Head-to-head · WeighScore
1st Optimal vs ElixaMD
The verdict
ElixaMD takes it — 63.5/100 to 61.6/100, but only just.
ElixaMD grades higher on WeighScore, our editorial score across cost value, dose & formulation, clinical oversight, labs & monitoring, fulfillment and contract terms. ElixaMD is a doctor-guided online weight-loss telehealth offering compounded semaglutide injections from $179 the first month, with free shipping, no membership, no contract, and no insurance required. 1st Optimal is close behind and may still be the better fit — see the factor split below.
We may earn a commission if you start care through some of these links, at no extra cost to you. It never moves the WeighScore, which is the weighted average of the six factors shown for every provider, and what we write about a provider is the same either way. See our disclosure.
Factor by factor
The same six graded dimensions, side by side. See the methodology.
The numbers
| Metric | 1st Optimal | ElixaMD |
|---|---|---|
| WeighScore | 61.6/100 | 63.5/100 |
| Grade | C | C |
| Scorecard rank | #291 | #257 |
| Semaglutide | Not disclosed | $179/mo (starting dose, first-month rate, compounded) |
| Tirzepatide | Not disclosed | Not disclosed |
| Coverage | Coverage not published | Coverage not published |
| Brand-name access | Compounded only | Compounded only |
| Oral / sublingual | Yes | Injection only |
Graded #291 · C
Strengths
- Offers both semaglutide and tirzepatide with injectable and oral formats
- Functional-medicine approach with at-home labs and blood-work interpretation
- Unlimited coaching and ongoing support included
- No long-term contracts
- Board-certified doctors and nurse practitioners referenced
Where it loses points
- No public monthly pricing disclosed
- No published state availability list
- Compounded vs branded sourcing not clarified on site
- Pricing only revealed after quiz or consultation
Graded #257 · C
Strengths
- Compounded semaglutide from $179 first month with free shipping, no membership, no contract, and no insurance required
- Genuinely all-inclusive: 1:1 physician guidance, free dietician visits and care coaching, 24/7 support, and an all-in-one patient portal
- Names its compounding pharmacies (RedRock Pharmacy, Beaker Pharmacy) — more transparent than most compounded sellers
- HSA/FSA eligible; full legal suite (Terms, Privacy, Privacy Practices, Refund, Medical Consent, California Bill of Rights)
Where it loses points
- $179 is a first-month/intro price — ongoing monthly cost is higher (tiers to ~$249-$299)
- Compounded semaglutide is not FDA-approved (the site discloses this) — not brand Wegovy or Ozempic
- Appears to offer compounded semaglutide only — tirzepatide is not advertised
- Displays a generic LegitScript Certified badge but no verifiable seal/listing; state-availability list not published
Also worth a look
Neither is our top-graded pick — CoreAge Rx leads the scorecard
Across all 499 providers, CoreAge Rx grades highest at 91.8/100 (A−). Top of the scorecard: flat transparent pricing, both molecules, nationwide — no teaser-rate games.
Pricing/verification reflect each provider's public disclosures at last grading; the WeighScore is our editorial judgment per the methodology. Prices change — confirm on each provider's site. Not medical advice; see our disclosure.