GLP-1 Program Ordering Guide
Staff reference for program dosages
| Program | Medication | Type | Pharmacy | Month 1 | Month 2 | Month 3 | Total |
|---|---|---|---|---|---|---|---|
| 22 | Tirzepatide | Quarterly | 2.5mg 10mg/mL vial |
5mg 10mg/mL vial |
7.5mg 10mg/mL vial |
12 doses | |
| 23 | Tirzepatide | Quarterly | 5mg 10mg/mL vial |
7.5mg 10mg/mL vial |
10mg 10mg/mL vial |
12 doses | |
| 24 | Tirzepatide | Quarterly | 7.5mg 10mg/mL vial |
10mg 10mg/mL vial |
12.5mg 10mg/mL vial |
12 doses | |
| 25 | Tirzepatide | Quarterly | 10mg 10mg/mL vial |
10mg 10mg/mL vial |
10mg 10mg/mL vial |
12 doses | |
| 26 | Tirzepatide | Quarterly | 12.5mg 10mg/mL vial |
12.5mg 10mg/mL vial |
12.5mg 10mg/mL vial |
12 doses | |
| 27 | Tirzepatide | Quarterly | 15mg 10mg/mL vial |
15mg 10mg/mL vial |
15mg 10mg/mL vial |
12 doses | |
| 42 | Tirzepatide | Quarterly | 2.25mg 9mg/1mL vial |
4.5mg 18mg/2mL vial |
6.75mg 27mg/3mL vial |
12 doses | |
| 43 | Tirzepatide | Quarterly | 4.5mg 18mg/2mL vial |
6.75mg 27mg/3mL vial |
11.25mg 45mg/2.5mL vial |
12 doses | |
| 44 | Tirzepatide | Quarterly | 6.75mg 27mg/3mL vial |
11.25mg 45mg/2.5mL vial |
11.25mg 45mg/2.5mL vial |
12 doses | |
| 45 | Tirzepatide | Quarterly | 11.25mg 45mg/2.5mL vial |
11.25mg 45mg/2.5mL vial |
11.25mg 45mg/2.5mL vial |
12 doses | |
| 52 | Semaglutide | Quarterly | 0.25mg 1mg/mL vial |
0.5mg 2.5mg/1mL vial |
1mg 5mg/2mL vial |
12 doses | |
| 53 | Semaglutide | Quarterly | 0.5mg 2.5mg/1mL vial |
1mg 5mg/2mL vial |
1.5mg 7.5mg/3mL vial |
12 doses | |
| 54 | Semaglutide | Quarterly | 1mg 5mg/2mL vial |
1.5mg 7.5mg/3mL vial |
2.5mg 10mg/4mL vial |
12 doses | |
| 55 | Semaglutide | Quarterly | 1.5mg 7.5mg/3mL vial |
1.5mg 7.5mg/3mL vial |
1.5mg 7.5mg/3mL vial |
12 doses | |
| 56 | Semaglutide | Quarterly | 2mg 10mg/4mL vial |
2mg 10mg/4mL vial |
2mg 10mg/4mL vial |
12 doses | |
| 57 | Semaglutide | Quarterly | 2.5mg 10mg/4mL vial |
2.5mg 10mg/4mL vial |
2.5mg 10mg/4mL vial |
12 doses | |
| 1 | Semaglutide | Quarterly | 0.25mg 5mg/mL vial |
0.5mg 5mg/mL vial |
1mg 5mg/mL vial |
12 doses | |
| 2 | Semaglutide | Quarterly | 0.5mg 5mg/mL vial |
1mg 5mg/mL vial |
1.5mg 5mg/mL vial |
12 doses | |
| 3 | Semaglutide | Quarterly | 1mg 5mg/mL vial |
1.5mg 5mg/mL vial |
2mg 5mg/mL vial |
12 doses | |
| 4 | Semaglutide | Quarterly | 1.5mg 5mg/mL vial |
1.5mg 5mg/mL vial |
1.5mg 5mg/mL vial |
12 doses | |
| 5 | Semaglutide | Quarterly | 2mg 5mg/mL vial |
2mg 5mg/mL vial |
2mg 5mg/mL vial |
12 doses | |
| 6 | Semaglutide | Quarterly | 2.5mg 5mg/mL vial |
2.5mg 5mg/mL vial |
2.5mg 5mg/mL vial |
12 doses | |
| 120 | Semaglutide | 24 Weeks | 1.5mg 5mg/mL vial |
1.5mg 5mg/mL vial |
1.5mg 5mg/mL vial |
24 doses | |
| 121 | Semaglutide | 24 Weeks | 2mg 5mg/mL vial |
2mg 5mg/mL vial |
2mg 5mg/mL vial |
24 doses | |
| 122 | Semaglutide | 24 Weeks | 2.5mg 5mg/mL vial |
2.5mg 5mg/mL vial |
2.5mg 5mg/mL vial |
24 doses | |
| 60 | Tirzepatide | Monthly | 2.25mg 9mg/1mL vial |
- | - | 4 doses | |
| 61 | Tirzepatide | Monthly | 4.5mg 18mg/2mL vial |
- | - | 4 doses | |
| 62 | Tirzepatide | Monthly | 6.75mg 27mg/3mL vial |
- | - | 4 doses | |
| 63 | Tirzepatide | Monthly | 11.25mg 45mg/2.5mL vial |
- | - | 4 doses | |
| 70 | Semaglutide | Monthly | 0.25mg 1mg/mL vial |
- | - | 28 doses (nightly) |
|
| 71 | Semaglutide | Monthly | 0.5mg 2.5mg/1mL vial |
- | - | 4 doses | |
| 72 | Semaglutide | Monthly | 1mg 5mg/2mL vial |
- | - | 4 doses | |
| 73 | Semaglutide | Monthly | 1.5mg 7.5mg/3mL vial |
- | - | 4 doses | |
| 74 | Semaglutide | Monthly | 2.5mg 10mg/4mL vial |
- | - | 4 doses |