To get a Wegovy prescription, your BMI needs to be 30 or higher. If your BMI is between 27 and 29.9, you can still qualify, but only if you also have at least one weight-related health condition. These are the FDA-approved thresholds, though your insurance company may apply additional requirements before agreeing to cover it.
BMI Thresholds for Adults
The two paths to qualifying for Wegovy as an adult break down like this:
- BMI of 30 or above (obesity): You qualify based on BMI alone. No additional diagnoses are needed.
- BMI of 27 to 29.9 (overweight): You qualify only if you also have at least one weight-related comorbidity.
To put those numbers in practical terms, a person who is 5’6″ has a BMI of 30 at roughly 186 pounds and a BMI of 27 at about 167 pounds. You can check your own BMI using the CDC’s adult calculator, which just needs your height and weight.
The conditions that count as weight-related comorbidities include high blood pressure, high cholesterol, type 2 diabetes or prediabetes, obstructive sleep apnea, and fatty liver disease. Heart disease also qualifies. In fact, the FDA approved a separate indication for Wegovy in 2024 specifically to reduce the risk of heart attack, stroke, and cardiovascular death in adults who have established heart disease along with obesity or overweight.
Requirements for Adolescents
Wegovy is approved for patients as young as 12, but the criteria work differently than for adults. Instead of a fixed BMI number, adolescents need 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 14-year-old boy and a 12-year-old girl will have different BMI cutoffs because growth patterns vary by age and sex. Your pediatrician uses CDC growth charts to determine where your child falls.
Unlike adults, adolescents in the 27-to-29.9 range with a comorbidity do not have a separate qualifying path. The FDA approval for teens requires obesity-level BMI only.
What Insurance Companies Actually Require
Meeting the FDA criteria gets you a valid prescription, but it doesn’t guarantee your insurance will pay for it. Most insurers require prior authorization, which means your doctor submits documentation proving you meet specific clinical criteria before coverage is approved.
Insurance requirements often go beyond the basic BMI check. For example, Maryland’s Medicaid program requires a documented BMI of 27 or higher recorded within the last 90 days, with current height and weight on file. Some plans also require proof that you’ve tried other weight-loss approaches first, such as a supervised diet program or other medications. The exact rules vary widely between insurers and even between plans within the same company.
Some plans exclude weight-management drugs entirely. Others cover Wegovy only for the cardiovascular indication, meaning you’d need documented heart disease in addition to meeting the BMI threshold. If your initial claim is denied, your doctor can often file an appeal with additional supporting documentation.
How BMI Is Measured for Your Prescription
Your qualifying BMI is the one recorded at the time your doctor writes the prescription. This is typically measured in the office using a scale and stadiometer (the height-measuring device on the wall). It’s worth knowing that BMI is calculated as your weight in kilograms divided by your height in meters squared. The categories the CDC uses are: 18.5 to 24.9 is normal weight, 25.0 to 29.9 is overweight, and 30.0 or above is obesity.
BMI doesn’t distinguish between muscle and fat, so some people with a high muscle mass register as overweight or obese without carrying excess fat. In practice, your doctor considers your overall health picture alongside the number, but for the purposes of qualifying for Wegovy, the BMI cutoff is what matters on paper.
Once You’re On Wegovy, There’s No Minimum BMI to Stay On It
A common concern is whether you’ll be taken off Wegovy once you lose enough weight to drop below 27 or 30. The FDA prescribing information does not set a minimum BMI for continuing treatment. Wegovy is approved for long-term, ongoing use, and the label describes it as a medication for “chronic weight management,” meaning it’s designed to be taken indefinitely to maintain your results.
The main reasons to stop are if you can’t tolerate the side effects even at a lower maintenance dose, or if you and your doctor decide the medication isn’t producing a meaningful response. Weight regain after stopping is common, which is part of why the drug is framed as a long-term therapy rather than a short course.
That said, your insurance company may reassess coverage at renewal. Some plans require periodic check-ins showing continued medical necessity. If your BMI drops significantly and you no longer have qualifying comorbidities, coverage decisions could change depending on your specific plan’s policies.