Because the advertised number and the monthly bill are often different products. Five mechanisms explain nearly the entire spread: annual-prepay teaser rates, membership fees billed separately, unpublished dose-tier increases, medication-only prices that exclude the care, and - at the very bottom - products that are not legitimately prescribed medication at all. Once you know the five, any price in this category can be decoded in about a minute. For concrete numbers, compare the full semaglutide tier table, then use the GLP-1 question library for the rest of the decision.
The five mechanisms, decoded
1. The annual-prepay teaser. The famous “$99/month” is usually the per-month rate of a full-year prepaid commitment; the month-to-month rate at the same provider can be double or more. Neither number is a lie; only one of them is the price you would actually pay.
2. The membership split. “$149/month medication” plus “$49/month membership” is $198. Splitting the bill makes the headline smaller; it does not make the total smaller.
3. The dose-tier reveal. Most people titrate up from a starting dose. Providers that publish only the starting-dose price are pricing the month you will spend the least time in. The tier table is the real price list - if you cannot see it before paying, that is the strategy.
4. Medication-only pricing. Some low prices genuinely are low because they include nothing else: the evaluation, follow-up, dose adjustments, and shipping each bill separately, or worse, do not exist.
5. Below the floor. In a market check completed September 3, 2026, we found no legitimately prescribed, pharmacy-compounded, physician-supervised GLP-1 priced under $100 a month all-in at every dose. Some providers advertise medication alone below $100 but add a membership or increase the rate by dose. Offers that claim to stay below that all-in floor deserve close scrutiny; gray-market vials and evaluation-free pipelines are different products with different risks: Are “research peptides” safe to buy online?
What an honest price looks like
It is transparent, it is published at every tier, and it includes the care. Ours, in full: oral semaglutide $112 / $189 / $258 by dose tier; injectable semaglutide $135 / $159 / $199; tirzepatide $169 / $219 / $269. Medication, evaluation and follow-up with James Simmons, MD, messaging and video visits, and overnight refrigerated shipping are all included, with nothing added afterward: no taxes, no visit fees, no delivery charges, no membership fee, and you can cancel future refills whenever you want. The price you see is the final price, full stop. We publish the full table because the alternative - being the surprise on someone’s third-month statement - is a business model we do not want.
The one-question audit for any provider
“What is the all-in monthly price, at the highest dose tier I might reach, month-to-month with no prepay - in writing?” Every mechanism above dissolves under that sentence. A provider with a good answer will give it instantly. A provider without one will offer you a quiz.
Frequently asked questions
What does compounded semaglutide actually cost without insurance? From $112 a month at Gentle Health with every tier published, full and final - the complete table and the market context are at How much does compounded semaglutide cost without insurance?
How much is tirzepatide per month? From $169 a month compounded, with brand and direct-program prices for comparison, at How much does tirzepatide cost per month?
Can you buy GLP-1 pills without a prescription? No - anything containing real GLP-1 medication legally requires one, and what the no-prescription shelf actually sells is sorted at Can you buy GLP-1 pills online?
Dr. James Simmons, MD