To qualify for semaglutide (brand name Wegovy) for weight loss, you need either a BMI of 30 or higher, or a BMI of 27 to 29.9 with at least one weight-related health condition. Those are the FDA-approved thresholds, but meeting them is only the first step. Your doctor’s assessment, your medical history, and your insurance plan all play a role in whether you actually get a prescription filled and covered.
BMI Thresholds for Adults
The core requirement is straightforward. If your BMI is 30 or above, you meet the FDA criteria for Wegovy based on weight alone. If your BMI falls between 27 and 29.9, you can still qualify, but only if you also have at least one weight-related medical condition. For reference, a BMI of 30 for someone who is 5’7″ translates to roughly 190 pounds.
The qualifying health conditions include:
- Type 2 diabetes
- High blood pressure
- High cholesterol
- Obstructive sleep apnea
- Cardiovascular disease that raises the risk of heart attack or stroke
- MASH (metabolic dysfunction-associated steatohepatitis), a form of liver inflammation linked to excess fat in the liver
You don’t need all of these. One is enough to bring you into the eligible range if your BMI is 27 or higher. Many people who don’t think of themselves as having a “condition” actually qualify once they check their blood pressure or cholesterol numbers.
Eligibility for Teens
Wegovy is approved for patients 12 years and older, but the standard is different from the adult criteria. Rather than a fixed BMI number, adolescents must have a BMI at or above the 95th percentile for their age and sex, which is the clinical definition of obesity in children and teens. A pediatrician calculates this using CDC growth charts. There is no lower-BMI-with-comorbidities pathway for adolescents the way there is for adults.
Medical Conditions That Disqualify You
Not everyone who meets the BMI criteria can safely take semaglutide. The drug carries a boxed warning related to thyroid tumors. If you or a close family member has a history of medullary thyroid carcinoma (a specific type of thyroid cancer) or a condition called Multiple Endocrine Neoplasia syndrome type 2, semaglutide is off the table entirely. Your prescriber will ask about this before writing a prescription.
A history of pancreatitis, severe kidney problems, or a known hypersensitivity to semaglutide also factors into the decision. Your doctor may order blood work before prescribing, typically checking blood sugar levels, kidney function, and sometimes a lipid panel. These aren’t qualification tests per se, but they help your provider confirm the medication is safe for you and establish a baseline to track your progress.
What Insurance Actually Covers
This is where qualification gets complicated. Meeting the FDA criteria does not guarantee your insurance will pay for the medication, and Wegovy’s list price runs over $1,300 per month without coverage. Many commercial insurance plans explicitly exclude weight loss medications from their benefits. UnitedHealthcare, one of the largest insurers in the U.S., currently limits Wegovy coverage to two narrow situations: reducing cardiovascular risk and treating MASH. Pure weight loss is not a covered use under that policy.
For the cardiovascular indication, UnitedHealthcare requires that you be 45 or older, have a BMI of at least 27, and have established heart disease confirmed by a prior heart attack, stroke, or peripheral arterial disease. You also need to already be on a regimen of cholesterol-lowering medication, blood pressure drugs, and antiplatelet therapy. For the MASH indication, you need a confirmed diagnosis with moderate to advanced liver scarring, documented by imaging or a recent biopsy, and a prescription from a gastroenterologist or liver specialist.
Other insurers have their own criteria, but the pattern is similar. Many require prior authorization, which means your doctor submits documentation proving you meet specific clinical benchmarks. Some plans require evidence that you’ve tried other weight loss interventions first, such as a structured diet program or behavioral counseling, before they’ll approve a GLP-1 medication. This “step therapy” requirement varies widely between plans.
If your employer-sponsored plan excludes weight loss drugs, your options are limited to paying out of pocket, using a manufacturer savings program (Novo Nordisk offers one for eligible patients), or checking whether a state Medicaid program covers it. Medicare Part D began covering Wegovy in 2024 for its cardiovascular indication, but not specifically for weight loss alone.
What Happens at Your First Appointment
When you see a provider about semaglutide, expect a conversation about your weight history, any prior attempts at losing weight, your current medications, and your overall health. The provider will check your BMI, review your blood pressure and lab results, and screen for contraindications like thyroid cancer history. If you qualify and the provider agrees it’s appropriate, they’ll typically start the prior authorization process with your insurer at the same time they write the prescription.
Semaglutide for weight loss is a once-weekly injection you give yourself at home. The starting dose is very low (0.25 mg) and increases gradually over about four months, with your dose going up every four weeks. This slow ramp-up helps minimize nausea, which is the most common side effect. The current maintenance doses are 2.4 mg per week for most patients, though a higher 7.2 mg dose is now available. Your provider may keep you at a given dose longer than four weeks if side effects are bothersome.
Telehealth and Online Prescribers
A growing number of telehealth platforms now prescribe semaglutide for weight loss, sometimes with a less rigorous screening process than a traditional doctor’s office. The qualification criteria are technically the same (the FDA indications don’t change based on who writes the prescription), but some online clinics use compounded versions of semaglutide rather than brand-name Wegovy. Compounded drugs are not FDA-approved and are mixed by specialty pharmacies rather than the original manufacturer. The FDA has raised safety concerns about compounded semaglutide, so if you go the telehealth route, confirm whether you’re receiving the brand-name product.
Regardless of where you get your prescription, the qualifying fundamentals remain the same: your BMI, your health history, and your insurance coverage are the three gates you need to pass through. The first two are usually the easiest. The third is where most people hit friction.