In the Trulicity vs Mounjaro choice, Mounjaro lowered A1C and weight more in a head-to-head trial, and in a 13,299-person heart trial it was not meaningfully worse than Trulicity at preventing heart problems, though it was not proven better. Trulicity costs less if you pay cash: $389 a month versus $499 for Mounjaro at LillyDirect. Both are FDA-approved weekly shots for type 2 diabetes.
The catch: your plan's coverage will likely matter more than any trial result.
The RX Index is the independent GLP-1 decision resource that compares cost, access, coverage and side effects so you can choose the right path before you buy.
Trulicity vs Mounjaro at a glance
| Trulicity | Mounjaro | |
|---|---|---|
| Medicine | Dulaglutide | Tirzepatide |
| How it works | GLP-1 | GIP and GLP-1 (two hormones) |
| How often | Once a week | Once a week |
| Dose range (adults) | 0.75 mg to 4.5 mg | 2.5 mg to 15 mg |
| Approved for | Type 2 diabetes, age 10 and up; lowering heart risk in adults | Type 2 diabetes, age 10 and up; lowering heart risk in adults |
| Approved for weight loss? | No | No (tirzepatide for weight loss is sold as Zepbound) |
| List price | $1,006.93 a month | $1,112.16 a fill |
| Cash price from Lilly | Starting at $389 a month | Starting at $499 a month |
Both are made by Eli Lilly. Mounjaro acts on two gut hormones, GIP and GLP-1. Trulicity acts on GLP-1 only.
If you're still weighing these against other options like Ozempic or a cash-pay plan, a quick quiz can narrow it down.
Which lowers A1C and weight more?
Mounjaro did, by a wide margin, in the head-to-head trial built to compare their blood sugar effects. SURPASS J-mono followed 636 adults in Japan for 52 weeks:
| Group | A1C change | Weight change |
|---|---|---|
| Mounjaro 5 mg | −2.4 points | −5.8 kg (about 13 lb) |
| Mounjaro 10 mg | −2.6 points | −8.5 kg (about 19 lb) |
| Mounjaro 15 mg | −2.8 points | −10.7 kg (about 24 lb) |
| Trulicity 0.75 mg | −1.3 points | −0.5 kg (about 1 lb) |
Keep the limits in mind. The trial used only Trulicity's lowest dose, 0.75 mg, and US adults can go up to 4.5 mg. Everyone was a Japanese adult not taking other diabetes medicines. Lilly, which makes both drugs, paid for the trial.
Which is better for your heart?
They came out about even. SURPASS-CVOT followed 13,299 adults with type 2 diabetes and heart disease for a median of about 4 years (210 weeks). People took Mounjaro (up to 15 mg) or Trulicity (1.5 mg). The main result counted heart-related deaths, heart attacks and strokes:
| Trulicity 1.5 mg | Mounjaro | |
|---|---|---|
| Heart death, heart attack or stroke | 13.0% | 12.1% |
| Death from any cause | 10.1% | 8.5% |
Mounjaro was "non-inferior," meaning it was not meaningfully worse than Trulicity, within a limit the trial set in advance. It was not proven better: the FDA label says "superiority to dulaglutide was not established." Fewer people died from any cause on Mounjaro, but the label notes that result wasn't tested in a way that proves it. The published paper in the New England Journal of Medicine reports nearly the same main result (12.2% vs 13.1%) using a slightly different group count.
Both drugs now carry an FDA-approved use for lowering heart risk in adults with type 2 diabetes. Trulicity's covers people with heart disease or several heart risk factors. Mounjaro's covers people at high risk for heart events.
How do the side effects compare?
Both mostly cause stomach and gut side effects. In SURPASS-CVOT, more people on Mounjaro had gut side effects. In J-mono, nausea hit 12% to 20% of people on Mounjaro and 8% on Trulicity 0.75 mg.
| Trulicity | Mounjaro | |
|---|---|---|
| Most common side effects (5% or more) | Nausea, diarrhea, vomiting, belly pain, decreased appetite | Nausea, diarrhea, decreased appetite, vomiting, constipation, indigestion, belly pain |
| Boxed warning | Thyroid C-cell tumors | Thyroid C-cell tumors |
| Severe gastroparesis | Not recommended | Not recommended |
| Birth control pills | No label warning | May work less well. Use a non-pill method or add a barrier method for 4 weeks after starting and after each dose increase |
That birth control point is real and easy to miss. If you take the pill, ask your prescriber about it before you start Mounjaro.
How are the pens different?
- Trulicity comes in single-dose pens, one per week, 4 to a box. Each pen can stay out of the fridge (up to 86°F) for a total of 14 days.
- Mounjaro comes in single-dose pens or vials, one per week. Each can stay out of the fridge (up to 86°F) for a total of 21 days. Its label also lists a multi-dose KwikPen and a multi-dose vial, each holding 4 doses.
How much do Trulicity and Mounjaro cost in 2026?
Trulicity is cheaper at list price and at cash price. With good commercial coverage, both can be $25. Here's what Lilly posts as of October 29, 2026:
| Trulicity | Mounjaro | |
|---|---|---|
| List price | $1,006.93 a month | $1,112.16 a fill |
| Commercial insurance that covers it, with savings card | As little as $25 for up to a 3-month fill. Saves up to $150 a month and $1,950 a year | As little as $25 for up to a 3-month fill. Saves up to $150 a month and $1,950 a year |
| Commercial insurance that doesn't cover it | Savings card requires coverage; cash price below | Savings card: as low as $499 a month for pens |
| Cash price from LillyDirect | Starting at $389 a month | Starting at $499 a month |
| Medicare | Savings card not allowed. Lilly says about 70% of its Medicare patients paid $0 per fill in 2024 | Savings card not allowed. Lilly, citing IQVIA data, says about 8 in 10 Part D patients pay $0 to $50 for a 28-day supply; the rest average about $262 |
Both savings cards end December 31, 2026.
What a year of cash pay comes to (our math): Trulicity at $389 a month is $4,668. Mounjaro at $499 a month is $5,988. That's $1,320 more for Mounjaro.
Lilly's figures on what patients pay come from its own analysis of pharmacy data. Only your insurer or pharmacy can tell you your real price. For Trulicity alone, see Trulicity price.
Can you switch from Trulicity to Mounjaro?
Yes, a prescriber can move you from one to the other. People often ask about it when A1C or weight goals aren't being met, or when a plan changes which drug it covers. How to switch and which starting dose to use is your prescriber's call. Neither trial above studied switching. Before you ask, check which drug your plan prefers and whether it needs prior authorization.
Which one fits you
| Your situation | Likely better fit | Why |
|---|---|---|
| A1C still high, and you want the bigger drop | Mounjaro | Larger A1C drop in SURPASS J-mono |
| Weight loss matters along with blood sugar | Mounjaro | Much more weight loss in J-mono |
| Heart disease and you want proven heart protection | Either | Similar heart results in SURPASS-CVOT |
| Paying cash | Trulicity | $389 vs $499 a month at LillyDirect |
| Commercial plan doesn't cover Mounjaro | Compare both | Mounjaro savings card can bring it to $499 |
| You take birth control pills | Ask first | Only Mounjaro carries this label warning |
| Your plan covers only one | The covered one | Both list above $1,000 a fill |
Both are FDA-approved brand medicines. Neither is a compounded drug, and neither appears in the FDA's drug shortage database as of October 29, 2026. For more choices, see Mounjaro vs Ozempic and Trulicity vs Ozempic.
Compare your GLP-1 options in 2 minutes
What we actually verified
- Read the current FDA prescribing information for Mounjaro (revised August 2026), Trulicity (revised March 2026) and Zepbound (revised August 2026).
- Took the SURPASS-CVOT heart results from Mounjaro's label and checked them against the published abstract on PubMed.
- Read the SURPASS J-mono abstract on PubMed and took every A1C, weight and nausea number from it.
- Opened Lilly's pricing pages, LillyDirect pages and savings card terms for both drugs.
- Checked the FDA drug shortage database for tirzepatide and dulaglutide.
- Did the yearly cash-pay math ourselves.
What we did not do: get a quote from any insurer or pharmacy, or confirm any plan's formulary. Prices and savings offers change, so confirm them before you fill.
Frequently asked questions
Is Mounjaro stronger than Trulicity?
For A1C and weight, yes, in a head-to-head trial: Mounjaro lowered A1C by 2.4 to 2.8 points versus 1.3 for Trulicity 0.75 mg. That trial didn't test Trulicity's higher doses. For heart protection, they came out about even.
Which has fewer side effects, Trulicity or Mounjaro?
Trulicity had fewer gut side effects in both trials. In J-mono, nausea affected 8% on Trulicity 0.75 mg and 12% to 20% on Mounjaro. Both carry the same boxed thyroid warning.
Is Trulicity cheaper than Mounjaro?
Yes. Trulicity lists at $1,006.93 a month and Mounjaro at $1,112.16 a fill. Paying cash through LillyDirect, Trulicity starts at $389 a month and Mounjaro at $499.
Can Mounjaro or Trulicity be used for weight loss?
Neither is approved for weight loss. Both are for type 2 diabetes. The same medicine as Mounjaro, tirzepatide, is FDA-approved for weight loss under the name Zepbound.
Does Medicare cover Trulicity and Mounjaro?
Many Part D plans cover them for type 2 diabetes. Lilly, citing IQVIA data, says about 8 in 10 Mounjaro Part D patients pay $0 to $50 for a 28-day supply, and about 70% of Trulicity Medicare patients paid $0 per fill in 2024. Medicare members can't use either savings card.
Can kids take Trulicity or Mounjaro?
Both are approved for children 10 and older with type 2 diabetes. The top child dose is 1.5 mg for Trulicity and 10 mg for Mounjaro.
Still not sure which GLP-1 path fits you? Take The RX Index's free Find My GLP-1 Path quiz — about 2 minutes, no signup.
Sources
- Mounjaro prescribing information (Eli Lilly, revised August 2026; checked October 29, 2026)
- Trulicity prescribing information (Eli Lilly, revised March 2026; checked October 29, 2026)
- Zepbound prescribing information (Eli Lilly, revised August 2026; checked October 29, 2026)
- Nicholls SJ et al. Cardiovascular Outcomes with Tirzepatide versus Dulaglutide in Type 2 Diabetes (SURPASS-CVOT). N Engl J Med. 2025;393(24):2409-2420
- Inagaki N et al. Tirzepatide monotherapy compared with dulaglutide in Japanese patients with type 2 diabetes (SURPASS J-mono). Lancet Diabetes Endocrinol. 2022;10(9):623-633
- Lilly: Mounjaro pricing information (checked October 29, 2026)
- Lilly: Trulicity pricing information (checked October 29, 2026)
- LillyDirect: Mounjaro self-pay (checked October 29, 2026)
- LillyDirect: Trulicity self-pay (checked October 29, 2026)
- Mounjaro savings card and resources (checked October 29, 2026)
- Trulicity savings card and resources (checked October 29, 2026)
- FDA drug shortage database (checked October 29, 2026)