Getting a weight loss shot starts with a medical evaluation, either in person or through telehealth, where a provider confirms you meet the eligibility criteria and writes a prescription. The process typically takes one to two appointments before you fill your first prescription at a pharmacy. Here’s what each step looks like and what to expect along the way.
Who Qualifies for a Weight Loss Shot
Weight loss injections are prescription medications, so you need to meet specific medical criteria. The standard thresholds are a BMI of 30 or greater (which falls in the obesity range), or a BMI of 27 or greater combined with at least one weight-related health condition like high blood pressure, type 2 diabetes, or high cholesterol.
Your provider will also review your medical history for conditions that could make these medications unsafe, such as a personal or family history of certain thyroid cancers, or a history of pancreatitis. If you meet the criteria, the prescription is written alongside recommendations for diet and physical activity changes.
Which Medications Are Available
Three brand-name weight loss injections are currently FDA-approved for chronic weight management in adults:
- Wegovy (semaglutide), a once-weekly injection
- Zepbound (tirzepatide), a once-weekly injection
- Saxenda (liraglutide), a daily injection
You may also hear about Ozempic and Mounjaro. These contain the same active ingredients as Wegovy and Zepbound, respectively, but are approved specifically for type 2 diabetes rather than weight loss. Some providers prescribe them off-label for weight management, though insurance coverage becomes more complicated when a drug is used outside its approved indication.
All of these work by mimicking a gut hormone that signals fullness to your brain. They slow down how quickly food leaves your stomach, reduce appetite, and help you feel satisfied with smaller meals. The net effect for most people is eating significantly less without the constant feeling of fighting hunger.
Step by Step: Getting Your Prescription
The process has a few distinct stages, and knowing them upfront saves time.
1. Schedule a Consultation
You can see your primary care doctor, an endocrinologist, or an obesity medicine specialist. Telehealth is also an option. Most states allow providers to establish a patient relationship and prescribe through a video visit, though a few still require an in-person exam first. A simple online questionnaire alone is not enough in any state to get a prescription. You’ll need a real-time interaction with a licensed provider who can evaluate your health history and make a diagnosis.
2. Complete Your Evaluation
Expect your provider to check your BMI, blood pressure, and potentially order bloodwork to screen for diabetes, cholesterol levels, and kidney or thyroid function. This visit is also where you’ll discuss which medication makes the most sense based on your health profile, side effect tolerance, and cost considerations.
3. Handle Insurance and Prior Authorization
If your provider prescribes a weight loss shot, the next hurdle is often the pharmacy and insurance side. Many insurance plans require prior authorization, which means your provider submits documentation proving you meet medical criteria before the insurer agrees to cover the drug. This can take a few days to a couple of weeks. Some insurers won’t cover weight loss medications at all unless you also have a diagnosis like type 2 diabetes. A high BMI alone may not be sufficient for coverage, even if it technically qualifies you for the prescription itself.
4. Fill and Start Your Prescription
Once approved, your prescription goes to a retail or specialty pharmacy. Some formulations of Zepbound (the vial form) are available exclusively through Eli Lilly’s direct pharmacy. Your first shipment will be the lowest starting dose, and you’ll inject it yourself at home using a pre-filled pen, which is similar in size and simplicity to an insulin pen.
What the Dose Schedule Looks Like
You don’t start at the full dose. Every weight loss injection uses a gradual increase, called titration, to give your body time to adjust and minimize side effects.
For semaglutide (Wegovy), the typical path is: 0.25 mg weekly for four weeks, then 0.5 mg, then 1 mg, then 1.7 mg, and finally 2.4 mg. Each step lasts at least four weeks. It takes roughly four to five months to reach the full dose. Tirzepatide (Zepbound) follows a similar pattern, starting at 2.5 mg weekly and increasing through several steps up to 15 mg depending on how you respond. Your provider adjusts the pace based on your weight loss progress and how well you tolerate each dose.
What It Costs With and Without Insurance
Cost is one of the biggest practical barriers. With commercial insurance and a manufacturer savings card, Wegovy can cost as little as $25 per month. Without insurance, Novo Nordisk (the maker of Wegovy) currently offers a self-pay price starting at $149 per month for certain doses, though this varies by dose level and may change over time. Higher doses for self-pay patients run $199 to $349 per month.
Zepbound has similar savings programs. Eli Lilly also sells a vial form directly to patients, which bypasses the prior authorization process entirely. Your provider can help you compare the real out-of-pocket cost for each option using electronic benefits tools that check your specific insurance plan in real time.
If your insurance denies coverage, your options include appealing the decision with additional documentation from your provider, switching to a medication your plan does cover, or paying out of pocket using manufacturer programs.
Common Side Effects and How They Change Over Time
Nausea is the most common side effect, affecting up to 50% of people at some point during treatment. Vomiting, diarrhea, constipation, and abdominal pain also occur, though less frequently. These symptoms are most pronounced during the first few weeks at each new dose level and generally fade as your body adjusts. Only about 4% of people in clinical trials stopped treatment because of nausea.
The gradual dose increases exist specifically to reduce these effects. Eating smaller meals, avoiding high-fat foods, and staying well hydrated all help. If nausea or vomiting becomes severe enough that you can’t keep fluids down, that warrants contacting your provider, since dehydration from persistent GI symptoms can strain the kidneys.
Why Compounded Versions Carry Extra Risk
If you’ve seen ads for cheaper semaglutide or tirzepatide from online clinics or compounding pharmacies, it’s worth understanding what you’re getting. Compounded versions are mixed by specialty pharmacies rather than manufactured by the brand-name companies. They are not reviewed by the FDA for safety, effectiveness, or quality.
The FDA has flagged several specific problems with compounded weight loss injections: products arriving warm without proper refrigeration, fraudulent labels listing pharmacies that didn’t actually make the product, and dosing errors that led to hospitalizations. Because compounded injectables often come in multi-dose vials rather than pre-filled pens, patients and even some providers have miscalculated doses, leading to serious gastrointestinal symptoms. Some patients have received doses beyond what the FDA-approved labeling recommends, with faster titration schedules or higher single doses.
Compounded drugs are legally intended only for patients whose medical needs can’t be met by an FDA-approved product. With brand-name options now available at reduced self-pay prices, the cost gap that once drove people toward compounded versions has narrowed considerably.