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 Five mechanisms explain nearly the entire spread: annual-prepay teaser rates, membership fees billed separately, unpublished dose-tier increases, medication-only prices that exclude the care, and - at the very bottom - products that are not legitimately prescribed medication at all.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 (the FDA’s warning on unapproved GLP-1 drugs).
What an honest price looks like
It is transparent, it is published at every tier, and it includes the care. Ours, in full: injectable semaglutide $135 / $159 / $199 by dose tier; 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 cancelling stops future charges and shipments. The price you see is the final price, full stop. (Brand-name care is priced differently: our doctor also prescribes Zepbound, Wegovy and Foundayo for $28/month of doctor’s care, and you buy the medicine from the maker’s own pharmacy at its self-pay price.) 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 $135 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