To qualify for Wegovy, you generally need a BMI of 30 or higher, or a BMI of 27 or higher with at least one weight-related health condition such as high blood pressure or high cholesterol. These are the FDA-approved criteria, but your actual path to a prescription also depends on your medical history, what your doctor finds during screening, and what your insurance plan requires.
BMI Thresholds for Adults
The FDA approves Wegovy for two groups of adults. The first is anyone with a BMI of 30 or above, which is the clinical definition of obesity. No additional health conditions are required at this threshold.
The second group includes people with a BMI between 27 and 29.9 (classified as overweight) who also have at least one weight-related comorbidity. The conditions that typically qualify you include high blood pressure, high cholesterol or triglycerides, type 2 diabetes, or obstructive sleep apnea. Your prescriber determines whether your specific condition counts as weight-related.
In both cases, the FDA approves Wegovy only in combination with a reduced-calorie diet and increased physical activity. It’s not intended as a standalone treatment.
Eligibility for Adolescents
Wegovy is approved for patients as young as 12. The standard is different from adults: rather than a fixed BMI number, adolescents must have a BMI at or above the 95th percentile for their age and sex, which corresponds to clinical obesity in pediatric terms. A BMI of 27 with a comorbidity isn’t enough for this age group. The 95th-percentile requirement is the only qualifying pathway for anyone under 18.
The Cardiovascular Risk Indication
Wegovy also carries a separate FDA-approved use: reducing the risk of heart attack, stroke, and cardiovascular death in adults who already have established heart disease and either obesity or overweight. This indication is distinct from weight management and has its own qualification criteria, particularly when it comes to insurance coverage.
Some insurers that exclude weight-loss medications from their plans will still cover Wegovy specifically for cardiovascular risk reduction. UnitedHealthcare, for example, covers it under this indication but requires you to already be on a set of heart-related medications, including a cholesterol-lowering drug, a beta blocker, a blood pressure medication, and an antiplatelet drug like aspirin, unless you have a documented contraindication to any of those.
What Your Doctor Checks Before Prescribing
Before writing a prescription, your doctor will run baseline blood work and review your medical history. The standard panel includes a blood sugar test (HbA1c), liver enzymes, kidney function markers, thyroid levels, and a lipid panel. These serve two purposes: confirming you’re safe to start the medication and establishing a baseline so any future changes can be tracked.
Thyroid screening is particularly important. Wegovy is contraindicated if you or a family member has a history of medullary thyroid carcinoma (a rare type of thyroid cancer) or a condition called Multiple Endocrine Neoplasia syndrome type 2. These are absolute disqualifiers, not judgment calls.
Your doctor will also assess kidney function, because the gastrointestinal side effects of Wegovy (nausea, vomiting, diarrhea) can cause dehydration that stresses the kidneys. If your kidney function is already significantly reduced, that requires careful evaluation before starting. A history of pancreatitis is another red flag that needs baseline testing, and if you develop confirmed acute pancreatitis while on Wegovy, you won’t be restarted on it.
Conditions That Disqualify You
A few situations make Wegovy off-limits entirely:
- Personal or family history of medullary thyroid carcinoma or MEN 2. This is a hard contraindication based on findings in animal studies.
- Prior serious allergic reaction to semaglutide. If you’ve had a severe reaction to Ozempic or another semaglutide product, Wegovy uses the same active ingredient.
- Pregnancy. Wegovy should be discontinued as soon as pregnancy is recognized.
- Active suicidal ideation or history of suicide attempts. The FDA advises avoiding Wegovy in these patients.
What Insurance Companies Require
Meeting the FDA criteria doesn’t guarantee your insurance will cover Wegovy. Most commercial plans require prior authorization, meaning your doctor submits documentation proving you meet specific clinical criteria before the insurer approves the prescription. This process can take days to weeks.
Common requirements include documented evidence of your BMI, confirmation of at least one weight-related comorbidity (if your BMI is under 30), and proof that you’re following a diet and exercise program. Some plans also require step therapy, meaning you must try and fail a less expensive weight-loss approach before they’ll approve Wegovy. The specifics vary widely between insurers and even between plans from the same insurer.
It’s worth knowing that many commercial plans still exclude weight-loss medications entirely. If yours does, the cardiovascular risk reduction indication or the newer MASH (a form of fatty liver disease) indication may be the only covered pathways, and those come with their own strict criteria, including specialist involvement for MASH.
Medicare Coverage Starting in 2026
Medicare has historically not covered anti-obesity medications under Part D. That changes with the Medicare GLP-1 Bridge, a demonstration program running from July 2026 through December 2027 that will cover Wegovy for weight management. The qualifying criteria are stricter than the FDA label:
- BMI of 35 or higher: No additional conditions required.
- BMI of 30 or higher: You must also have heart failure with preserved ejection fraction, uncontrolled high blood pressure (above 140/90 despite already taking two blood pressure medications), or chronic kidney disease stage 3a or above.
- BMI of 27 or higher: You must also have pre-diabetes, a previous heart attack, a previous stroke, or symptomatic peripheral artery disease.
All three pathways require you to be at least 18 and actively following a structured nutrition and physical activity plan. Your provider must submit a prior authorization request attesting that you meet these criteria. If you already qualify for Wegovy under Part D for its cardiovascular indication (because you have established heart disease), you’d go through your plan’s existing formulary process instead of the Bridge program.