Trulicity vs Ozempic: Which Works Better, Dosage, and Cost
Trulicity (dulaglutide) and Ozempic (semaglutide) are GLP-1 injections for type 2 diabetes, and the retrieved labeling lists no weight-loss use for either. Trulicity lists at $1,006.93 per month; the Ozempic pill self-pays at $149 to $299 per month.
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Trulicity and Ozempic are both GLP-1 receptor agonist injections for type 2 diabetes, but they are different molecules made by different companies. Trulicity is dulaglutide, from Eli Lilly, injected under the skin once weekly, and it was first approved in the United States in 2014 [1]. Ozempic is semaglutide, from Novo Nordisk, and the injection has been prescribed for about eight years [2]. Neither the Trulicity label nor the Ozempic materials reviewed here lists a weight-management indication [1][2]. On price, Trulicity’s list price is $1,006.93 per month [8], while the new Ozempic pill is sold self-pay at $149 to $299 per month depending on the strength [2].
Which one works better? There is one head-to-head trial between the two molecules, published in 2018 in Lancet Diabetes & Endocrinology, but its text was not available for verification here; Trulicity’s current label includes 3 mg and 4.5 mg strengths [1], and the retrieved materials do not show which doses that trial tested, so it cannot settle the question at today’s strengths [3]. The strongest verified numbers come from separate trials of each drug: Trulicity’s highest dose, 4.5 mg once weekly, lowered HbA1c by 1.77% at 36 weeks in its own dose-escalation trial [4], and semaglutide at 2.4 mg once weekly — a dose studied in adults with overweight or obesity, not an Ozempic diabetes dose — produced an average weight change of −14.9% over 68 weeks [5].
What are Trulicity and Ozempic, and what are they approved for?
Trulicity (dulaglutide) is a GLP-1 receptor agonist given by subcutaneous injection. The FDA first approved it in 2014 [1]. Its label lists two uses: improving glycemic control, along with diet and exercise, in adults and children 10 and older with type 2 diabetes; and reducing the risk of major adverse cardiovascular events (MACE) — heart attack, stroke, cardiovascular death — in adults with type 2 diabetes who either have established cardiovascular disease or have multiple cardiovascular risk factors [1].
Ozempic (semaglutide) is also a GLP-1 receptor agonist. The injection is indicated to improve blood sugar along with diet and exercise, to reduce the risk of MACE in adults with type 2 diabetes who also have known heart disease, and to reduce the risk of worsening kidney disease, end-stage kidney disease, and death due to cardiovascular disease in adults with type 2 diabetes and chronic kidney disease [2]. Ozempic injection and Ozempic tablets are not approved for use in children [2].
Both products carry thyroid warnings, described in each one’s own materials. Trulicity’s boxed warning states that dulaglutide causes thyroid C-cell tumors in rats and that human relevance has not been determined; the label contraindicates the drug in anyone with a personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), or with serious hypersensitivity to dulaglutide [1]. Ozempic’s safety information states that in studies with rodents, Ozempic and medicines that work like it caused thyroid tumors including cancer, that it is not known whether Ozempic causes thyroid tumors or MTC in people, and that it should not be used by anyone with a personal or family history of MTC or with MEN 2 [2].
Is Ozempic stronger than Trulicity for lowering A1C?
The one direct comparison is a trial called SUSTAIN 7, published in 2018 in Lancet Diabetes & Endocrinology, which compared semaglutide against dulaglutide head to head [3]. The full text of that publication was not available for verification here, so no A1C, weight, or side-effect figures from it are quoted on this page [3].
There is a second limitation: Trulicity’s current label includes 3 mg and 4.5 mg single-dose pens [1], and the retrieved materials do not show whether the 2018 trial tested those strengths, so its results cannot be assumed to describe the top of today’s Trulicity dose range.
What is well verified is how Trulicity’s higher doses perform against its standard dose. In AWARD-11, a randomized, double-blind trial at 203 sites in 15 countries, 1,842 adults with type 2 diabetes inadequately controlled on metformin were assigned to once-weekly dulaglutide at 1.5 mg, 3.0 mg, or 4.5 mg for 52 weeks, with the primary A1C endpoint measured at 36 weeks [4]. Participants had a mean baseline HbA1c of 8.6% and a mean BMI of 34.2 kg/m² [4].
At 36 weeks, dulaglutide 4.5 mg reduced HbA1c by 1.77% versus 1.54% for the 1.5 mg dose (treatment-regimen estimand), an estimated treatment difference of −0.24 percentage points, P<0.001 [4]. On the efficacy estimand the gap was larger: −1.87% versus −1.53%, a difference of −0.34 percentage points, P<0.001 [4]. The 3.0 mg dose beat 1.5 mg on the efficacy estimand (−0.17 percentage points, P=0.003) but not on the treatment-regimen estimand (−0.10, P=0.096) [4]. Several authors of AWARD-11, including the corresponding author, are Eli Lilly employees [4].
No comparable published trial of Ozempic’s current doses against Trulicity’s current doses is available in the materials reviewed here, so the question of which lowers A1C more at today’s strengths has not been answered by a verified head-to-head source.
What is the dosage chart for Trulicity versus Ozempic?
The two drugs are dosed very differently, and the milligram numbers are not comparable across them — dulaglutide and semaglutide are different molecules, so 1.5 mg of one is not equivalent to 1.5 mg of the other [1][2].
One scope note before the table: the retrieved materials include Trulicity’s prescribing information and Novo’s announcement about the Ozempic pill, but no Ozempic injection prescribing information. The Ozempic injection’s dose ladder is therefore not described on this page, and the table below compares the Trulicity injection with the Ozempic tablets only [1][2].
| Trulicity (dulaglutide) injection | Ozempic (semaglutide) tablets | |
|---|---|---|
| How it is taken | Injected under the skin once weekly, any time of day, with or without food; abdomen, thigh, or upper arm [1] | Taken by mouth; one month is defined as one bottle of 30 tablets [2] |
| Starting dose | 0.75 mg once weekly, per prescribing information [1] | Novo’s self-pay pricing describes 1.5 mg as the starting dose; tablet dosing from a prescribing label is not quoted here [2] |
| Available strengths | 0.75, 1.5, 3, and 4.5 mg single-dose pens [1] | 1.5 mg, 4 mg, and 9 mg tablets [2] |
| Highest strength | 4.5 mg once weekly, the maximum recommended dosage [1] | 9 mg is the highest strength marketed; Novo has filed for a 25 mg strength, with an FDA decision expected by end of 2026 [2] |
For Trulicity, the prescribing information states that after 4 weeks the dosage may be increased to 1.5 mg once weekly for additional glycemic control, and that further increases happen in 1.5 mg increments after at least 4 weeks on the current dosage, up to a maximum of 4.5 mg once weekly [1]. For children 10 and older, the label’s starting dosage is 0.75 mg once weekly, increased only if additional glycemic control is needed [1]. If a Trulicity dose is missed, the label says to take it as soon as possible if there are at least 3 days (72 hours) until the next scheduled dose [1].
For the Ozempic pill, the self-pay prices are tiered by strength — $149 per month for the 1.5 mg dose Novo describes as the starting dose, $199 per month for 4 mg, and $299 per month for 9 mg — with one month defined as one 30-tablet bottle [2]. This page does not suggest any starting or target dose for either drug; the dosing described here is a summary of FDA-approved prescribing information, and an individual prescription governs [1].
What are the side effects of Trulicity and Ozempic?
The commonly reported side effects are similar. Trulicity’s most common adverse reactions, reported at 5% or more, are nausea, diarrhea, vomiting, abdominal pain, and decreased appetite [1]. In AWARD-11, nausea through 36 weeks occurred in 13.4% of the 1.5 mg group, 15.6% of the 3 mg group, and 16.4% of the 4.5 mg group; vomiting occurred in 5.6%, 8.3%, and 9.3%, respectively — so the higher doses carried somewhat more GI burden [4].
Trulicity’s warnings and precautions include acute pancreatitis; hypoglycemia when combined with insulin or an insulin secretagogue; serious hypersensitivity reactions including anaphylaxis and angioedema; acute kidney injury from volume depletion; severe gastrointestinal reactions (the label states Trulicity is not recommended in patients with severe gastroparesis); complications of diabetic retinopathy; acute gallbladder disease; and pulmonary aspiration during general anesthesia or deep sedation [1]. The severe GI and pulmonary aspiration sections were added to the label in November 2024 [1]. Trulicity also delays gastric emptying, which can reduce the rate of absorption of other oral medications taken at the same time [1].
Ozempic’s safety information lists overlapping categories: pancreatitis, changes in vision, low blood sugar when used with a sulfonylurea or insulin, dehydration leading to kidney problems, severe stomach problems, serious allergic reactions, and gallbladder problems [2]. Ozempic’s information also tells patients to stop using it 2 months before a planned pregnancy, and states that breastfeeding is not recommended during treatment with Ozempic tablets [2]. One device note: the Ozempic pen should never be shared with another person, even with a changed needle, because of infection risk [2].
Trulicity’s label instructs patients to inform healthcare providers of any planned surgeries or procedures [1], and Ozempic’s safety information tells patients to tell their provider if they are scheduled for surgery or other procedures that use anesthesia or deep sedation [2].
Which causes more weight loss, Trulicity or Ozempic?
Neither the Trulicity label nor the Ozempic materials reviewed here carries a weight-management indication [1][2]. Any weight change on these drugs is a secondary effect of a diabetes treatment, not the treated condition.
The verified weight numbers that exist are not head-to-head. In AWARD-11 — a trial of people with type 2 diabetes on metformin — the highest Trulicity dose produced a mean weight change of −4.6 kg at 36 weeks, versus −3.0 kg on the 1.5 mg dose, a difference of −1.6 kg, P<0.001 [4].
For semaglutide, the large weight number comes from a different drug, at a different dose, in a different population. STEP 1 enrolled 1,961 adults with a BMI of 30 or more (or 27 or more with a weight-related condition) who did not have diabetes, and treated them for 68 weeks with semaglutide 2.4 mg once weekly or placebo, plus lifestyle intervention [5]. Mean weight change was −14.9% with semaglutide versus −2.4% with placebo, a treatment difference of −12.4 percentage points; in absolute terms, −15.3 kg versus −2.6 kg [5]. Some 86.4% of the semaglutide group lost at least 5% of body weight, 69.1% lost at least 10%, and 50.5% lost at least 15% [5]. That 2.4 mg weekly dose is not an Ozempic diabetes dose, and the trial population did not have diabetes, so these figures cannot be read as “what Ozempic does” [5].
For context on what drugs actually studied for obesity achieve, SURMOUNT-1 enrolled 2,539 adults with a BMI of 30 or more, or 27 or more with at least one weight-related complication, excluding diabetes, and treated them for 72 weeks with tirzepatide — a different molecule again — at 5, 10, or 15 mg weekly, or placebo. Mean weight change was −15.0% on 5 mg, −19.5% on 10 mg, and −20.9% on 15 mg, versus −3.1% on placebo; adverse events led 4.3%, 7.1%, and 6.2% of the tirzepatide groups to stop treatment, versus 2.6% on placebo [6]. These three trials — AWARD-11, STEP 1, and SURMOUNT-1 — studied different drugs, doses, durations, and populations, so their numbers cannot be lined up as a single ranking [4][5][6].
How do the heart-related indications differ?
The cardiovascular claims on the two labels are worded differently, and the difference matters. Trulicity’s MACE indication covers adults with type 2 diabetes who have established cardiovascular disease or multiple cardiovascular risk factors — a broader group that includes people who have not yet had a cardiovascular event [1]. The label’s section 14.5 describes a cardiovascular outcomes trial in exactly that population [1]. The retrieved label excerpt does not name that trial or report its results, and no outcomes-trial publication could be retrieved for verification, so no hazard ratios or event rates are quoted on this page [1].
The Ozempic injection’s MACE indication is framed around adults with type 2 diabetes who also have known heart disease — secondary prevention language [2]. The Ozempic pill goes further: Novo states it is the only oral GLP-1 medicine approved for both primary and secondary cardiovascular risk reduction — heart attack, stroke, and death — in adults with type 2 diabetes at high risk for these events [2]. The two labels’ wordings are not interchangeable, and this page does not treat them as such [1][2].
What does Trulicity cost without insurance?
Trulicity’s list price is $1,006.93 per month, where a month is defined as four pens [8]. List price is the wholesale acquisition cost (WAC) — the price Lilly charges wholesalers — and it excludes rebates, insurance, pharmacy charges, and any patient assistance, so it is not what most patients actually pay [8]. The WAC figure is from AnalySource, accessed January 1, 2026 [8].
Lilly publishes what patients actually paid, based on an internal analysis of HealthVerity real-world data covering January through December 2024, accessed September 20, 2025 [8]:
| Coverage type | Out-of-pocket experience per Trulicity prescription |
|---|---|
| Commercial or employer insurance | About 40% pay $0; 90% pay less than $75 [8] |
| Medicare | About 70% pay $0; 90% pay less than $47 [8] |
| Medicaid | About 90% pay $0 [8] |
For commercially insured patients with Trulicity coverage, the Trulicity Savings Card drops the cost to as little as $25 for a 1-, 2-, or 3-month fill, where one month is 28 days and up to 4 pens [10]. Savings are capped at $150 per 1-month fill, $300 per 2-month fill, and $450 per 3-month fill, with a $1,950 annual maximum, up to 13 fills per calendar year, and the card expires December 31, 2026 [10]. The card excludes anyone enrolled in Medicaid, Medicare, Medicare Part D or Advantage, Medigap, DoD, VA, TRICARE, or state drug assistance programs, and is limited to US or Puerto Rico residents 18 and older [10]. Lilly also donates medicines to the Lilly Cares Foundation, a nonprofit that provides them free to qualified people in need, reachable at 1-800-545-6962 [8].
On the Ozempic side, the pricing published so far covers the pill, not the injection. Novo states the pill will be covered by insurance for most patients with type 2 diabetes for as little as $25 for up to a 3-month prescription, and self-pay through NovoCare Pharmacy or select telehealth providers runs $149 per month for the 1.5 mg starting dose, $199 for 4 mg, and $299 for 9 mg, with government beneficiaries excluded [2].
| Product and route | Published price |
|---|---|
| Trulicity, list price (WAC) | $1,006.93 per month (4 pens) [8] |
| Trulicity, savings card (commercial insurance only) | As little as $25 per 1-, 2-, or 3-month fill [10] |
| Ozempic pill, with insurance | As little as $25 for up to a 3-month prescription [2] |
| Ozempic pill 1.5 mg, self-pay | $149 per month [2] |
| Ozempic pill 4 mg, self-pay | $199 per month [2] |
| Ozempic pill 9 mg, self-pay | $299 per month [2] |
A comparable published list price for the Ozempic injection was not available in the materials reviewed here. CMS does publish a weekly reference dataset of pharmacy acquisition costs (NADAC, the National Average Drug Acquisition Cost), updated most recently on September 8, 2026, but the retrieved dataset page did not display per-unit prices for Trulicity or Ozempic products, so no per-unit or per-month pharmacy-cost comparison can be made from it here [9].
Reports have also circulated about Medicare drug-price negotiation affecting these products and about a Novo Nordisk list-price cut for GLP-1s. The CMS pages describing third-cycle negotiated drug selections and negotiated prices, and the analysis of Novo’s list-price announcement, could not be retrieved for verification, so no negotiated price, selection status, or list-price change is stated as fact on this page [11][14][15].
What replaced Rybelsus, and how does Trulicity compare to it?
Oral semaglutide was previously sold in the US as Rybelsus tablets at 3 mg, 7 mg, and 14 mg, first approved in 2019. Those strengths have been reformulated and relaunched as Ozempic tablets at 1.5 mg, 4 mg, and 9 mg, available in US pharmacies starting May 4, 2026 [2]. Novo states the new pill works similarly to the old 3/7/14 mg tablets, with the same efficacy and safety profile in a smaller pill [2]. That statement does not mean the old and new strengths convert one-to-one, and this page makes no such conversion claim [2]. Rybelsus continues to be sold outside the US; Novo tells US Rybelsus patients to continue their medication as directed and speak with their healthcare professional about transitioning [2].
Against Trulicity, the Ozempic pill’s clearest difference is the route: Novo describes it as the only FDA-approved oral peptide GLP-1 medication for adults with type 2 diabetes, taken by mouth rather than injected [2]. It is manufactured end to end in the US and available through more than 70,000 US pharmacies [2]. Novo has also filed a supplemental application for a 25 mg tablet strength, with an FDA decision expected by the end of 2026 [2].
Can you switch from Trulicity to Ozempic?
No verified switching protocol between the two drugs is available in the materials reviewed here. A published guidance paper on switching between GLP-1 receptor agonists exists in the medical literature, but its text could not be retrieved for verification, so no step-by-step instructions — including whether to overlap, pause, or restart at a lower dose — are quoted here [13]. What can be said is that the two drugs are not substitutes at the milligram level: dulaglutide and semaglutide are different molecules with different dosing ladders, so a Trulicity dose does not map onto an Ozempic dose [1][2].
Device and routine differences are worth raising with a clinician. Trulicity comes as single-dose pens, one strength per pen, injected once weekly [1]. The Ozempic pen must never be shared with another person, even if the needle has been changed, because of infection risk [2]. The Ozempic pill adds an oral option to the semaglutide brand [2]. As one clinician quoted in Novo’s announcement put it, injectable and oral medicines both treat adults with type 2 diabetes but “are not the same,” and the goal is to find the option that fits a patient’s needs, preferences, and routines [2].
What should you bring to a conversation with your clinician?
The dosing and safety details on this page are summaries of FDA-approved prescribing information and company-published pricing; an individual prescription and insurance plan govern what actually applies [1]. Useful items for that conversation include: current A1C and weight trends, GI tolerability on any current GLP-1, heart and kidney history (the two products’ approved cardiovascular and kidney claims are worded differently), insurance formulary status and out-of-pocket cost, and any planned surgery or anesthesia — which Trulicity’s label and Ozempic’s safety information both ask patients to report [1][2].
To report suspected adverse reactions to Trulicity, the label lists Eli Lilly at 1-800-545-5979 or the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch [1]. This page is general information, not medical advice, and it does not suggest starting, stopping, switching, or combining any GLP-1 medication — those decisions belong with a prescriber [1][2].
Sources
- US Food and Drug Administration. Trulicity (dulaglutide) injection prescribing information. 2025.
- PR Newswire. Novo Nordisk’s Ozempic pill, the only FDA-approved oral peptide GLP-1 medication for adults with type 2 diabetes, soon to be available in the US. May 1, 2026.
- The Lancet Diabetes & Endocrinology. Semaglutide versus dulaglutide once weekly in patients with type 2 diabetes (SUSTAIN 7): a randomised, open-label, phase 3b trial.
- PubMed Central. Efficacy and Safety of Dulaglutide 3.0 mg and 4.5 mg Versus Dulaglutide 1.5 mg in Metformin-Treated Patients With Type 2 Diabetes in a Randomized Controlled Trial (AWARD-11).
- PubMed. Once-Weekly Semaglutide in Adults with Overweight or Obesity.
- PubMed. Tirzepatide Once Weekly for the Treatment of Obesity.
- The Lancet. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial.
- Eli Lilly and Company. Trulicity cost information with or without insurance.
- Medicaid.gov. NADAC (National Average Drug Acquisition Cost) 2026. Updated September 8, 2026.
- Eli Lilly and Company. Trulicity savings card, cost and resources.
- Centers for Medicare & Medicaid Services. CMS announces selection of drugs for third cycle of Medicare Drug Price Negotiation Program, including first-ever Part B drugs. January 27, 2026.
- UnitedHealthcare. Discontinuation of Bydureon BCise and Byetta. December 19, 2024.
- PubMed Central. Switching Between Glucagon-Like Peptide-1 Receptor Agonists: Rationale and Practical Guidance.
- Mercer. Novo Nordisk’s GLP-1 list price cut. What to watch next.
- Centers for Medicare & Medicaid Services. Selected drugs and negotiated prices.
Frequently asked questions
Is Ozempic stronger than Trulicity for lowering A1C?
There is no verified answer at today's strengths. The only head-to-head trial (SUSTAIN 7, Lancet Diabetes & Endocrinology, 2018) could not be retrieved for verification, and the retrieved materials do not show which doses it tested. Trulicity is now marketed at strengths up to 4.5 mg. The best verified figure comes from Trulicity's own trial: 4.5 mg lowered HbA1c by 1.77% at 36 weeks versus 1.54% for 1.5 mg.
Which causes more weight loss, Trulicity or Ozempic?
Neither the Trulicity label nor the Ozempic materials reviewed here lists weight loss as an approved use; both are diabetes drugs. In Trulicity's own trial, the 4.5 mg dose produced −4.6 kg at 36 weeks in people with type 2 diabetes. The large semaglutide weight number (−14.9% at 68 weeks) comes from a 2.4 mg obesity dose in people without diabetes, not an Ozempic diabetes dose, so the figures are not comparable.
Can you switch from Trulicity to Ozempic?
Switching is a prescriber decision, and no verified switching protocol appears in the materials reviewed here — a published GLP-1 switching guidance paper could not be retrieved for verification. The milligram doses do not map between dulaglutide and semaglutide, which are different molecules. Do not stop, start, or combine GLP-1 medications without a clinician.
Why isn't Trulicity or Ozempic approved for weight loss?
Neither the Trulicity label nor the Ozempic materials reviewed here carries a weight-management indication; both list glycemic control and cardiovascular risk reduction in type 2 diabetes. Weight change on either drug is a secondary effect. The semaglutide dose studied for obesity (2.4 mg weekly) is different from the diabetes dosing, and its trial enrolled adults without diabetes.
What is the highest dose of each drug?
Trulicity's maximum recommended dosage is 4.5 mg injected once weekly, reached by increases in 1.5 mg increments after at least 4 weeks at each strength. The Ozempic pill is currently marketed at 1.5 mg, 4 mg, and 9 mg tablets; Novo has filed for a 25 mg strength with an FDA decision expected by the end of 2026. The milligram numbers are not comparable across the two drugs.
Is Trulicity being discontinued?
No discontinuation appears in the materials reviewed here. The label was updated as recently as November 2024 with new warnings sections, Lilly's savings card runs through December 31, 2026, and Lilly continues to publish current pricing. Reports about Medicare negotiation selecting Trulicity could not be verified against CMS and are not stated as fact.
What replaced Rybelsus, and do I need a new prescription?
Rybelsus tablets (3, 7, and 14 mg) were reformulated as Ozempic tablets at 1.5, 4, and 9 mg, available in US pharmacies starting May 4, 2026. Novo says the new pill has the same efficacy and safety profile in a smaller pill, but the strengths do not convert one-to-one. Novo tells Rybelsus patients to continue as directed and discuss transitioning with their healthcare professional.
Which is cheaper without insurance?
Trulicity's list price is $1,006.93 per month (four pens), though list price excludes rebates and insurance and is not what most patients pay. The Ozempic pill self-pays at $149 per month for 1.5 mg, $199 for 4 mg, and $299 for 9 mg through NovoCare Pharmacy or select telehealth providers. A comparable published list price for the Ozempic injection was not available here.
This article summarizes FDA labeling, published research and company information current as of September 14, 2026. It is not medical advice and does not replace a conversation with your own healthcare provider. How we research and verify.