Adults with a BMI of 30 or higher qualify for Wegovy. Adults with a BMI of 27 to 29.9 also qualify if they have at least one weight-related health condition, such as high blood pressure, type 2 diabetes, or high cholesterol. These are the FDA-approved thresholds, though your insurance plan may layer on additional requirements before covering the prescription.
BMI Thresholds for Adults
The two qualifying categories are straightforward. A BMI of 30 or above is classified as obesity, and that alone meets the criteria. No additional diagnosis is needed. If your BMI falls between 27 and 29.9 (the “overweight” range), you’ll need a documented weight-related comorbidity to qualify. Common qualifying conditions include high blood pressure, type 2 diabetes, obstructive sleep apnea, and abnormal cholesterol levels.
To check your BMI, divide your weight in kilograms by your height in meters squared, or use any online BMI calculator. As a rough reference, a 5’6″ adult weighing about 186 pounds has a BMI of 30. At the same height, 167 pounds puts you around 27.
BMI Thresholds for Adolescents
Wegovy is approved for patients aged 12 and older, but teens qualify based on BMI percentile rather than a raw number. A pediatric patient needs a BMI at or above the 95th percentile for their age and sex, which corresponds to clinical obesity in children. Unlike adults, adolescents in the overweight-but-not-obese range do not currently qualify.
The actual BMI number that hits the 95th percentile varies by age and sex. For a 12-year-old boy, that cutoff is about 24.2. For a 12-year-old girl, it’s 25.2. By age 17, those thresholds rise to 28.2 for boys and 29.6 for girls. Your child’s pediatrician will plot their BMI on a CDC growth chart to determine where they fall.
The Cardiovascular Indication
In March 2024, the FDA approved a separate indication for Wegovy: reducing the risk of heart attack, stroke, and cardiovascular death in adults who already have established cardiovascular disease and are either obese or overweight. This approval was based on a large trial showing that 6.5% of participants on Wegovy experienced a major cardiovascular event compared to 8% on placebo.
Under this indication, the BMI thresholds are the same (27 or above), but the qualifying condition is specifically established cardiovascular disease rather than a general weight-related comorbidity. Some insurance plans treat this as a distinct approval pathway with its own requirements, such as a prescription from or in consultation with a cardiologist.
What Insurance Actually Requires
Meeting the FDA criteria doesn’t guarantee your insurance will cover Wegovy. Most plans add their own layer of prior authorization requirements. These vary widely, but a few patterns are common.
Many insurers want documentation that you’ve already attempted lifestyle changes, such as a supervised diet or exercise program, before approving coverage. Some require that your prescriber be a specific type of specialist depending on the indication. For the cardiovascular indication, for example, Maryland’s Medicaid program requires the prescription come from or be coordinated with a cardiologist. Plans covering the newer liver-related indication require involvement of a gastroenterologist or hepatologist.
Renewal criteria add another hurdle. Aetna, as one example, requires that after seven months of Wegovy therapy, the patient must have lost at least 5% of their baseline body weight or maintained an initial 5% loss. If you don’t meet that benchmark, coverage can be denied for continued treatment. Other insurers set similar thresholds, though the specific percentage and timeline differ by plan.
How Treatment Ramps Up
If you qualify and get approved, you won’t start at the full dose. Wegovy follows a 16-week escalation schedule designed to reduce nausea and other gastrointestinal side effects. You begin with a low weekly injection and increase the dose every four weeks across four steps. The maintenance dose, reached around week 17, is 2.4 mg once weekly. Some adults stay at 1.7 mg if they can’t tolerate the higher dose. The same escalation schedule applies to adolescents.
This gradual ramp-up means you’re looking at roughly four months before reaching the therapeutic dose where most of the weight loss effect occurs. Clinical trials measured outcomes over 68 weeks total, so the full picture of what Wegovy can do takes well over a year to develop.