Semaglutide vs. Bariatric Surgery Cost: A Complete Comparison

Bariatric surgery and semaglutide are two popular treatments for weight management. While both can support weight loss goals, their significant costs may lead to financial hesitation.

The good news is you can find an option that works for your health and budget. A full cost breakdown for surgery and semaglutide with, and without, insurance helps you understand the best option. Read on to discover how much each option costs and hidden fees you may not have considered.

Semaglutide vs. Bariatric Surgery

Semaglutide is a medication that can help facilitate weight loss. It mimics the effects of GLP-1, a naturally occurring hormone that regulates our appetite and helps control blood sugar levels. Currently, the FDA has approved three name-brand semaglutide medications: Ozempic, Wegovy, and Rybelsus.

There’s also compounded semaglutide, which is when a pharmacy creates a customized medication with semaglutide as the active ingredient. Compounded medications are potential choices when commercially available options cannot meet health or financial needs, though they’re not FDA-approved.

Compounded or commercial, semaglutide comes in either an injection you self-inject at home once a week or an oral tablet taken daily.

An alternative weight loss treatment is bariatric surgery. The term is misleading since there are multiple types. The most common include:

• Gastric sleeve: A surgeon removes most of the stomach, meaning less food will fit inside and the patient feels full sooner.
• Gastric bypass: The surgeon makes the actual stomach smaller.
• Adjustable gastric band: A surgeon places a band around the top of the stomach, creating a pouch with an adjustable opening. The inserted band makes someone feel fuller after eating.

Cost Breakdown Without Insurance (2024 Data)

The National Institute of Health estimates that bariatric surgery costs between $15,000 to $25,000. This range is intentionally big since the exact price depends on the surgery type, any complications, an individual’s insurance policy, and the follow-up care required.

Estimating the total cost for semaglutide is also tricky, since the price is paid monthly and each option has a wildly different price point. And how varied are we talking? Here are the list prices before insurance or discounts:

• Ozempic: $997.58 a month
• Wegovy: $1,349.02 a month
• Rybelsus: $997.58 a month
• Compounded semaglutide: can be as low as $179 a month

Upfront Costs

With semaglutide, the starting cost is the first month’s prescription, which could be the list prices above or a lower cost when insurance covers semaglutide. The nice thing about this pricing structure is that you pay on a month by month basis, meaning there isn’t a five figure hospital bill.

Bariatric surgery usually has that five figure upfront bill. There can also be follow-up costs which are hard to predict since they depend on how well someone recovers from surgery and if complications arise. For those with insurance, any surgery and follow-up costs are split between the insurance company and the individual.

Long-term Expenses

Comparing monthly payments to estimated surgery costs is like comparing apples to oranges. To make the comparison easier, here’s what each option may cost at the one-year and two-year mark:

Type	Cost at one-year mark	Cost at two-year mark
Bariatric surgery	$15,000-$25,000	$15,000-$25,000 (note: the amount could be more or the same, depending on surgical outcomes)
Ozempic	$11,970.96	$23,941.92
Wegovy	$16,188.24	$32,376.48
Rybelsus	$11,970.96	$23,941.92
Compounded Semaglutide	$2,148	$4,296

Insurance Coverage Comparison

For semaglutide, private insurance plans and Medicaid may (or may not) cover all or part of the bill. To find out what you’ll pay out-of-pocket, look at your plan’s drug formulary. Medicare, whether original or Medicare Advantage, covers semaglutide for type 2 diabetes or heart disease indication but not for weight loss. In fact, Medicare is legally prohibited from covering drugs prescribed specifically for weight loss.

Medicare can cover bariatric surgery when a physician determines a patient has specific indicators of morbid obesity (defined by Medicare as a BMI ≥30). Many private insurance plans and some state Medicaid plans also cover these surgeries, so long as the patient has prior authorization.

Prior Authorization Requirements

And what exactly is prior authorization? It’s when a doctor obtains approval for a treatment from a patient’s insurance company. When applying for prior authorizations, private insurance companies usually require physicians to justify why the surgery or prescription is medically necessary. They may also have to demonstrate that the patient enrolled in a non-surgical weight loss program first but didn’t get the desired results within a set time frame, often three to six months.

Insurance companies can deny claims for either bariatric surgery or semaglutide. If they do, you and your doctor can appeal their decision. The insurance company then has 30 days to respond or 72 hours if the appeal is urgent. The Obesity Action Collective offers guidance on how to repeal a denial for bariatric surgery and semaglutide.

What’s Typically Covered?

The exact costs covered for bariatric surgery vary wildly depending on your deductible and insurance policy.

Semaglutide costs are more predictable, thanks to the drug savings programs developed by Novocare, the manufacturer of Ozempic, Wegovy, and Ryblesus:

• Ozempic: With insurance, a one-, two-, or three-month supply costs as little as $25 out of pocket.
• Wegovy: A 28-day supply costs as little as $0 with insurance.
• Ryblesus: With insurance, it’s as little as $10 for a one-, two-, or three-month supply.
• Compounded semaglutide: Since these are custom medications, it’s more difficult to predict out-of-pocket costs, though they should be comparable if covered (around $10-25 a month).

If insurance doesn’t cover semaglutide, compounded semaglutide is the most affordable choice. That said, the savings program through the NovoCare Pharmacy means name-brand Wegovy direct from the manufacturer costs as little as $499 a month for qualifying individuals without insurance.

Effectiveness vs. Cost Analysis

When deciding between surgery and semaglutide, you want an option that doesn’t break the bank and works. You also want to keep in mind the potential maintenance cost (i.e. a monthly prescription or surgery follow-up costs).

Weight Loss Results Over Time

Surgery is more effective than semaglutide in the short-term, according to a 2023 meta-analysis that analyzed multiple studies on the two interventions. That’s because the surgery removes excess weight at once, instead of slowly over a longer period like semaglutide.

Still, that study mentions that surgery is also more invasive and can result in adverse complications, such as blood clots and infections. In fact, about one third of bariatric surgery patients are hospitalized for follow-up procedures within the five years following surgery.

One of the most common follow-ups? Weight regain. 20-25% of patients experience weight regain or insufficient weight loss after bariatric surgery, often due to emotional eating, unplanned snacking, or binge eating.

Folks using semaglutide may experience fewer side effects and gradual weight loss. There’s usually 6% weight reduction during the first three months and around 10-11% at the six-month mark. In one clinical trial on Wegovy, the average weight loss was 15% in 68 weeks.

These stats, however, are averages, meaning exact outcomes vary. For Joanna, taking semaglutide resulted in losing 40 pounds in four months while Jayci lost 25 pounds in four months.

Maintenance Costs

Another thing to keep in mind is maintenance costs, which are much more predictable with semaglutide since they come in the form of a monthly prescription.

Bariatric surgery maintenance costs depend on the success of the surgery and if rehospitalization is necessary. A 2023 study found the average out-of-pocket costs after surgery was $1,000 to $1,300 annually (and that’s usually on top of the original $15,000-25,000 estimate).

Treatment Type	Maintenance cost in year one	Maintenance cost in year two	Maintenance cost in year three	Three-year Total Cost
Gastric sleeve	$1,083	$1,236	$1,266	$23,585
Gastric bypass	$1,228	$1,377	$1,369	$23,974
Ozempic	$11,970.96	$11,970.96	$11,970.96	$35,912.88
Wegovy	$16,188.24	$16,188.24	$16,188.24	$48,564.72
Rybelsus	$11,970.96	$11,970.96	$11,970.96	$35,912.88
Compounded Semaglutide	$2,148	$2,148	$2,148	$6,444

Hidden Costs to Consider

Bariatric surgery is more likely to require follow-up care, including potential rehospitalization for complications like infections at the surgical site or Gallbladder stones. If more intensive follow-up care is required, estimated costs tip closer to the top of the range ($25,000 or more).

Some people also find it useful to meet with a doctor to discuss their semaglutide weight loss journey or how to keep weight off after surgery. For reference, the average primary care appointment costs $253. If insured, you’ll split that cost with your insurance provider.

Some online pharmacies, like SkinnyRx, include ongoing support in their monthly prescription fee, eliminating this cost for some taking semaglutide.

Which Is More Cost-Effective?

So, is semaglutide or bariatric surgery cheaper? There isn’t an easy answer. Data suggests that gastric sleeve surgery is most cost effective overall, but the most affordable choice depends on your insurance, surgery type, semaglutide type, and required follow-up.