Do I Qualify for Wegovy? BMI, Age, and Eligibility Explained

The short answer

Two things move you out of eligibility regardless of your BMI: a personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), and pregnancy. The Wegovy label lists MTC and MEN 2 as contraindications and carries a boxed warning about thyroid C-cell tumors seen in rodent studies. It also advises stopping the drug when pregnancy is recognized. These are absolute gatekeepers that a checklist online cannot waive.

This page walks the actual eligibility rules from the label, the comorbid conditions that count if your BMI is between 27 and 29.9, what insurers typically demand for prior authorization, how a legitimate telehealth consult confirms eligibility, and the cost structure you will face depending on coverage. It is a self-assessment tool grounded in the FDA label, not a diagnosis. Only a licensed clinician who reviews your history can prescribe.

The exact FDA eligibility criteria for Wegovy

The FDA prescribing information for Wegovy states it is indicated for chronic weight management in adults with an initial BMI of 30 kg/m2 or greater (obesity), or 27 kg/m2 or greater (overweight) in the presence of at least one weight-related comorbid condition. That single sentence is the eligibility test. Everything else in an intake questionnaire exists to confirm those numbers and rule out the contraindications.

BMI is your weight in kilograms divided by your height in meters squared. In practical US terms, a person who is 5 feet 4 inches tall reaches a BMI of 30 at roughly 175 pounds and a BMI of 27 at roughly 157 pounds; a person who is 5 feet 8 inches reaches 30 at about 197 pounds and 27 at about 178 pounds. These are illustrative anchors, not a substitute for the calculated figure your prescriber will document.

The label frames BMI as an initial value. That wording matters: eligibility is judged at the start of treatment. If your BMI later falls below the threshold because the drug is working, that does not retroactively mean you never qualified, though it can affect how an insurer views continued coverage.

Wegovy also carries an FDA indication for adolescents aged 12 and older who meet a BMI at or above the 95th percentile for age and sex. This page focuses on adult eligibility; pediatric use is a separate clinical decision made with a specialist.

What counts as a qualifying comorbidity at BMI 27 to 29.9

If your BMI sits between 27 and 29.9, you qualify only if you also have at least one weight-related comorbid condition. The Wegovy label names hypertension (high blood pressure), type 2 diabetes, and dyslipidemia (abnormal cholesterol or triglycerides) as examples. These are the conditions most commonly documented to support eligibility in this BMI band.

Other weight-related conditions that clinicians frequently consider in this range include obstructive sleep apnea, cardiovascular disease, and prediabetes, though the specific conditions an individual prescriber or insurer will accept can vary. The label's examples are the clearest anchor.

This is the band where documentation matters most. A prescriber will want a diagnosis in your record, not a self-report. If you believe you have high blood pressure or borderline cholesterol but have never been formally evaluated, getting those numbers on paper is often the practical first step toward qualifying.

For women navigating hormonal transitions, conditions like polycystic ovary syndrome (PCOS) frequently travel with insulin resistance and metabolic changes. PCOS itself is not one of the label's named examples, but the metabolic conditions it drives, such as type 2 diabetes or dyslipidemia, can be. Discuss the full picture with a clinician who knows your history.

Absolute disqualifiers: thyroid cancer history and pregnancy

Two conditions remove you from eligibility regardless of BMI. The Wegovy label lists as contraindications a personal or family history of medullary thyroid carcinoma (MTC), and a personal or family history of Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Wegovy also carries a boxed warning, the FDA's strongest, about thyroid C-cell tumors observed in rodent studies. If MTC or MEN 2 runs in your family, this is a firm stop, not a judgment call.

Pregnancy is the other. The label advises discontinuing Wegovy when pregnancy is recognized, because of potential risk to the fetus based on animal data. Because weight loss offers no benefit during pregnancy and may cause harm, semaglutide is not used while pregnant. Clinicians commonly advise stopping the drug well before a planned pregnancy given its long half-life.

Known serious hypersensitivity to semaglutide or any component of Wegovy is also a contraindication. Beyond these, the label describes warnings, not absolute bars, for conditions such as a history of pancreatitis, gallbladder disease, kidney problems, and diabetic retinopathy in people with type 2 diabetes. These require careful clinical judgment rather than an automatic no.

An online checklist can flag these, but it cannot clear you. Family history of thyroid cancer, in particular, is exactly the kind of fact a legitimate prescriber must confirm before writing a prescription.

A self-assessment checklist grounded in the label

Use this to gauge whether a consult is worth booking. It mirrors the label's criteria and is not a diagnosis. Answering yes to the BMI question and no to every disqualifier suggests you may be a candidate; a clinician makes the final call.

Step 1, BMI: Is your BMI 30 or higher? If yes, you meet the weight threshold on its own. If your BMI is 27 to 29.9, continue to step 2.

Step 2, comorbidity (only needed for BMI 27 to 29.9): Do you have a documented weight-related condition such as high blood pressure, type 2 diabetes, or abnormal cholesterol? If yes, you may meet the threshold. If no, you likely do not qualify for Wegovy at this BMI under the label.

Step 3, disqualifiers: Do you, or a close blood relative, have a history of medullary thyroid carcinoma or MEN 2? Are you pregnant, planning pregnancy soon, or breastfeeding? Have you had a serious allergic reaction to semaglutide? A yes to any of these means Wegovy is not appropriate, and no questionnaire can override that.

Step 4, age: Are you an adult (18+)? Adult eligibility is what this checklist covers. If every answer points toward eligibility, the next step is a consult with a prescriber licensed in your state who can verify your BMI, review your records, and confirm there are no contraindications.

How a telehealth consult confirms eligibility

The legal path to Wegovy runs through a prescriber. A telehealth consult typically starts with an intake form covering your height, weight, medical history, current medications, and family history of thyroid cancer or MEN 2. A licensed clinician reviews it, and in many states conducts a live or asynchronous evaluation before deciding whether to prescribe.

The clinician's job is to confirm you meet the label criteria, screen for the contraindications and warnings, and choose an appropriate starting dose and titration schedule. Wegovy is started low and increased over weeks to reduce gastrointestinal side effects. A responsible provider also sets follow-up to monitor tolerance and progress.

If a prescription is written, it is sent to a licensed pharmacy that dispenses the FDA-approved product. You should be able to identify the pharmacy and confirm it is dispensing branded, FDA-approved Wegovy rather than an unapproved compounded version. A prescriber who never asks about your thyroid or family history, or who promises approval before any review, is a warning sign.

This site does not sell or prescribe medication. When we point you to compare providers licensed in your state, that is a navigational step to help you find a legitimate telehealth clinician; the evaluation and any prescription come from that licensed provider, not from us.

What insurers require for prior authorization

Coverage for Wegovy is uneven. Many commercial plans that cover it place it behind prior authorization, and some plans, along with traditional Medicare for weight loss alone, exclude anti-obesity medications entirely. Whether your specific plan covers Wegovy is the first thing to verify, ideally before you get attached to a number on the scale.

When a plan does cover it, prior authorization commonly asks the prescriber to document your BMI, confirm a qualifying weight-related condition if your BMI is under 30, and often show evidence of a prior attempt at lifestyle change such as a supervised diet or exercise program. Some plans impose step therapy, requiring you to try a preferred or lower-cost drug first.

Because requirements differ by plan, the most reliable move is to call the member services number on your insurance card and ask two direct questions: is Wegovy on the formulary, and what does prior authorization require. Your prescriber's office then submits the documentation. Denials can often be appealed, especially when the clinical criteria are clearly met.

Keep in mind that meeting the FDA label criteria and meeting your insurer's coverage criteria are two different tests. You can qualify medically under the label and still face a plan that does not cover the drug, which pushes you toward the savings card or self-pay routes described below.

Understanding the cost: coverage paths compared

The single sharpest question on any Wegovy money page is what it costs, and the honest answer is that it depends entirely on which coverage path applies to you. There is no one price. The table below lays out the structure so you know which lever determines your out-of-pocket figure, and where to get the live number.

We deliberately do not quote a specific dollar amount here, because manufacturer prices, savings-card terms, and self-pay programs change. For the current figure, go to the source that governs your path: Novo Nordisk's Wegovy savings page and NovoCare's Wegovy cost and coverage page publish the manufacturer's own list price, savings-card terms, and self-pay program details.

The most expensive path is almost always the branded list price paid entirely out of pocket with no coverage and no savings program. The least expensive is a covered plan with a low copay, sometimes further reduced by a manufacturer savings card if you have commercial insurance. Between those sit the cash self-pay program the manufacturer offers and, separately, compounded versions, which are not FDA-approved and carry their own risks discussed below.

Wegovy versus Zepbound, Ozempic, and Mounjaro

A common source of confusion is which of these drugs you actually qualify for, because they are not interchangeable on the label. Wegovy (semaglutide 2.4 mg) and Zepbound (tirzepatide) are both FDA-approved for chronic weight management, so both use the same BMI eligibility rule: 30 or higher, or 27 or higher with a weight-related condition.

Ozempic (semaglutide) and Mounjaro (tirzepatide) are FDA-approved for type 2 diabetes, not weight loss. Prescribing either purely for weight management is off-label. That is legal and sometimes done, but it means the eligibility framing shifts to diabetes management, and insurance coverage for a weight-loss purpose is often harder to obtain.

If your goal is weight management specifically, the two on-label choices are Wegovy and Zepbound. A prescriber may weigh factors such as your medical history, tolerance, and coverage in choosing between them. Both share the same thyroid-cancer and MEN 2 contraindications and the same BMI thresholds.

One difference matters especially for women: the tirzepatide label (Zepbound and Mounjaro) warns that the drug can reduce the effectiveness of oral contraceptives, and advises a backup method or switching to a non-oral contraceptive around the start and dose increases. Semaglutide (Wegovy, Ozempic) does not carry this warning.

Wegovy, contraception, and menopause: the women's angle

Because eligibility is one question and safe use is another, women weighing Wegovy should factor in reproductive and hormonal context. If you use the oral contraceptive pill, semaglutide's lack of a contraceptive-interaction warning is a genuine practical advantage over tirzepatide, which does carry that warning. This can influence which drug fits your life, not just which one you qualify for.

Pregnancy planning changes the calculus. Wegovy is not used during pregnancy, and its long half-life means clinicians commonly advise stopping it a set period before trying to conceive. If pregnancy is on your horizon, raise it at the consult so the timing is planned rather than reactive.

Menopause often brings weight redistribution and metabolic shifts, and many women ask whether a GLP-1 medication and menopause hormone therapy can coexist. That is a question for your clinician; the Wegovy label does not list menopause hormone therapy as a contraindication, but any medication combination should be reviewed by the prescriber who knows your full history.

For questions about menopause hormone therapy itself, ACOG's patient guidance on hormone therapy for menopause is a reliable starting point, and for cost specifics on hormone therapy we point to our own how-much-does pages rather than inventing figures.

Why to avoid unapproved and compounded sellers

Compounded semaglutide and tirzepatide are not FDA-approved products. The FDA has warned about unapproved and compounded GLP-1 products, and the availability of compounded versions shifted as the branded drugs moved on and off the shortage list. A compounded product has not gone through the FDA review that confirms the branded drug's identity, strength, quality, and purity.

If Wegovy is out of reach on price, the safer response is to explore the manufacturer's savings card or self-pay program, or to work with your prescriber on coverage, rather than buying a compounded or gray-market version. The dollars saved do not account for the risk of an unverified product.

Be especially wary of any website that sells semaglutide with no prescription, no medical intake, and no licensed prescriber. Legitimate access always involves an evaluation by a clinician and dispensing by a licensed pharmacy. A checkout flow that skips the consult is not a shortcut; it is a red flag.

You can confirm that a product is FDA-approved through the FDA's Drugs@FDA database. If a seller's product does not appear there as an approved product, treat that as a reason to walk away.

Turning a likely yes into a prescription

If the checklist points toward eligibility, the sequence from here is straightforward. First, confirm your BMI and gather any documentation of a weight-related condition if your BMI is under 30. Second, check your insurance: call member services to learn whether Wegovy is covered and what prior authorization requires. Third, book a consult with a prescriber licensed in your state.

At the consult, be candid about family history of thyroid cancer or MEN 2, any pregnancy plans, past pancreatitis or gallbladder issues, and every medication you take. These are not hoops; they are how a prescriber keeps you safe and chooses the right starting dose and titration schedule.

If you are approved and covered, the prescriber's office handles prior authorization. If you are not covered, ask about the manufacturer savings card if you have commercial insurance, or the self-pay program, and get the current numbers from the manufacturer pages rather than from a third-party quote.

This site does not prescribe or sell. Our role is to help you understand the label criteria and then compare providers licensed in your state so the evaluation happens with a legitimate clinician.

Frequently asked questions

What BMI do I need to qualify for Wegovy?

The FDA label for Wegovy indicates it for adults with an initial BMI of 30 or higher, or a BMI of 27 or higher when you also have at least one weight-related condition such as high blood pressure, type 2 diabetes, or abnormal cholesterol. A prescriber calculates and documents your BMI at the start of treatment.

Can I get Wegovy if my BMI is under 27?

Under the FDA label, no. The lowest qualifying threshold is a BMI of 27, and at 27 to 29.9 you also need a documented weight-related comorbid condition. Below 27, you do not meet the label criteria for Wegovy, and a legitimate prescriber should not write it for weight management.

What conditions disqualify me from Wegovy?

A personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) is a contraindication, as is pregnancy and a serious allergy to semaglutide. Wegovy also carries a boxed warning about thyroid C-cell tumors seen in rodent studies. These are firm stops regardless of BMI.

Does insurance cover Wegovy, and what does prior authorization need?

Coverage varies widely, and some plans exclude weight-loss drugs entirely. When a plan covers Wegovy, prior authorization commonly requires documented BMI, a qualifying comorbidity if your BMI is under 30, and often evidence of a prior lifestyle or diet attempt. Call your insurer's member services to confirm your specific plan's rules.

How much does Wegovy cost without insurance?

There is no single price, and it changes, so we do not quote a figure here. Your cost depends on the path: branded list price, a manufacturer savings card if you are commercially insured, or the manufacturer's cash self-pay program. Get the current number from Novo Nordisk's Save on Wegovy page or NovoCare's Wegovy cost and coverage page.

Is Wegovy or Ozempic the right one for weight loss?

Wegovy (semaglutide 2.4 mg) is FDA-approved for chronic weight management. Ozempic (also semaglutide) is FDA-approved for type 2 diabetes, so using it for weight alone is off-label. If weight management is your goal, the on-label choices are Wegovy and Zepbound (tirzepatide).

Does Wegovy affect birth control pills?

Semaglutide, the active ingredient in Wegovy, does not carry a warning about reducing oral contraceptive effectiveness. Tirzepatide, in Zepbound and Mounjaro, does carry that warning and advises backup or non-oral contraception around the start and dose increases. Discuss your contraception with your prescriber.

How does a telehealth consult confirm I qualify?

A licensed clinician reviews an intake covering your height, weight, medical and family history, and current medications, then evaluates you before deciding whether to prescribe. They verify you meet the BMI criteria, screen for contraindications like thyroid cancer history and pregnancy, and, if appropriate, send a prescription to a licensed pharmacy dispensing the FDA-approved product.

Primary sources

1. FDA Prescribing Information, Wegovy (semaglutide) injection
2. FDA Prescribing Information, Zepbound (tirzepatide) injection
3. FDA Prescribing Information, Ozempic (semaglutide) injection
4. FDA Prescribing Information, Mounjaro (tirzepatide) injection
5. FDA Drugs@FDA approved-drug database
6. Novo Nordisk, Save on Wegovy
7. NovoCare, Wegovy cost & coverage
8. NIDDK (NIH), Prescription Medications to Treat Overweight & Obesity
9. ACOG, Hormone Therapy for Menopause (patient FAQ)