Stopping, regain, cost & access

The single most important thing to understand before starting: these are treatments, not cures. They work while you take them, and the weight returns when you stop — which reframes them as long-term therapy for a chronic condition, with the cost and access questions that implies.

Stopping means regain

The withdrawal data: When treatment stops, the appetite biology reasserts itself. A year after stopping semaglutide, people regained about two-thirds of the lost weight (STEP 1 extension). In a tirzepatide withdrawal trial, those switched to placebo regained ~14% while those continuing kept losing; ~90% who continued held onto their loss vs ~17% who stopped. Blood pressure, glucose and lipid gains reverse in step. Evidence ●●●●●
The framing: This behaves like blood-pressure or cholesterol medication: it works while taken, and the numbers drift back when it stops — not because the patient failed, but because the underlying drive was being suppressed, not removed. Current practice treats anti-obesity medication as indefinite therapy paired with the lifestyle foundation, not a time-limited course.

Cost & access

Price: US list prices run ~$1,000–1,350/month, but real cash prices have fallen sharply via manufacturer direct-pay programs — roughly $350–500/month for self-pay in late 2025. These figures move fast and vary by dose and country; treat any single number as a snapshot, not a fixed price.
Insurance & compounding: US Medicare is barred by statute from covering drugs for weight loss (it can cover them for a separate approved indication such as cardiovascular risk or sleep apnoea); commercial coverage is patchy, with prior authorisation common. The mass market in cheaper compounded semaglutide/tirzepatide lost its legal footing when the FDA declared the shortages over in 2025 — and the agency has flagged wrong salt forms and dosing errors (some causing hospitalisation) in compounded products.

Decide for the long term up front

Because stopping predictably reverses the result, the honest question before starting is not ‘can I lose the weight?’ but ‘can I sustain this — cost, tolerability and all — for the long haul, alongside the habits that carry the outcome either way?’

The Weight Loss Guide