Switching protocol

Lost insurance coverage

Formulary dropped your current drug, or you changed plans. Often means switching to whatever is covered, not whatever you'd pick.

Intolerable side effects

Nausea, vomiting, fatigue, injection-site reactions. Switching may help, but lower titration of current drug is often tried first.

Weight loss plateau

Lost progress is stalled at sub-target weight. Tirzepatide may produce additional loss after semaglutide plateau (SURMOUNT-1 / STEP-1 cross-comparison).

Drug shortage / availability

Wegovy and Zepbound have intermittent supply issues. Pharmacist-initiated swaps require prescriber sign-off.

Cost reduction

Out-of-pocket pricing varies. Manufacturer copay cards, direct-pay programs, and compounded alternatives change the calculus.