Who qualifies for Wegovy and Zepbound? The BMI rules, the conditions, and what your plan adds

You qualify for Wegovy or Zepbound for weight loss as an adult with a BMI of 30 or more, or 27 or more with a weight-related condition such as high blood pressure or high cholesterol. Wegovy also treats adults with heart disease at BMI 27 and up, and a liver disease called MASH; Zepbound also treats sleep apnea at BMI 30 and up. Insurers often ask for more: Aetna's 2026 policy wants BMI 35 and six months in a weight program, and Medicare's Bridge wants BMI 35, or 30 or 27 with specific conditions.

Julian CaraulaniFounder, PriceTracker GLP-1Last checked October 2026

19 min read · published October 2026

Key takeaways

1For weight loss, both labels cover adults with obesity (BMI 30+) or overweight (BMI 27+) with at least one weight-related condition. Wegovy injection also covers ages 12 and up.
2Wegovy has two more uses: lowering heart attack and stroke risk in adults with established heart disease and BMI 27+, and MASH liver disease with F2 to F3 fibrosis, which has no BMI line at all.
3Zepbound also treats moderate to severe sleep apnea in adults with obesity; the trials required an AHI of 15 or more and BMI 30+.
4Plans often ask for more: Aetna's 2026 weight policy and BCBS Michigan want BMI 35, Aetna adds six months in a weight program and 5% loss to renew.
5Medicare's Bridge: BMI 35, or 30 with heart failure, uncontrolled blood pressure or kidney disease, or 27 with prediabetes, a past heart attack or stroke, or artery disease.

You qualify for Wegovy or Zepbound for weight loss if you are an adult with a BMI of 30 or more, or a BMI of 27 or more plus at least one weight-related condition such as high blood pressure, high cholesterol or type 2 diabetes. That is the line the FDA drew when it approved Zepbound in November 2023, and the line both drugs' trials used.¹¹⁴⁹ Wegovy's injection also covers children 12 and older with obesity.¹

Weight is not the only door. Wegovy is also approved to lower the risk of heart attack, stroke and cardiovascular death in adults with established heart disease and obesity or overweight, and to treat a liver disease called MASH.² Zepbound is also approved for moderate to severe obstructive sleep apnea in adults with obesity.⁸ Each of those uses has its own test, set out below.

Then the second filter: your plan. A prescription and a covered prescription are different things. Aetna's 2026 weight-loss policy asks for a BMI of 35 and six months in a weight program before it pays,¹⁵ and Medicare's GLP-1 Bridge takes BMI 30 only with one of three named conditions.²⁶ This page walks through all three layers, label, plan and Medicare, with a BMI table by height so you can check your own number.

BMI 27

The lowest BMI at which an adult qualifies for Wegovy or Zepbound for weight loss, and only with a weight-related condition. Without one, the line is 30. Wegovy's MASH use has no BMI line at all.

Who qualifies, at a glance

Every approved use of the two drugs, the test it carries on the label or in its trial, and the age it covers. "BMI" is body mass index, weight against height; the formula and a full table come further down.

Use	Drug and form	Who the label covers	The number behind it
Weight loss and keeping it off	Wegovy injection	Adults and children 12+ with obesity; adults with overweight plus a weight-related condition¹	Adults: BMI 30+, or 27 to 29.9 with a condition.⁴ Ages 12 to 17: BMI at the 95th percentile or above for age and sex⁶
Weight loss and keeping it off	Wegovy tablets	Adults with obesity, or overweight plus a weight-related condition³	Same adult numbers; not established for children³
Weight loss and keeping it off	Zepbound (pen, vial or KwikPen)	Adults with obesity, or overweight plus a weight-related condition⁸	BMI 30+, or 27 to under 30 with a condition;⁹ not established for children¹⁰
Lower risk of heart attack, stroke and CV death	Wegovy injection and tablets	Adults with established CV disease and obesity or overweight²	The trial: age 45+, BMI 27+, a prior heart attack, stroke or peripheral artery disease, no diabetes⁵
MASH (fatty liver disease with scarring)	Wegovy injection only	Adults with noncirrhotic MASH and F2 to F3 fibrosis²	No BMI line. The trial used a liver biopsy showing stage 2 or 3 fibrosis⁶
Moderate to severe obstructive sleep apnea	Zepbound	Adults with obesity⁸	The trials: AHI of 15 or more and BMI 30+⁹

Two practical readings of that table. If you have type 2 diabetes, you still meet the weight-loss test at BMI 27, since diabetes counts as a weight-related condition in FDA's own wording.¹¹ And if your only route is the heart use, it belongs to Wegovy, not Zepbound: Zepbound's label carries no cardiovascular indication.⁸

What the FDA labels actually say

The label is the document a prescriber works from and the one every insurer copies into its policy. Here is Wegovy's injection indication for weight, in the label's words:¹

WEGOVY injection is indicated in combination with a reduced calorie diet and increased physical activity ... to reduce excess body weight and maintain weight reduction long term in ... adults and pediatric patients aged 12 years and older with obesity ... adults with overweight in the presence of at least one weight-related comorbid condition
Wegovy prescribing information

The tablet's wording is the same for adults and leaves out children.³ Zepbound's reads almost word for word, with sleep apnea added as a second use:⁸

to reduce excess body weight and maintain weight reduction long term in adults with obesity or adults with overweight in the presence of at least one weight-related comorbid condition. ... to treat moderate to severe obstructive sleep apnea (OSA) in adults with obesity.
Zepbound prescribing information

Read them closely and you will notice what is missing: neither indication prints a BMI number. They say "obesity" and "overweight". The numbers come from two places: the trials each label describes, and the standard medical definitions of those words. The label also ties every use to diet and activity ("in combination with a reduced calorie diet and increased physical activity"), which is why plans and Medicare ask your prescriber to confirm a lifestyle program.¹²⁷

Where BMI 30 and BMI 27 come from

The trials. Wegovy's Study 2, 68 weeks long, enrolled 1,961 people with a BMI of 30 or more, or 27 to 29.9 with at least one weight-related condition such as treated or untreated high cholesterol or high blood pressure.⁴ Zepbound's Study 1 enrolled 2,539 adults on the same two lines, naming high cholesterol, high blood pressure, sleep apnea and heart disease as example conditions.⁹ Both weight trials left out people with type 2 diabetes, who were studied separately.⁴⁹

FDA then wrote the numbers out when it approved Zepbound on 8 November 2023: adults with obesity, "body mass index of 30 kilograms per square meter (kg/m2) or greater", or overweight, "body mass index of 27 kg/m2 or greater", with at least one weight-related condition "such as high blood pressure, type 2 diabetes or high cholesterol".¹¹

The words line up with the CDC's adult categories: obesity is a BMI of 30.0 or higher, and severe obesity a BMI of 40.0 or higher.¹⁴ Overweight is the band below, 25.0 to 29.9, but the drugs start at 27 within it, and only with a condition.

In plain English

The label's conditions are examples, not a closed list. "Such as" in the trial descriptions and in FDA's release leaves the judgment with the prescriber.⁴¹¹ Insurers and Medicare do close the list, which is where most denials start.

The heart, liver and sleep apnea uses, test by test

Wegovy for heart disease

FDA approved this use on 8 March 2024, for adults with cardiovascular disease and either obesity or overweight.¹³ The label now covers both the injection and the tablets for it.²³ Who the trial took is the useful detail: everyone was 45 or older, with a BMI of 27 or more and established heart or artery disease, meaning a prior heart attack, a prior stroke or peripheral arterial disease. People with type 1 or type 2 diabetes were excluded.⁵

So the heart use does not need a second weight-related condition at BMI 27 to 29.9: the heart disease is the condition. It does need the history to be on paper, because every plan that covers it asks for one.

Wegovy for MASH

MASH stands for metabolic dysfunction-associated steatohepatitis, the condition once called NASH: fat in the liver with inflammation and scarring. Wegovy injection treats noncirrhotic MASH with moderate to advanced fibrosis, stages F2 to F3, in adults, under accelerated approval that depends on a confirmatory trial.² The tablets are not approved for it.³

This is the one Wegovy use with no BMI requirement in its indication.² The trial enrolled people by liver biopsy, showing MASH with fibrosis stage 2 or 3.⁶ Qualifying runs through a liver diagnosis, usually from a gastroenterologist or hepatologist, not through the scale.

Zepbound for obstructive sleep apnea

FDA approved Zepbound for moderate to severe obstructive sleep apnea in adults with obesity on 20 December 2024.¹² The trials measured severity with the apnea-hypopnea index, AHI, the number of breathing pauses and shallow breaths per hour of sleep: they enrolled people with an AHI of 15 or more and a BMI of 30 or more.⁹ An AHI of 15 needs a sleep study, so this route starts with one.

Our Zepbound for sleep apnea guide covers the condition itself and how that use is billed.

From the AMA, which is a professional body with nothing to sell you here. Covers how clinicians actually think about prescribing these drugs. It is general education and it is not an assessment of you.

Who should not take them

Eligibility has a floor and a ceiling. The labels name the people who should not take the drug at all, whatever their BMI:

Thyroid cancer history. Both labels are contraindicated with a personal or family history of medullary thyroid carcinoma (MTC) or in people with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).⁷¹⁰
A known allergy to semaglutide or tirzepatide, or to an ingredient of the product.⁷¹⁰
Pregnancy. Both labels say to stop when pregnancy is recognized, for the weight and heart uses of Wegovy and for Zepbound.⁷¹⁰
Children, for Zepbound and the Wegovy tablet. Zepbound's safety and effectiveness are not established in pediatric patients; neither are the Wegovy tablets'.¹⁰³

Every prescriber, in person or online, asks about these. They are why an intake form wants your family history as well as your weight. Your prescriber decides the rest from your full history; nothing on this page is a substitute for that conversation.

The phrase does most of the work at BMI 27 to 29.9, and the sources name different examples. Lined up:

Source	Conditions it names	Closed list?
Wegovy weight trials (label)	Treated or untreated high cholesterol (dyslipidemia) or high blood pressure, "such as"⁴	No
Zepbound weight trial (label)	High cholesterol, high blood pressure, obstructive sleep apnea, heart disease, "such as"⁹	No
FDA Zepbound approval, 2023	High blood pressure, type 2 diabetes, high cholesterol, "such as"¹¹	No
Medicare GLP-1 Bridge, BMI 30 to 34.9	Heart failure with preserved ejection fraction; uncontrolled high blood pressure; chronic kidney disease stage 3a or higher²⁶	Yes
Medicare GLP-1 Bridge, BMI 27 to 29.9	Prediabetes; a previous heart attack or stroke; peripheral artery disease with symptoms²⁶	Yes

Notice the gap between the rows. High cholesterol qualifies on the label and does not appear anywhere in Medicare's list. High blood pressure qualifies on the label at 27; Medicare accepts it only when uncontrolled and only from BMI 30.²⁶ If you are on Medicare, the label's examples are not your test.

BMI for Wegovy and Zepbound: the table by height

The formula, in US units: BMI = weight in pounds × 703 ÷ (height in inches × height in inches). In metric, weight in kilograms divided by height in meters squared. Reverse it to find the weight that reaches a given BMI at your height: weight = BMI × height in inches × height in inches ÷ 703.

We ran that for every inch from 4 ft 10 in to 6 ft 6 in at the four lines that matter: 27 (with a condition), 30 (on its own), 35 (Aetna's and BCBS Michigan's weight policies, and Medicare's no-condition tier) and 40 (the CDC's severe obesity line).¹⁴¹⁵²¹²⁶ Each figure is rounded up to the next whole pound, so it is the lowest weight that actually reaches the line.

Height	Inches	BMI 27	BMI 30	BMI 35	BMI 40
4 ft 10 in	58	130 lb	144 lb	168 lb	192 lb
4 ft 11 in	59	134 lb	149 lb	174 lb	199 lb
5 ft 0 in	60	139 lb	154 lb	180 lb	205 lb
5 ft 1 in	61	143 lb	159 lb	186 lb	212 lb
5 ft 2 in	62	148 lb	165 lb	192 lb	219 lb
5 ft 3 in	63	153 lb	170 lb	198 lb	226 lb
5 ft 4 in	64	158 lb	175 lb	204 lb	234 lb
5 ft 5 in	65	163 lb	181 lb	211 lb	241 lb
5 ft 6 in	66	168 lb	186 lb	217 lb	248 lb
5 ft 7 in	67	173 lb	192 lb	224 lb	256 lb
5 ft 8 in	68	178 lb	198 lb	231 lb	264 lb
5 ft 9 in	69	183 lb	204 lb	238 lb	271 lb
5 ft 10 in	70	189 lb	210 lb	244 lb	279 lb
5 ft 11 in	71	194 lb	216 lb	251 lb	287 lb
6 ft 0 in	72	200 lb	222 lb	259 lb	295 lb
6 ft 1 in	73	205 lb	228 lb	266 lb	304 lb
6 ft 2 in	74	211 lb	234 lb	273 lb	312 lb
6 ft 3 in	75	216 lb	241 lb	281 lb	321 lb
6 ft 4 in	76	222 lb	247 lb	288 lb	329 lb
6 ft 5 in	77	228 lb	253 lb	295 lb	338 lb
6 ft 6 in	78	234 lb	260 lb	303 lb	347 lb

Why round up matters. At 5 ft 5 in and 180 lb, the formula gives 29.95. That is not 30. A policy written as "BMI greater than or equal to 30" reads 29.95 as below the line, and a form that rounds to one decimal shows 30.0 while the math says otherwise. If you sit within a pound or two of a line, ask your prescriber to record the exact figure from a measured height and weight on the day, not a remembered one.

The BMI and GLP-1 calculator does this for any height and weight and tells you which tier you land in.

How insurers narrow the label

A plan can cover a drug for fewer people than the label allows, and most do. Three things move, in roughly this order of frequency: whether the plan covers weight-loss drugs at all, the BMI line, and the extra steps before and after approval.

Coverage at all is the employer's choice. Aetna tells employers they can "customize your benefits to include or exclude GLP-1 drug coverage for weight management".²⁰ KFF's 2025 survey found 16% of firms with 200 to 999 workers, 30% of firms with 1,000 to 4,999 and 43% of firms with 5,000 or more cover GLP-1s used mainly for weight loss.²⁴ Our employer coverage guide has the full picture of who covers and who dropped it.

The BMI line often moves to 35. Aetna's 2026 policy for its BMI 35 design reads:¹⁵

The patient is 18 years of age or older. The patient has participated in a comprehensive weight management program that encourages behavioral modification, reduced-calorie diet, AND increased physical activity with continuing follow-up for at least 6 months prior to using drug therapy. The patient has a baseline body mass index (BMI) greater than or equal to 35 kg/m 2 .
Aetna policy 6450-C

Blue Cross Blue Shield of Michigan set the same line for its large group, fully insured members: 18 or older with a BMI of 35 or higher.²¹ Notice what a BMI 35 policy drops: the weight-related condition. At 35 you need no condition; below it, on these designs, no condition gets you in for weight loss.

The extra steps. A documented weight program is the most common add-on. Aetna wants six months of it before drug therapy,¹⁵ and KFF found 34% of employers that cover these drugs require a dietitian, case manager, therapist or lifestyle program.²⁴ Renewal is the second: Aetna's continuation test for Wegovy, Zepbound and Foundayo is at least 3 months at a stable maintenance dose and at least 5% of baseline weight lost, or that 5% kept off.¹⁶

Plan or program	BMI line for weight loss	Before approval	To renew
FDA label (no plan)	30, or 27 with a condition¹¹	A prescription	n/a
Aetna, BMI 35 design (6450-C, 2026)	35, adults 18+¹⁵	6 months in a weight program, documented¹⁵	3 months at a stable dose and 5% weight loss, or 5% kept off¹⁶
BCBS Michigan and BCN, large group fully insured	35, adults 18+²¹	Prior authorization²¹	Not published on the page we read
FEP Blue (federal employees)	Policy-specific	An excluded drug needs a formulary exception from your prescriber²²	Policy-specific
TRICARE Prime, Select and premium plans	TRICARE's own clinical criteria²³	A network prescriber and a prior authorization²³	Not on the FAQ
TRICARE For Life	Not covered for weight loss²³	n/a	n/a
Medicare GLP-1 Bridge	35; or 30 or 27 with named conditions²⁶	Prescriber certifies a lifestyle program; prior authorization²⁷	See our Medicare guide

The formulary matters too, not only the criteria. CVS Caremark, which runs pharmacy benefits for many employer plans, said it would add Zepbound back to its commercial formularies as a preferred option on 1 October 2026, for plan sponsors that cover these drugs.²⁵ If your plan uses Caremark and denied Zepbound earlier in 2026, the answer may be different now.

For the plan you actually have, our coverage checker holds sourced fact sheets per insurer and drug, including Aetna and Wegovy, Cigna and Wegovy and UnitedHealthcare and Zepbound, each with the policy's own words.

What plans ask for on the heart, liver and sleep apnea uses

These uses are where a plan that excludes weight-loss drugs may still pay, because the drug is treating something else. They are also where the paperwork is most specific. Aetna's 2026 policy is the clearest published example we found, and each criterion below needs documentation for approval:

Wegovy for heart risk. A history of a previous heart attack, a previous stroke, symptomatic peripheral artery disease (with test or procedure evidence such as an ankle-brachial index below 0.85), or a prior revascularization such as a bypass or stent. A baseline BMI of 27 or more. No type 2 diabetes. And current standard heart treatment, or a clinical reason not to have it.¹⁸
Wegovy for MASH. Prescribed by or with a gastroenterologist or hepatologist, with F2 to F3 fibrosis confirmed by elastography (ultrasound or MRI) or a past liver biopsy.¹⁹
Zepbound for sleep apnea. An established diagnosis of moderate to severe obstructive sleep apnea with an AHI of at least 15 events per hour on an in-lab sleep study or a home sleep test, and a current BMI of 30 or more.¹⁷

The type 2 diabetes exclusion on the heart route is the one that surprises people. Aetna's note points patients with type 2 diabetes and heart disease to Ozempic, which carries its own cardiovascular indication for that group, rather than Wegovy.¹⁸ The heart trial itself excluded diabetes, which is where that line comes from.⁵

If a plan turns you down on any route, the denial letter names the criterion you missed. Our appeal guide covers what to send back, and a Wegovy prior authorization letter or Zepbound prior authorization letter template gives your prescriber the structure plans expect.

Medicare: who qualifies for the GLP-1 Bridge

Medicare drug plans cannot pay for drugs used only for weight loss; Part D may cover Wegovy when it is prescribed for cardiovascular disease.²⁹ The Medicare GLP-1 Bridge is the separate CMS program that opened weight-loss coverage on 1 July 2026, with a $50 copay outside the Part D benefit.²⁸ Its eligibility test is stricter than the label in one direction and looser in another:

Your BMI when you start GLP-1 therapy	Plus at least one of	Compared with the label
35 or higher	Nothing else²⁶	Same as label: any BMI over 30 qualifies there
30 to 34.9	Heart failure with preserved ejection fraction; uncontrolled high blood pressure; chronic kidney disease stage 3a or higher²⁶	Stricter: the label needs no condition at 30
27 to 29.9	Prediabetes; a previous heart attack or stroke; peripheral artery disease with symptoms²⁶	Narrower list than the label's examples

You must be 18 or older, and your prescriber must certify that you are using the drug as part of a lifestyle program focused on diet and exercise.²⁶²⁷ Medicare.gov rules out anyone who already gets a GLP-1 covered through their Part D plan, and people with type 2 diabetes, moderate to severe sleep apnea or fatty liver disease, whose Part D plan may cover a GLP-1 for that condition instead.²⁷ One detail from Novo saves a question at the appointment: your doctor does not need to be enrolled in Medicare for you to use the Bridge.³⁰

Run your own numbers through the Medicare Bridge eligibility check, and read does Medicare cover GLP-1s for the drug-by-drug routes, the copay rules and what happens after 2027.

Already on a GLP-1? Your starting BMI is the one that counts

People who lose weight on a cash-pay GLP-1 often worry they have priced themselves out of coverage. The published rules point the other way. Medicare's tiers apply to your BMI "when you start GLP-1 therapy".²⁶ Aetna's policy tells reviewers that if a patient is moving from another weight-loss drug, they should "consider their baseline BMI at the start of any drug therapy".¹⁵

The practical step: keep the record of your weight on the day you first started, with the date and who measured it. A pharmacy receipt with no weight on it does not help; a visit note or intake record that does is what a reviewer asks for.

What a telehealth intake asks

An online prescriber applies the same label as an office doctor. NovoCare, Novo Nordisk's own pharmacy, links people without a prescription to telehealth prescribers from its home page,³¹ and the telehealth programs on our board run their own intake the same way. Expect the questions to follow the label, in roughly this order:

Height and current weight, which set your BMI. Have a recent measured figure ready rather than a guess.
Weight-related conditions, if your BMI is 27 to 29.9: blood pressure, cholesterol, blood sugar, sleep apnea, heart disease.⁴⁹
The contraindications: thyroid cancer history in you or your family, MEN 2, allergies, pregnancy or plans for it.⁷¹⁰
Other GLP-1 medicines, including compounded versions, because both labels advise against combining GLP-1 drugs.³⁸
Your medical history and current medicines, which help if a plan later asks for documentation.

The prescription is one question; paying for it is another, and the price differs widely between routes. Novo's own self-pay prices for Wegovy are $349 a month for the standard pen doses and $149 to $299 for the tablet by strength.³¹ The programs we track list all-in monthly prices, membership included, ranked here:

Live chart · checked 15 Oct 2026

Every Wegovy price we track, all in

Wegovy all-in monthly price by program

Sesame Care$208
Wellorithm$899
Lemonaid Health$2K

3 programs, cheapest first: the monthly price plus any membership fee, read off each seller's own page. The full ranking

If you qualify for Zepbound rather than Wegovy, the cheapest verified Zepbound price today is $348 a month, and the live ranking sits below. For the steps from qualifying to a filled prescription, see how to get Wegovy and how to get Zepbound.

Which route fits you

Match your situation to the route that is most likely to say yes. Each row assumes the label test is met; the third column is the extra test that route adds.

Your situation	Route most likely to cover it	What that route adds
BMI 35+, commercial plan that covers weight-loss drugs	Your plan, weight-loss criteria	Often a documented weight program (Aetna: 6 months) and a 5% renewal test¹⁵¹⁶
BMI 30 to 34.9, commercial plan	Your plan, if its design uses the label line	A BMI 35 design will refuse; ask which design your employer bought¹⁵²¹
BMI 27 to 29.9 with high blood pressure or cholesterol	A plan that follows the label	The condition documented on the request
Prior heart attack, stroke or peripheral artery disease, BMI 27+, no diabetes	Your plan, under Wegovy's heart use; on Medicare, Part D²²⁹	The cardiac history on file and current heart treatment¹⁸
Diagnosed MASH with F2 to F3 fibrosis	Your plan, under Wegovy's liver use	A liver specialist and elastography or biopsy¹⁹
Moderate to severe sleep apnea, BMI 30+	Your plan, under Zepbound's sleep apnea use	A sleep study showing AHI 15+¹⁷
Medicare with Part D, no diabetes, in a Bridge tier	Medicare GLP-1 Bridge, $50 a month²⁷	Prescriber certifies a lifestyle program²⁷²⁸
TRICARE For Life	Medicare Part D or the Bridge, not TRICARE²³	Bridge tiers apply
Plan excludes weight-loss drugs, no other covered use	Self-pay from the maker, or a program on our board	The label test only, set by the prescriber

What to bring to the appointment

Eligibility is decided on documents, so bring them. This list is short on purpose: each item answers a question a label, a plan or Medicare will ask.

Your measured height and weight, and if you are already on a GLP-1, the record of your weight when you started.¹⁵²⁶
Diagnoses with dates: blood pressure readings, cholesterol results, an A1C or prediabetes result, sleep study results with the AHI, heart history, liver imaging.
Your plan's drug list and the policy name, if you have coverage. Search your insurer's site for the drug name plus "prior authorization".
Proof of a weight program, if your plan asks for one: dates, the program name, visits with a dietitian or coach.¹⁵²⁴
Family history of thyroid cancer or MEN 2, which every prescriber screens for.⁷¹⁰

With those in hand, the first question, do I qualify, usually takes one visit. The second, will it be paid for, is answered by the route table above.

Sources31

Wegovy prescribing information (DailyMed, revised 6/2026), weight-reduction indication for the injection read October 2026“WEGOVY injection is indicated in combination with a reduced calorie diet and increased physical activity ... to reduce excess body weight and maintain weight reduction long term in ... adults and pediatric patients aged 12 years and older with obesity ... adults with overweight in the presence of at least one weight-related comorbid condition” ↩
Wegovy prescribing information (DailyMed), cardiovascular and MASH indications read October 2026“to reduce the risk of major adverse cardiovascular (CV) events (CV death, non-fatal myocardial infarction, or non-fatal stroke) in adults with established CV disease and either obesity or overweight ... for the treatment of noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH), formerly known as nonalcoholic steatohepatitis (NASH), with moderate to advanced liver fibrosis (consistent with stages F2 to F3 fibrosis) in adults. This indication is approved under accelerated approval based on improvement of MASH and fibrosis.” ↩
Wegovy prescribing information (DailyMed), indications for the tablets read October 2026“WEGOVY tablets are indicated in combination with a reduced calorie diet and increased physical activity ... to reduce excess body weight and maintain weight reduction long term in adults with obesity, or in adults with overweight in the presence of at least one weight-related comorbid condition ... The safety of WEGOVY tablets and WEGOVY 7.2 mg injection have not been established in pediatric patients or patients with MASH. ... Concomitant use of WEGOVY (semaglutide) tablets or WEGOVY (semaglutide) injection with other semaglutide-containing products or with any other GLP-1 receptor agonist is not recommended.” ↩
Wegovy prescribing information (DailyMed), who the weight trials enrolled read October 2026“Study 2 was a 68-week trial that enrolled 1,961 patients with obesity (BMI greater than or equal to 30 kg/m 2 ) or with overweight (BMI 27 to 29.9 kg/m 2 ) and at least one weight-related comorbid condition, such as treated or untreated dyslipidemia or hypertension; patients with type 2 diabetes mellitus were excluded.” ↩
Wegovy prescribing information (DailyMed), who the cardiovascular trial enrolled read October 2026“All patients were 45 years or older, with an initial BMI of 27 kg/m 2 or greater and established CV disease (prior myocardial infarction, prior stroke, or peripheral arterial disease). Patients with a history of type 1 or type 2 diabetes were excluded.” ↩
Wegovy prescribing information (DailyMed), the pediatric trial and the MASH trial read October 2026“201 pubertal pediatric patients aged 12 years and older with BMI corresponding to ≥95th percentile standardized for age and sex ... Enrolled patients had a baseline or recent liver biopsy showing clinically significant MASLD (metabolic dysfunction-associated steatotic liver disease), defined as MASH with fibrosis stage 2 or 3” ↩
Wegovy prescribing information (DailyMed), contraindications and pregnancy read October 2026“Personal or family history of MTC or in patients with MEN 2. ... Known hypersensitivity to semaglutide or any of the excipients in WEGOVY tablets or WEGOVY injection. ... For patients receiving WEGOVY for CV risk reduction or weight reduction, discontinue WEGOVY when pregnancy is recognized.” ↩
Zepbound prescribing information (DailyMed, revised 8/2026), indications read October 2026“to reduce excess body weight and maintain weight reduction long term in adults with obesity or adults with overweight in the presence of at least one weight-related comorbid condition. ... to treat moderate to severe obstructive sleep apnea (OSA) in adults with obesity. ... Coadministration with other tirzepatide-containing products or with any GLP-1 receptor agonist is not recommended.” ↩
Zepbound prescribing information (DailyMed), who the weight and sleep apnea trials enrolled read October 2026“enrolled 2,539 adult patients with obesity (BMI ≥30 kg/m 2 ), or with overweight (BMI 27 to ... kg/m 2 ) and at least one weight-related comorbid condition, such as dyslipidemia, hypertension, obstructive sleep apnea, or CV disease; patients with type 2 diabetes mellitus were excluded. ... The efficacy of ZEPBOUND for moderate to severe obstructive sleep apnea (OSA) (apnea-hypopnea index [AHI] ≥15) in patients with obesity (BMI ≥30 kg/m 2 ) was evaluated” ↩
Zepbound prescribing information (DailyMed), contraindications, children and pregnancy read October 2026“Personal or family history of medullary thyroid carcinoma or in patients with Multiple Endocrine Neoplasia syndrome type 2 ... The safety and effectiveness of ZEPBOUND have not been established in pediatric patients. ... Pregnancy: May cause fetal harm. When pregnancy is recognized, discontinue ZEPBOUND.” ↩
FDA, Zepbound approval for chronic weight management (8 November 2023) read October 2026“Today, the U.S. Food and Drug Administration approved Zepbound (tirzepatide) injection for chronic weight management in adults with obesity (body mass index of 30 kilograms per square meter (kg/ m2) or greater) or overweight (body mass index of 27 kg/m2 or greater) with at least one weight-related condition (such as high blood pressure, type 2 diabetes or high cholesterol)” ↩
FDA, Zepbound approval for obstructive sleep apnea (20 December 2024) read October 2026“Today, the U.S. Food and Drug Administration approved Zepbound (tirzepatide) for the treatment of moderate to severe obstructive sleep apnea (OSA) in adults with obesity, to be used in combination with a reduced-calorie diet and increased physical activity.” ↩
FDA, Wegovy approval to reduce cardiovascular risk (8 March 2024) read October 2026“Today, the U.S. Food and Drug Administration approved a new indication for use for Wegovy (semaglutide) injection to reduce the risk of cardiovascular death, heart attack and stroke in adults with cardiovascular disease and either obesity or overweight.” ↩
CDC, adult obesity facts: the BMI definitions read October 2026“Obesity is defined as having a body mass index (BMI) of 30.0 or higher. Severe obesity is defined as having a BMI of 40.0 or higher.” ↩
Aetna, Weight Loss (BMI 35) GIP-GLP-1, GLP-1 Agonists PA with Limit 6450-C, adult starting criteria read October 2026“The patient is 18 years of age or older. The patient has participated in a comprehensive weight management program that encourages behavioral modification, reduced-calorie diet, AND increased physical activity with continuing follow-up for at least 6 months prior to using drug therapy. The patient has a baseline body mass index (BMI) greater than or equal to 35 kg/m 2 . [NOTE: If the patient is transitioning from another drug therapy for weight loss, please consider their baseline BMI at the start of any drug therapy.]” ↩
Aetna 6450-C, continuation (renewal) criteria for weight loss read October 2026“If the request is for Wegovy (semaglutide), tirzepatide (Zepbound/Mounjaro), or Foundayo (orforglipron), then ALL of the following criteria are met: The patient has completed at least 3 months of therapy with the requested drug at a stable maintenance dose. The patient has lost at least 5 percent of baseline body weight OR the patient has continued to maintain their initial 5 percent weight loss.” ↩
Aetna 6450-C, obstructive sleep apnea criteria for tirzepatide read October 2026“The patient has an established diagnosis of moderate to severe OSA with an apnea-hypopnea index (AHI) of at least 15 events per hour on polysomnography (PSG) or home sleep apnea test (HSAT) with a technically adequate device. [ACTION REQUIRED: Documentation is required for approval.] The patient has a current body mass index (BMI) greater than or equal to 30 kg/m 2 .” ↩
Aetna 6450-C, cardiovascular risk-reduction criteria for Wegovy read October 2026“Symptomatic peripheral arterial disease (PAD), as evidenced by intermittent claudication with ankle-brachial index (ABI) less than 0.85 (at rest), peripheral arterial revascularization procedure, or amputation due to atherosclerotic disease. Prior history of revascularization (coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or angioplasty). The patient has a baseline body mass index (BMI) greater than or equal to 27 kg/m 2 . ... The patient does NOT have type 2 diabetes. ... Patients with type 2 diabetes may be treated for risk reduction of cardiovascular events with Ozempic. ... The patient is currently receiving guideline-directed management and therapy (GDMT) for cardiovascular disease” ↩
Aetna 6450-C, MASH criteria for Wegovy injection read October 2026“The requested drug is being prescribed by, or in consultation with, a gastroenterologist or hepatologist. The patient’s moderate to advanced liver fibrosis (consistent with stages F2 to F3 fibrosis) at baseline has been confirmed by ONE of the following: non-invasive liver disease assessment (e.g., ultrasound-based elastography, magnetic resonance elastography [MRE]) OR historical liver biopsy.” ↩
Aetna, GLP-1 benefit options for employers read October 2026“You can choose to customize your benefits to include or exclude GLP-1 drug coverage for weight management.” ↩
Blue Cross Blue Shield of Michigan, GLP-1 coverage change for large group, fully insured members (revised 29 May 2025) read October 2026“New prior authorization requirements for coverage of these GLP-1 drugs for large group, fully insured members are in effect for those who are 18 or older and have a body mass index of 35 or higher.” ↩
FEP Blue, pharmacy FAQ on excluded weight-loss GLP-1s read October 2026“Yes, you can still obtain a weight loss GLP-1 that is not covered or excluded. In order to do so, your healthcare provider must submit a formulary exception request on your behalf.” ↩
TRICARE, does TRICARE cover Wegovy, Ozempic and Mounjaro (updated 6 August 2026) read October 2026“TRICARE covers Wegovy, Saxenda, and Zepbound for weight management if you have coverage under one of these plans ... Meet TRICARE’s clinical criteria ... Have a prescription from a network provider. ... TRICARE doesn’t cover weight loss drugs for: TRICARE For Life beneficiaries ... As of July 1, 2026, Medicare Part D covers certain weight loss drugs under the Medicare GLP-1 Bridge Program” ↩
KFF, 2025 Employer Health Benefits Survey, GLP-1 coverage for weight loss read October 2026“Among firms that offer health benefits with 200 or more workers, 16% of firms with 200 to 999 workers, 30% of firms with 1,000 to 4,999 workers, and 43% of firms with 5,000 or more workers cover GLP-1 agonists when used primarily for weight loss in 2025. ... Thirty-four percent of firms covering these drugs for weight loss require enrollees to meet with a dietitian, case manager, or therapist, or participate in a lifestyle program in order to receive the coverage.” ↩
CVS Health, CVS Caremark weight-management formulary changes read October 2026“CVS Caremark will add Zepbound back to our commercial formularies as an additional preferred option October 1, 2026, increasing access to GLP-1s at a more affordable price for plan sponsors who elect to provide coverage of those medications for their members.” ↩
Medicare.gov, weight-loss drugs: who is eligible for the Medicare GLP-1 Bridge read October 2026“You must be 18 or older and meet one of these requirements when you start GLP-1 therapy: You have a body mass index (BMI) of 35 or higher. You have a BMI of 30 or higher and you have at least one of these conditions: Diastolic heart failure (also called heart failure with preserved ejection fraction) Uncontrolled high blood pressure (also called hypertension) Chronic kidney disease at stage 3a or higher You have a BMI of 27 or higher and have at least one of these conditions: Prediabetes A previous heart attack (also called myocardial infarction) or stroke Blocked arteries in your legs or arms (also called peripheral artery disease) with symptoms” ↩
Medicare.gov, weight-loss drugs: who is out and what the prescriber certifies read October 2026“You aren't eligible if you: Already get GLP-1 drugs covered through your Medicare Part D plan ... Have type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease (but your Part D plan might cover your GLP-1s). ... Your provider must certify that you're using the GLP-1 drug as part of a lifestyle program that focuses on diet and exercise.” ↩
CMS, Medicare GLP-1 Bridge FAQ: the copay read October 2026“Eligible beneficiaries will have a $50 copay. Eligible GLP-1 drugs furnished under the Medicare GLP-1 Bridge are provided outside of the Part D benefit payment flow and coverage.” ↩
Humana, does Medicare cover weight-loss drugs read October 2026“doesn’t cover weight loss medications when used only for weight loss. ... Drugs like Ozempic ® and Wegovy ® may be covered by Part D if prescribed for diabetes management or cardiovascular disease.” ↩
Novo Nordisk, Wegovy and the Medicare GLP-1 Bridge read October 2026“Your doctor does not need to be enrolled in Medicare for you to be able to participate in this program.” ↩
NovoCare Pharmacy, self-pay prices and the telehealth link (manufacturer context) read October 2026“Telehealth Need a prescription? Connect with a prescriber here. ... Patients pay $149 for each month of 1.5 mg, $199 per month for 4 mg and $299 per month for 9 mg and 25 mg. ... then $349 per month for Wegovy ® 0.25 mg, 0.5 mg, 1 mg, 1.7 mg or 2.4 mg” ↩

Common questions

What BMI do you need for Wegovy?

For weight loss, a BMI of 30 or more, or 27 or more with at least one weight-related condition such as high blood pressure or high cholesterol. Those are the lines Wegovy's weight trials used. For its heart use, the trial took adults 45+ with a BMI of 27 or more and established heart disease. Its MASH liver use has no BMI requirement. Children 12 and older qualify for the injection at a BMI at or above the 95th percentile for age and sex.

Who qualifies for Zepbound?

Adults with a BMI of 30 or more, or 27 or more with at least one weight-related condition such as high blood pressure, type 2 diabetes or high cholesterol, for weight loss. Zepbound is also approved for moderate to severe obstructive sleep apnea in adults with obesity; its trials used an AHI of 15 or more and a BMI of 30 or more. Zepbound is not established for anyone under 18.

What are the Zepbound prescription requirements?

A prescription from a licensed prescriber who finds that you meet the label: adult, with obesity, or overweight plus a weight-related condition, or with obesity and moderate to severe sleep apnea. You should not take it with a personal or family history of medullary thyroid cancer or MEN 2, or during pregnancy. Insurance adds its own requirements, often a higher BMI, a weight program and a prior authorization.

Can I get Wegovy with a BMI of 27?

Yes, if you also have a weight-related condition, such as high blood pressure or high cholesterol, or if you have established heart disease such as a prior heart attack or stroke. Without a condition, the line is BMI 30. Many insurance plans set their own line higher, and Medicare's Bridge accepts BMI 27 only with prediabetes, a past heart attack or stroke, or symptomatic peripheral artery disease.

Does type 2 diabetes count as a weight-related condition for Wegovy or Zepbound?

Yes. FDA named type 2 diabetes among the example conditions when it approved Zepbound for weight management. Two exceptions sit in the coverage rules: Aetna's heart-risk criteria for Wegovy require that you do not have type 2 diabetes, and Medicare's Bridge excludes people with type 2 diabetes, whose Part D plan may cover a GLP-1 for diabetes instead.

Why does my insurance require a BMI of 35 for Wegovy?

Because your employer or plan chose a stricter design than the FDA label. Aetna publishes a BMI 35 policy for Wegovy, Zepbound and Foundayo that also asks for six months in a weight program, and Blue Cross Blue Shield of Michigan applies BMI 35 to its large group, fully insured members. Ask HR or the insurer which policy your plan uses; some designs follow the label's 30 and 27 instead.

Do I still qualify if I lost weight on a GLP-1 I paid for myself?

Usually, yes. Medicare's Bridge applies its BMI tiers to your BMI when you started GLP-1 therapy, and Aetna tells its reviewers to use the baseline BMI from the start of any weight-loss drug therapy. Keep a dated record of your starting weight from a visit note or intake form.

Who qualifies for Wegovy or Zepbound on Medicare?

Through the Medicare GLP-1 Bridge, people 18 or older with Part D coverage and a BMI of 35 or more, or 30 or more with heart failure with preserved ejection fraction, uncontrolled high blood pressure or stage 3a+ kidney disease, or 27 or more with prediabetes, a previous heart attack or stroke, or symptomatic peripheral artery disease. The copay is $50 a month. Wegovy for heart disease and Zepbound for sleep apnea go through Part D instead.

Can a teenager get Wegovy or Zepbound?

Wegovy injection is approved for children 12 and older with obesity; its pediatric trial enrolled pubertal patients with a BMI at or above the 95th percentile for age and sex. The Wegovy tablets and Zepbound are not established for anyone under 18.

Do I need a sleep study to get Zepbound for sleep apnea?

In practice, yes. The sleep apnea use is for moderate to severe obstructive sleep apnea, which the trials defined as an AHI of 15 or more, a number that only a sleep study produces. Aetna's policy, for example, asks for an AHI of at least 15 on an in-lab or home sleep test and a current BMI of 30 or more.

How do I calculate my BMI for a GLP-1 prescription?

Multiply your weight in pounds by 703, then divide by your height in inches squared. At 5 ft 6 in (66 inches), 186 lb gives a BMI of 30.0 and 168 lb gives 27.1. Use a measured height and weight from the day, because a result like 29.95 counts as under 30 on a policy that says 30 or more.

Choosing a program? See our ranking of the best online GLP-1 programs for every partner side by side, or the Wegovy price page for what the drug itself costs.

Who qualifies for Wegovy and Zepbound? The BMI rules, the conditions, and what your plan adds

Who qualifies, at a glance

What the FDA labels actually say

Where BMI 30 and BMI 27 come from