Starting Wegovy involves a few clear steps: confirming you’re eligible, getting a prescription, and following a gradual dose increase over about four months before reaching the full maintenance dose. The process is designed to let your body adjust slowly, which reduces side effects and makes the medication easier to tolerate long-term.
Who Qualifies for a Prescription
Wegovy is FDA-approved for adults with a BMI of 30 or higher, or a BMI of 27 or higher paired with at least one weight-related health condition such as high blood pressure, high cholesterol, or type 2 diabetes. It’s also approved for teens aged 12 and older whose BMI falls at or above the 95th percentile for their age and sex.
Beyond weight management, the FDA has also approved Wegovy to reduce the risk of heart attack, stroke, and cardiovascular death in adults who already have heart disease and either obesity or overweight. A separate indication covers a form of fatty liver disease with moderate to advanced scarring. Your prescriber will determine which indication applies to you, but the weight management criteria are what most people will qualify under.
The 4-Month Dose Escalation
You don’t jump straight to the full dose. Wegovy uses a step-up schedule that increases every four weeks over roughly 16 weeks:
- Month 1: 0.25 mg once weekly
- Month 2: 0.5 mg once weekly
- Month 3: 1.0 mg once weekly
- Month 4: 1.7 mg once weekly
- Month 5 onward: 2.4 mg once weekly (maintenance dose)
Each dose level comes as a separate pre-filled pen, so your pharmacy will dispense a new strength each month. The gradual increase exists because the most common side effects, especially nausea, tend to spike when the dose goes up. Giving your body four weeks at each level lets it adjust before the next increase. If a particular step hits you hard, your prescriber may keep you at that dose for an extra few weeks before moving up.
How to Give Yourself the Injection
Wegovy is a once-weekly injection you give yourself at home. The pen is pre-filled and single-use, so there’s no mixing or measuring involved. You press it against your skin, click the button, and hold it in place for a few seconds until the dose is delivered.
The three approved injection sites are your stomach (at least two inches from your belly button), the front of your thigh, or the back of your upper arm. Rotate between these areas each week to avoid irritation. Pick a consistent day of the week for your injection. It doesn’t need to be the same time of day, and you can take it with or without food.
Dealing With Early Side Effects
Nausea is the most talked-about side effect, and it’s most common during the first few months while your dose is climbing. Some people feel it mildly for a day or two after each injection; others find it more persistent, particularly at the higher dose steps. Constipation is also common and can worsen if you take anti-nausea medication, which itself can slow digestion.
A few practical strategies help. Eat smaller portions, roughly what you’d serve a young child, and stop the moment you feel full rather than finishing what’s on your plate. Rich or greasy foods tend to make nausea worse. Some people find that certain high-fiber or fatty foods that were fine before, like sausage or cruciferous vegetables, suddenly cause significant discomfort. If constipation becomes an issue, a stool softener or a small serving of prunes can help keep things moving. Most people find that side effects ease considerably once they’ve been on the maintenance dose for a few weeks.
What Insurance Typically Requires
Most insurers require prior authorization before covering Wegovy, and the requirements can be strict. A common pattern, based on plans like the North Carolina State Health Plan, includes proof that you meet the BMI thresholds, documentation that you’ve participated in a structured weight management program involving diet changes, exercise, and behavioral counseling for at least six months before starting medication, and confirmation that Wegovy will be used alongside a reduced-calorie diet and physical activity.
Some plans also require you to show results after the first few months. For example, losing at least 5% of your starting body weight within three months of reaching the maintenance dose, or your coverage may not be renewed. Ask your prescriber’s office to handle the prior authorization paperwork, since they’ll know what documentation your specific plan needs. If you’re denied, many offices will file an appeal. Without insurance, the list price is over $1,300 per month, so confirming coverage before your first fill saves a lot of frustration.
Storing Your Pens
Keep your Wegovy pens in the refrigerator between 36°F and 46°F (2°C to 8°C), ideally in their original carton to block light. If you need to travel or lose refrigerator access, a pen can stay at room temperature for up to 28 days as long as it stays below 86°F (30°C) and isn’t exposed to direct light. Once it’s been out of the fridge for 28 days, discard it even if there’s medication left. Never freeze a pen, and never use one that’s been frozen.
If You Miss a Dose
If your next scheduled dose is more than two days (48 hours) away, take the missed dose as soon as you remember, then resume your regular schedule. If the next dose is less than two days away, skip the missed one entirely and take the next dose on your usual day. Never double up. If you miss two or more consecutive weeks, take your next dose on the regularly scheduled day or contact your prescriber, because a longer gap may mean you need to restart at a lower dose to avoid a surge of side effects.
What the First Few Months Look Like
Most people notice appetite changes within the first week or two, even at the lowest 0.25 mg dose. You’ll likely feel full faster and think about food less often. Meaningful weight loss usually becomes visible during months two and three as the dose increases. In clinical trials, adults lost an average of about 15% of their body weight over 68 weeks, though individual results vary widely.
The medication works best as part of a broader shift in eating and activity habits. The reduced appetite gives you a window to build new patterns around portion size, food choices, and movement that can stick even if you eventually stop the medication. People who treat Wegovy as a temporary fix without changing underlying habits tend to regain weight after discontinuation, so use the early months to establish routines you can sustain.