-to-head comparison, so the numbers cannot be set side by side precisely. They do point the same way: on average, the weekly injection produced more weight loss. Averages are not predictions for any one person, and how well you tolerate a medicine, and stay on it, matters as much as its trial result.
Side effects
Both cause mostly digestive side effects, such as nausea, diarrhea, vomiting and constipation, and for both they are most common while the dose is going up. On Foundayo’s highest dose, 35% of people had nausea at some point (10% on placebo), and across its trials 8% stopped because of side effects (3% on placebo).
The two labels share the class warnings: neither is for anyone with a personal or family history of medullary thyroid carcinoma or MEN2, neither should be combined with another GLP-1 medicine, and both labels advise people on birth-control pills to switch method or add a barrier method for a period after starting and after each dose increase. The doctor goes through your history and other medicines before prescribing either.
Daily routine
Foundayo is one tablet a day, at any time, swallowed whole, with or without food. There is no wait before eating or drinking, unlike the Wegovy pill. The trade is that a missed dose comes around every day rather than once a week.
Zepbound is one injection a week, on the same day each week. You choose single-dose vials, drawn up with a syringe, or the KwikPen, which holds four weekly doses and uses a new pen needle each time. Both cost the same at LillyDirect; Zepbound vial vs KwikPen explains the difference.
If needles are the main obstacle to starting, a daily pill removes it. If remembering a daily dose is harder for you than a weekly shot, the injection may fit better.
What each costs self-pay
| Starting dose | Higher doses | |
|---|---|---|
| Foundayo, per month | $149 (0.8 mg and 2.5 mg) | $199 at 5.5 mg; $299 at 9 mg, 14.5 mg and 17.2 mg ($349 at the top two if not refilled within 45 days) |
| Zepbound, per four weeks | $299 (2.5 mg) | $399 at 5 mg; $449 at 7.5 mg to 15 mg if refilled within 45 days, otherwise $499 to $699 |
Foundayo’s 2.5 mg and 5.5 mg prices are temporarily reduced until December 31, 2026. A Foundayo month is 30 days; a Zepbound fill is 28 days, so a year of Zepbound is 13 fills. At Gentle Health, the doctor’s care is $28/month for either medicine, charged once the doctor writes the prescription, with no minimum. What a full year adds up to is in how much is Zepbound without insurance? and Foundayo: cost, who it is for, and how it compares.
Insurance and Medicare
Both have Lilly savings cards for commercial insurance that covers them, bringing a covered fill down to as little as $25, with caps, and both cards end December 31, 2026. Both are on the temporary Medicare GLP-1 Bridge for eligible people, with a $50 monthly copay through December 31, 2027 (CMS). Gentle Health does not bill insurance or handle prior authorizations, so if your plan covers one of them, check that route first.
Which one?
That is a decision for you and your doctor, but the trade-offs are usually these:
- Zepbound produced more weight loss on average in its trials, is also approved for sleep apnea in adults with obesity, and is taken once a week, but it is an injection and costs more self-pay.
- Foundayo is a pill with no needles and no food rules, and costs less self-pay, but its average trial weight loss was lower and it is taken every day.
You can also change later. Moving from one to the other means a new prescription, and the doctor decides the starting dose.
Getting either through Gentle Health
You complete one online intake, and the doctor reviews it in writing or by video visit, depending on your state’s rules. If a medicine is right for you, the doctor sends the prescription to LillyDirect, which texts or emails you how to check out. You pay us $28/month for the doctor’s care, including messaging and video visits, and LillyDirect for the medicine. There is no minimum, and you can cancel any time. A prescription is never guaranteed. The steps are in how to get a Foundayo prescription online and how to get a Zepbound prescription online. Gentle Health is not affiliated with Eli Lilly.
Frequently asked questions
Is Foundayo as effective as Zepbound? In their separate main trials, average weight loss was 11.1% on Foundayo’s highest dose and 20.9% on Zepbound’s highest dose, over 72 weeks each. The trials were not head to head, but on average the injection produced more weight loss.
Is Foundayo cheaper than Zepbound? Self-pay, yes. On LillyDirect, Foundayo costs $149 to $299 a month by dose, and Zepbound $299 to $449 per four weeks if refilled on time, as of October 2026.
Can I switch from Zepbound to Foundayo, or back? Yes, with a new prescription. Don’t take both together; the doctor decides the starting dose of the new medicine and when to begin it.
Do I need to take Foundayo with food or on an empty stomach? Either. The label says once a day, with or without food.
Does Gentle Health charge more for one than the other? No. The doctor’s care is $28/month for either, and you buy the medicine from LillyDirect.
Dr. James Simmons, MD