To qualify for Wegovy, 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 such as high blood pressure, high cholesterol, or type 2 diabetes. These are the FDA-approved criteria, but your insurance company may add its own requirements on top of them, which can make the real-world qualification process more involved than it appears on paper.
BMI Thresholds for Adults
The core qualification comes down to your body mass index. If your BMI is 30 or above, you meet the obesity threshold and qualify based on weight alone. If your BMI falls between 27 and 29.9, you’re in the “overweight” category, and you’ll need documentation of at least one weight-related comorbidity. The conditions that count include high blood pressure (treated or untreated), abnormal cholesterol levels, type 2 diabetes, obstructive sleep apnea, and heart disease.
Your doctor calculates BMI from your height and weight at the time of the visit. If you’re right on the borderline, keep in mind that BMI can fluctuate a few points depending on time of day, hydration, and recent meals. Some providers will use your highest documented BMI from recent medical records rather than a single office measurement.
Qualification for Adolescents
Wegovy is approved for patients aged 12 and older. For adolescents, the standard isn’t a fixed BMI number. Instead, the requirement is 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 or adolescent medicine specialist typically makes this determination using CDC growth charts. Unlike adults, teens in the overweight-but-not-obese range do not currently qualify.
What Your Doctor Will Check First
Before writing a prescription, most providers run a baseline panel of blood tests. This typically includes liver enzymes, kidney function markers, a measure of long-term blood sugar control, a cholesterol panel, and a pancreatic enzyme called lipase. These results serve two purposes: they help identify any conditions that might affect whether Wegovy is safe for you, and they create a reference point so your doctor can monitor changes once you start the medication.
There are two firm medical disqualifications. You cannot take Wegovy if you or a close 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. You’re also disqualified if you’ve had a serious allergic reaction to semaglutide, the active ingredient in Wegovy. Your provider will ask about these during your initial visit.
Insurance Requirements Go Further
Meeting the FDA criteria doesn’t guarantee your insurance will cover the prescription. Most insurers require prior authorization, and many add a layer the FDA doesn’t: proof that you’ve already tried losing weight through other means. A common requirement is documentation of participation in a structured weight management program for at least six months before drug therapy. This program typically needs to include behavioral counseling, a reduced-calorie diet, and increased physical activity with ongoing follow-up visits.
The specifics vary widely between plans. Some insurers accept a record of regular check-ins with your primary care doctor about weight loss. Others want formal enrollment in a registered dietitian-led or hospital-affiliated program. A few plans require that you’ve tried and failed on an older, less expensive weight loss medication first. If your first prior authorization request is denied, ask your doctor’s office about the appeals process. Many denials are overturned when additional documentation is submitted.
If you’re paying out of pocket or using a telehealth weight loss service, the insurance layer disappears entirely. You still need a prescription from a licensed provider who confirms you meet the clinical criteria, but there’s no prior authorization or waiting period involved.
The Dosing Ramp-Up Process
Wegovy isn’t prescribed at its full dose from day one. Once you qualify, you’ll follow a gradual five-step escalation over about four months. You start at 0.25 mg once per week for the first month, then increase to 0.5 mg in month two, 1 mg in month three, and 1.7 mg in month four. By month five, you reach the maintenance dose of 2.4 mg per week, which is where you stay long-term.
This slow titration exists to reduce side effects like nausea and digestive discomfort. Your provider may hold you at a lower dose longer if side effects are significant, but the goal is to reach 2.4 mg. The clinical trials that demonstrated Wegovy’s effectiveness, with average weight loss around 15% of body weight over 68 weeks, used this maintenance dose.
What “Lifestyle Changes” Actually Means
Wegovy is FDA-approved specifically as an addition to a reduced-calorie diet and increased physical activity, not as a standalone treatment. In practice, this means your prescriber should discuss nutrition and exercise goals with you at the outset. You don’t need to follow a specific named diet or exercise regimen, but the expectation is that you’re making meaningful changes alongside the medication.
This matters for qualification because some insurers will deny coverage renewals if there’s no evidence of ongoing lifestyle modification in your medical records. Keeping follow-up appointments where your provider documents your dietary habits and activity level helps maintain continuous coverage. It also reflects reality: the medication works best when paired with behavioral changes, and people who stop the drug without having built sustainable habits tend to regain weight.
Supply and Availability
Wegovy experienced significant shortages in 2023 and 2024, particularly at the lower starter doses, which made it difficult for new patients to begin treatment even after qualifying. As of early 2025, semaglutide no longer appears on the FDA’s drug shortage list. This means the supply bottleneck that previously delayed new prescriptions has largely resolved, and pharmacies should be able to fill all five dose strengths without extended wait times.