Who Qualifies for Semaglutide? Eligibility Requirements 2025

The Basic Qualification Criteria

Let's cut straight to it. The FDA-approved guidelines for semaglutide (marketed as Wegovy for weight loss) specify eligibility based on these primary factors:

Understanding the BMI Requirements

BMI (Body Mass Index) is the primary metric used, though it's not perfect. Here's how it breaks down:

• BMI 25-26.9: Generally not eligible unless exceptional circumstances
• BMI 27-29.9: Eligible with weight-related comorbidities
• BMI 30-34.9: Class I obesity—typically eligible
• BMI 35-39.9: Class II obesity—definitely eligible
• BMI 40+: Class III obesity—eligible, often prioritized

Want to calculate your BMI? The formula is: weight (kg) ÷ [height (m)]² or weight (lbs) ÷ [height (inches)]² × 703

Weight-Related Health Conditions That Matter

If your BMI is 27-29.9, you'll need at least one of these conditions to qualify:

Who Should NOT Take Semaglutide

Just as important as knowing who qualifies is understanding who doesn't. These are contraindications—situations where semaglutide should not be used:

Special Considerations and Gray Areas

Some situations require extra discussion with your healthcare provider:

If You Have Type 1 Diabetes

Semaglutide is NOT approved for type 1 diabetes. It's designed for type 2 diabetes and weight management. Type 1 diabetics should not use it off-label for weight loss.

If You're Over 65

Age alone isn't a disqualifier, but older adults may need closer monitoring. Kidney function, medication interactions, and overall health status become more important considerations.

If You Have Kidney Disease

Semaglutide can be used with mild to moderate kidney disease, but severe kidney impairment requires careful evaluation. Your healthcare provider will need recent kidney function tests.

If You're Taking Other Medications

Semaglutide slows stomach emptying, which can affect absorption of other medications, especially:

• Oral diabetes medications (especially insulin or sulfonylureas—hypoglycemia risk)
• Blood thinners like warfarin
• Oral contraceptives (may be less effective)
• Medications requiring precise timing

The Consultation Process: What to Expect

When you consult with a healthcare provider about semaglutide, here's what they'll typically assess:

Insurance Coverage vs. Cash Pay

Here's where things get tricky. You might medically qualify but face coverage issues:

Insurance Coverage Requirements

Most insurance plans have additional requirements beyond FDA criteria:

• Failed attempts at weight loss with diet and exercise (documented)
• BMI thresholds may be higher (sometimes requiring 35+ even without comorbidities)
• Specific comorbidity requirements may be more stringent
• Prior authorization required (can take weeks)
• Step therapy (trying cheaper medications first)

Cash Pay Options

If insurance doesn't cover it or you don't want to navigate the approval process, cash-pay options exist:

• Compounded semaglutide: $199-$345/month through online providers
• Brand name (Wegovy): $1,200-$1,400/month without insurance
• Patient assistance programs: Available for those who qualify financially

Online Prescriptions: Are They Legitimate?

Yes, online healthcare providers can legally prescribe semaglutide IF they follow proper protocols:

• Licensed healthcare provider in your state
• Proper medical evaluation (not just a questionnaire)
• Ongoing monitoring and follow-up
• Medication from licensed pharmacies

What If You Don't Qualify?

If semaglutide isn't right for you, alternatives exist:

• Tirzepatide: Similar mechanism, different eligibility criteria
• Other GLP-1 agonists: Liraglutide (Saxenda) has different dosing
• Non-GLP-1 options: Phentermine, naltrexone-bupropion, orlistat
• Lifestyle interventions: Medical nutrition therapy, supervised exercise programs
• Bariatric surgery: For those who qualify and haven't succeeded with medications

The Bottom Line on Eligibility

Most adults with a BMI of 30+ or BMI of 27+ with weight-related health conditions will qualify for semaglutide. The key is working with a legitimate healthcare provider who can properly evaluate your individual situation.

Don't self-diagnose or self-prescribe. A proper medical evaluation ensures semaglutide is safe and appropriate for your specific circumstances.