The drug price is settled. Shop the prescribing service.
When insurance will not cover the drug, the medication costs what LillyDirect and NovoCare charge, just about wherever you buy it. What varies is the service that writes and maintains the prescription: $108 to $1,678 a year for the same thing.
This is the short version of the full comparison, which has the table, the numbers behind every claim, and the caveats in full.
$108
Your own doctor, estimated: quarterly check-ins at the $27 average copay
$117+
Amazon, a floor: from $39 a visit, refill policy unpublished
$1,678
Hims / LifeMD, first year: $39, then $149 a month

What I would do
- Ask your own doctor first. Quarterly check-ins at an average $27 copay are about $108 a year, and refills and dose changes usually go through the portal at no charge. Even a schedule with a visit for every dose change stays near $250 a year.
- No prescribing doctor? Start with Amazon, from $39 a visit, and ask the clinician one question before anything else: does the prescription come with refills? Amazon publishes no refill policy, and that answer is the difference between about a hundred dollars a year and several times that.
- Pay a monthly membership only if you know which problem it solves. Coaching is Noom at $99. Insurer-chasing is Ro or LifeMD at $149. Otherwise the fee mostly buys re-authorizations your own doctor typically handles free between visits.
The caveats that matter
- The drug price is settled at Lilly and Novo’s standard cash prices. None of the nine marks it up, and none discounts it.
- The medication is never included in a membership fee, on any of these routes.
- Every site leads with its cheapest number: discounted first months, plans that “start at” a price, prepaid annual rates. The price you will live with is a click or two deeper, sometimes unpublished.
- Amazon and CVS are floors, not totals. Neither publishes a refill policy.
- Only Amazon promises in writing not to charge you if it declines you, and Ro refunds your $39 start. The rest say nothing, and people report paying a full month to be told their BMI was too low.
- The cheap committed rates require prepay: Ro’s $74 a month means $888 up front; Sesame’s $59 needs an annual plan.
- Scope: cash pay for the drug, official branded product only. Ordinary doctor visits may still be insured, which is what keeps the top row cheap.

