I want to add a cautionary note about the compounding route: with the FDA's evolving stance on compounded semaglutide and the ongoing legal battles, availability may change. Novo Nordisk has been aggressive about challenging the shortage designations that allow compounding. If/when Wegovy is no longer in shortage, many compounding pharmacies will be legally required to stop producing it.

This isn't a reason not to use compounded — it's a reason to have a backup plan and to be aware that the landscape is shifting. Talk to your provider about contingency plans.

I should add — the gym membership and protein supplements are costs I'd incur regardless of whether I was on semaglutide. If you strip those out and compare purely medication-related costs (sema + supplies + labs + visits), I'm at $2,305 over 10 months, or $230/month. That's what the treatment itself costs me.

For the health improvements I've gotten (53 lbs lost, off 2 medications, sleep apnea resolved, pre-diabetes reversed, lipids normalized), I would pay significantly more. The ROI on health is effectively infinite.

Has anyone done the calculation on what a single cardiovascular event costs vs. a year of semaglutide? I imagine a heart attack or stroke makes even brand-name Wegovy look like a bargain.

Average cost of a heart attack in the US: $760,000 in lifetime direct medical costs. Average cost of stroke care: $240,000 in the first year alone. A year of brand-name Wegovy: $16,320.

If semaglutide reduces MACE events by 20% (as shown in SELECT), the expected value calculation isn't even close. For a high-risk patient, the medication pays for itself many times over in avoided catastrophic costs. This is why insurance SHOULD cover it — and increasingly will, once payers catch up to the outcomes data.