1. Health insurance caps the annual price to a few thousand dollars, which is worth the money for most people for the health and social advantages
2. Wealthy suburban families shop at Wal-Mart quite a lot
Edit: I meant off-label, not without a prescription. Same treatment by insurance.
There is a booming black market for bootleg Chinese Semaglutide (and Tirzepatide, and Retatrutide, and etc)