BMI for Wegovy: Do You Qualify? Calculator + Insurance Rules
Wegovy is FDA approved for weight loss, heart risk and MASH liver disease; you qualify when your diagnosis matches one of those uses. Health plans then add their own rules before they pay. In STEP 1, people on Wegovy lost 14.9% of body weight on average, vs 2.4% on placebo.
- Active ingredient
- semaglutide
- How it is taken
- weekly injection or daily tablet
- Approved for
- Weight loss, heart risk and MASH liver disease
- Best result (STEP 1)
- 14.9% weight loss
Wegovy in brief
Its half-life is about 1 week: half leaves after 7 d, and about 3% remains after five half-lives (35 d).
The STEP 1 trial at 68 weeks showed 14.9% of body weight, compared with 2.4% on placebo.
Monthly prices in US dollars cover the list price and self-pay offers, and each one comes from the maker's price page.
Sources: FDA label (DailyMed), healthsystemtracker.org, prnewswire.com 1 2.
Who qualifies?
| Who sets the rule | Who qualifies |
|---|---|
| FDA label | Adults with heart disease and obesity or overweight have a lower chance of heart attack, stroke, or heart-related death. This applies to the injection and the tablets. |
| FDA label | This medicine supports weight loss and keeping weight off long term, together with diet and activity. It is for adults and children 12 and older who have obesity, or for adults who have overweight along with a weight-related condition. |
| FDA label | For adults, the injection treats MASH liver disease with moderate to advanced scarring and no cirrhosis. |
| FDA label | In adults, the tablets are approved for weight loss and for lowering heart risk. |
| Medicare GLP-1 Bridge | BMI 35 or higher, no condition needed |
| Medicare GLP-1 Bridge | You need a BMI of 30 or higher, plus heart failure, uncontrolled blood pressure, or CKD 3a+ |
| Medicare GLP-1 Bridge | Qualification requires BMI 27 or higher, along with prediabetes, a past heart attack or stroke, or PAD |
| Typical commercial plan (Aetna policy) | BMI 30 or higher |
| Typical commercial plan (Aetna policy) | BMI 27 or higher with a weight-related condition |
| Typical commercial plan (Aetna policy) | a diet and activity program comes first for 6 months |
Sources: FDA label (DailyMed), medicare.gov 1 2, aetna.com.
What the weight loss trials showed
| Trial | Medicine | Who took part | Length | People | Main result | Comparison |
|---|---|---|---|---|---|---|
| STEP 1 | Wegovy | Adults with obesity or overweight, without diabetes | 68 weeks | 1,961 | 14.9% weight loss | 2.4% on placebo |
| OASIS 4 | Wegovy | Adults with obesity or overweight, without diabetes | 64 weeks | 307 | 13.6% weight loss | 2.4% on placebo |
Trial source: STEP 1 (FDA label (DailyMed)).
How does weight loss compare?
| What changes | What the label says |
|---|---|
| Risk of Thyroid C-Cell Tumors | In rodents, thyroid C-cell tumors were caused by the drug. Whether the same occurs in people is not known. Do not use this medicine if you have a history of medullary thyroid cancer (MTC) yourself or in your family, or if you have MEN 2. |
The FDA labels provide these points: DailyMed FDA label.
Warnings from the FDA label (DailyMed).
Coverage for weight loss
A GLP-1 used only for weight loss has no coverage under Medicare Part D.
Wegovy is listed on the Medicare GLP-1 Bridge at $50 per month for people who meet its rules.
Where Medicaid covers weight-loss GLP-1s, prior authorization is standard.
Sources: humana.com, CMS, KFF.
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- Does Medicare Cover Wegovy? Criteria, Copay, How to Appeal
- Does BCBS Cover Wegovy? Coverage by State Plan, PA Rules, Appeals
More choices for weight loss
| Medicine | For eligibility | How it is taken | Trial result |
|---|---|---|---|
| Wegovy | Weight loss, heart risk and MASH liver disease | weekly injection or daily tablet | 14.9% weight loss |
 Ozempic | Uses include type 2 diabetes, heart risk, and kidney disease associated with type 2 diabetes | weekly injection | Not listed |
 Rybelsus | Type 2 diabetes and heart risk | daily tablet | Not listed |
 Mounjaro | Type 2 diabetes and heart risk | weekly injection | Not listed |
 Zepbound | Weight loss and sleep apnea | weekly injection | 20.9% weight loss |
 Foundayo | Weight loss | daily tablet | 11.1% weight loss |
 Trulicity | Type 2 diabetes and heart risk | weekly injection | Not listed |
 Saxenda | Weight loss | daily injection | 7.4% weight loss |
 Victoza | Type 2 diabetes and heart risk | daily injection | Not listed |
| Byetta | Type 2 diabetes | twice-daily injection | Not listed |
Source: FDA label (DailyMed).
Questions to ask your prescriber
- Does the label rule for this medicine apply to me?
- What will my plan ask me for before it pays?
- Which brand fits my diagnosis?
See the full Wegovy prescribing details on DailyMed for complete information.