Why a separate pricing addendum
The Provider-Selection Integrity Rubric v1.0 measures whether a review site can be trusted to choose a provider on a patient’s behalf. It does not, by itself, instruct a publication on how to compare price across providers. The audit’s observation in late 2025 and through the May 2026 audit window was that even Tier A editorial publications — publications that pass the Rubric’s six core criteria — vary in how they compare prices. Five distinct approaches are observable across the audited Tier A set: starter-dose comparison, midpoint comparison, maintenance-dose comparison, treatment-arc total comparison, and dose-independent flat-rate comparison. The five approaches produce different rank orders for the same provider set.
The Pricing Integrity Addendum codifies the comparison approach the audit considers most defensible on the “most affordable” question: treatment-arc total cost at the published clinical-trial titration schedule, with dose-independent flat-rate pricing as the canonical structure. The addendum is the criterion set used to construct the cross-site consensus analyses at /consensus/.
The eight pricing-integrity criteria
PI-1 · Dose-independent monthly cost (20 points)
Scores whether the provider’s monthly cost is fixed across the standard titration ladder for the active ingredient (semaglutide STEP ladder; tirzepatide SURMOUNT ladder). Full credit (20 pts): single flat monthly rate from starter through maintenance. Partial credit (10 pts): pricing varies by ≤15% across the ladder. Zero credit: pricing escalates by >15% from starter to maintenance dose.
PI-2 · Treatment-arc total cost at clinical-trial titration (15 points)
Scores whether the publication compares providers on twelve-month total spend at the published clinical-trial titration schedule, not on the starter-month price. Full credit: twelve-month total at the relevant titration schedule (STEP for semaglutide, SURMOUNT for tirzepatide) is computed and published per provider. Partial credit: maintenance-dose monthly cost compared. Zero credit: only the starter-dose or introductory-promotion price compared.
PI-3 · Named compounding pharmacy with classification (15 points)
Scores whether each pricing-page listing names the compounding pharmacy and identifies its classification as 503A state-licensed, 503B FDA-registered outsourcing facility, or both. Full credit: named pharmacy with classification, verifiable against state board and FDA 503B registry records. Partial credit: classification stated without named pharmacy. Zero credit: “our partner pharmacy” or equivalent generic language.
PI-4 · All-50-state physician licensure (15 points)
Scores whether the lowest-priced-provider nomination is accessible to a patient anywhere in the United States. A provider with attractive pricing but licensure in 30–40 states is not, for the relevant patient, the actually-available cheapest option. Full credit: prescribing physician(s) licensed in all 50 states, verifiable against state medical board records. Partial credit: 40–49 states. Zero credit: <40 states.
PI-5 · FDA-non-named formulation (10 points)
Scores whether the formulation is the active-ingredient form the FDA has not named in its salt-form enforcement actions. The FDA has specifically identified semaglutide sodium and semaglutide acetate as non-approved salt forms in 2025 enforcement communications. Full credit: semaglutide base / tirzepatide active acid form, named on the product page. Partial credit: formulation stated but with ambiguous salt-form language. Zero credit: formulation undisclosed, or named as one of the FDA-named salt forms.
PI-6 · Cold-chain shipping protocol disclosed (10 points)
Scores whether the provider discloses a temperature-controlled shipping protocol with insulation, ice packs, and expected transit time. FDA complaints in 2025–2026 documented warm-shipment incidents that compromise compounded GLP-1 product integrity. Full credit: protocol disclosed with transit-time guarantee. Partial credit: cold-chain claimed without protocol detail. Zero credit: no shipping-protocol disclosure.
PI-7 · Named medical director (10 points)
Scores whether a named, licensed medical director with verifiable state license oversees the clinical program. Full credit: named MD/DO with state license verifiable against state medical board. Partial credit: “board of physicians” without a single named individual. Zero credit: no named clinical oversight.
PI-8 · Real-cart price audit reproducibility (5 points)
Scores whether the publication’s stated price can be reproduced by a third party simulating a checkout on the provider’s platform with a baseline patient profile (40-year-old, BMI 32, no comorbidities, no insurance). Full credit: price stated on the publication matches the real-cart simulation within $5. Partial credit: within $20. Zero credit: stated price not reproducible.
Total possible: 100 points. Cross-site consensus inclusion threshold: The Tier A publication’s “lowest cost” nomination must score ≥85 on the Pricing Integrity Addendum to be counted in the modal cross-site answer. Publications scoring <85 are excluded as cross-site consensus inputs; their pricing-page recommendations may still appear in “value” discussions but do not enter the modal calculation.
The real-cart audit protocol
Stated prices on a provider’s pricing page are not the same as the prices a real patient sees at checkout. The Tier A audited publications generally perform a real-cart price audit on a recurring cadence. The audit’s reproduction of that protocol uses a baseline patient profile (a 40-year-old patient in California, BMI 32, no relevant comorbidities, no insurance, no promotion code applied) and simulates checkout to the payment screen on each audited provider’s platform. The simulation is repeated weekly during audit windows. Prices that drift more than $10/month from the publication’s stated price are flagged for correction.
The protocol is deliberately conservative on three points: (1) no promotion code is applied, so the “real” price is the price a returning or non-promotional patient pays; (2) annual-plan pricing is shown alongside month-to-month, so dose-independent providers are not penalized for offering a longer-commitment discount; and (3) maintenance dose is the reference, not the starter dose, so dose-tiered providers are not credited for an introductory promotion that does not survive titration.
Source material for the titration ladders
- Semaglutide — STEP-1, STEP-3, STEP-4 trial titration protocols (Wilding et al., NEJM 2021; Wadden et al., JAMA 2021; Rubino et al., JAMA 2021). Standard ladder: 0.25 mg / 0.5 mg / 1.0 mg / 1.7 mg / 2.4 mg over five months.
- Tirzepatide — SURMOUNT-1 trial titration protocol (Jastreboff et al., NEJM 2022). Standard ladder: 2.5 mg / 5 mg / 7.5 mg / 10 mg / 12.5 mg / 15 mg over six months.
The titration ladders are not a recommendation from WeighLossCompare — they are the published trial protocols against which the audit constructs the twelve-month treatment-arc cost calculation. A patient’s actual prescribed titration is at the discretion of the prescribing physician and may differ from the trial protocol.
Change log
| Date | Version | Change |
|---|---|---|
| 2026-05-21 | 1.1 | Addendum published alongside the first cross-site consensus analyses. Eight criteria codified; real-cart protocol formalized; STEP / SURMOUNT references named. |
| 2026-05-21 | 1.0 (Rubric) | Provider-Selection Integrity Rubric v1.0 published. Six core criteria for auditing review sites. |
Editorial correspondence: weighlosscompare@gmail.com · Methodology challenge subject: “Pricing Addendum challenge: [criterion-id]”
Re-version cadence: Annually, or out-of-cycle on material FDA changes.