The most expensive mistake in this market is not paying too much a month. It is paying for months you will not use. Real-world data are consistent on this point and not widely quoted: in obesity cohorts without diabetes, approximately one third of members remain on therapy at one year, and among those with type 2 diabetes nearly half discontinue by twelve months and approximately seventy per cent by twenty-four [1]. Set that beside what this market actually charges and a structural problem appears.
The cheapest rate is almost always an annual one
Across the sellers this desk tracks, the pattern is near-universal: the figure on the product card is the twelve-month prepay rung, and the month-to-month rate for the same vial is substantially higher. A buyer comparing cards is comparing prepaid years. The published semaglutide figures run from $69 to $449 a month, a spread of 6.5 times, and the bottom of that range is dense with annual commitments. The ranked board shows which figures carry a term behind them.
What the persistence figures do and do not say
These are real-world claims and cohort data, not trial results, and they measure something the trials cannot: what people do when nobody is calling them for a study visit. The commentary behind the figures proposes using pharmacy claims to spot early warning signs of discontinuation, and the signs it names are worth reading as a buyer rather than a payer: delayed refills, prolonged use of starter doses, high out-of-pocket costs, and patterns of gastrointestinal adverse effects [1].
Two of those four are about money. High out-of-pocket cost is itself a predictor of stopping, which means the annual prepay sits on both sides of the equation: it lowers the monthly figure and raises the amount at risk.
Cost is itself a reason people stop
A retrospective real-world cohort of adults with overweight or obesity and no diabetes (n = 248, mean age 55.0 years, mean BMI 34.8 kg/m², 77.5 per cent female) recorded why people came off semaglutide. Discontinuation due to non-severe gastrointestinal adverse events was 10.4 per cent, and discontinuation due to cost was 5.7 per cent[2]. The authors describe persistence in the cohort as low and call for structured support to improve it.
Those two reasons are worth holding side by side. One in twenty people in that cohort stopped because of the price, not the drug — which is a different failure from not tolerating it, and the only one a buyer can do anything about before starting.
The measurement nobody has made
No published figure describes persistence among people who paid twelve months up front. It is plausible that prepaying improves persistence — sunk cost is a real motivator — and it is equally plausible that the people willing to prepay are simply different from those who are not. Neither has been measured, and this article is not going to pretend otherwise. What can be said is that the general population figure is about one in three at a year, and that the discount structure of this market is built on twelve.
What to actually do
What a plan costs to leave is the other half of this, and stopping has its own price. Ask three questions before accepting an annual rate. What is the month-to-month figure for the same product? What happens to money already paid if the plan stops? And does the rate hold if the dose rises — because most sellers publish nothing about that, and a dose increase is one of the points where people stop. The cost calculator will run the arithmetic at whatever term you are considering.
Price figures above are computed from this site’s own records at build time, most recently read September 2026. The persistence figures are cited and are not this site’s own.